Supreme Court Upholds Tennessee Ban on “Transgender” Minor Surgery and Chemical Treatments

Supreme Court Upholds Tennessee Ban on “Transgender” Minor Surgery and Chemical Treatments

The Supreme Court has upheld in a 6-3 decision Tennessee’s ban on “transgender” surgery and chemical treatments for minors.

For background on the law and case, see our prior posts:

• Appeals Court Reinstates Tennessee Law Prohibiting Child Gender Surgeries, Hormones, Puberty Blockers
• SCOTUS to Hear Challenge to Tennessee State Law Banning Child Sex Transitions
• US Supreme Court Poised to Uphold Tennessee’s Ban on Transgender Treatments for Minors

From the Roberts majority Opinion:

In this case, we consider whether a Tennessee law banning certain medical care for transgender minors violates the Equal Protection Clause of the Fourteenth Amendment….

In March 2023, Tennessee joined the growing number of States restricting sex transition treatments for minors by enacting the Prohibition on Medical Procedures Performed on Minors Related to Sexual Identity, S. B. 1, 113th Gen. Assem., 1st Extra. Sess.; Tenn. Code Ann. §68–33–101 et seq. (SB1). While the State’s legislature acknowledged that discordance between a minor’s gender identity and biological sex can cause “discomfort or distress,” §68–33101(c), it identified concerns regarding the use of puberty blockers and hormones to treat gender dysphoria in minors. In particular, the legislature found that such treatments “can lead to the minor becoming irreversibly sterile, having increased risk of disease and illness, or suffering from adverse and sometimes fatal psychological consequences,” §68–33–101(b), and that minors “lack the maturity to fully understand and appreciate” these consequences and may later regret undergoing the treatments, §68–33–101(h). The legislature further found that sex transition treatments were “being performed on and administered to minors in th[e] state with rapidly increasing frequency,” §6833–101(g), notwithstanding the fact that the full range of harmful effects associated with the treatments were likely not yet known, see §68–33–101(b). The legislature also noted that guidelines regarding sex transition treatments for minors had “changed substantially in recent years,” §68–33–101(g), and that health authorities in Sweden, Finland, and the United Kingdom had “placed severe restrictions” on such treatments after determining that there was “no evidence” that their benefits outweigh their risks, §68–33–101(e); see supra, at 3. Finally, the legislature determined that there is evidence that gender dysphoria “can be resolved by less invasive approaches that are likely to result in better outcomes.” §68–33–101(c)….

***

We are asked to decide whether SB1 is subject to heightened scrutiny under the Equal Protection Clause. We hold it is not. SB1 does not classify on any bases that warrant heightened review.

On its face, SB1 incorporates two classifications. First, SB1 classifies on the basis of age. Healthcare providers may administer certain medical treatments to individuals ages 18 and older but not to minors. Second, SB1 classifies on the basis of medical use. Healthcare providers may administer puberty blockers or hormones to minors to treat certain conditions but not to treat gender dysphoria, gender identity disorder, or gender incongruence. Classifications that turn on age or medical use are subject to only rational basis review….

We also reject the argument that the application of SB1 turns on sex. The plaintiffs and the dissent contend that an adolescent whose biological sex is female cannot receive puberty blockers or testosterone to live and present as a male, but an adolescent whose biological sex is male can, while an adolescent whose biological sex is male cannot receive puberty blockers or estrogen to live and present as a female, but an adolescent whose biological sex is female can. See Brief for Respondents in Support of Petitioner 22; post, at 10–15 (SOTOMAYOR, J., dissenting). So conceived, they argue, SB1 prohibits certain treatments for minors of one sex while allowing those same treatments for minors of the opposite sex….

***

The rational basis inquiry “employs a relatively relaxed standard reflecting the Court’s awareness that the drawing of lines that create distinctions is peculiarly a legislative task and an unavoidable one.” Massachusetts Bd. of Retirement, 427 U. S., at 314. Under this standard, we will uphold a statutory classification so long as there is “any reasonably conceivable state of facts that could provide a rational basis for the classification.” FCC v. Beach Communications, Inc., 508 U. S. 307, 313 (1993). Where there exist “plausible reasons” for the relevant government action, “our inquiry is at an end.” Id., at 313–314 (internal quotation marks omitted). SB1 clearly meets this standard. Tennessee determined that administering puberty blockers or hormones to a minor to treat gender dysphoria, gender identity disorder, or gender incongruence “can lead to the minor becoming irreversibly sterile, having increased risk of disease and illness, or suffering from adverse and sometimes fatal psychological consequences.” Tenn. Code Ann. §68–33–101(b). It further found that it was “likely that not all harmful effects associated with these types of medical procedures when performed on a minor are yet fully known, as many of these procedures, when performed on a minor for such purposes, are experimental in nature and not supported by high- quality, long-term medical studies.” Ibid. Tennessee determined that “minors lack the maturity to fully understand and appreciate the life-altering consequences of such procedures and that many individuals have expressed regret for medical procedures that were performed on or administered to them for such purposes when they were minors.” §6833–101(h). At the same time, Tennessee noted evidence that discordance between sex and gender “can be resolved by less invasive approaches that are likely to result in better outcomes for the minor.” §68–33–101(c). SB1’s age- and diagnosis-based classifications are plainly rationally related to these findings and the State’s objective of protecting minors’ health and welfare. §68–33–101(a).

***

This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field. The voices in these debates raise sincere concerns; the implications for all are profound. The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best. Our role is not “to judge the wisdom, fairness, or logic” of the law before us, Beach Communications, 508 U. S., at 313, but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment. Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process.

MORE TO FOLLOW

Absolutely massive news: The Supreme Court just upheld Tennessee’s ban on sex changes, puberty blockers and hormones for kids.

We won. It’s now illegal to medically transition a child in Tennessee AND we set the precedent for the entire country. @LandonStarbuck and I fought… pic.twitter.com/9U4YxzmdTW

— Robby Starbuck (@robbystarbuck) June 18, 2025

BREAKING: Supreme Court upholds Tennessee's ban on transgender hormone disruption for minors, 6-3, with only Kagan, Sotomayor, and Jackson dissenting.

Remember Ketanji compared this law to a ban on interracial marriage… pic.twitter.com/BsSpfWzoiM

— Breitbart News (@BreitbartNews) June 18, 2025

At oral arguments for US v Skrmetti, a mom told @DailySignal her son knew he was a trans girl since "birth."

"Violet told us when she was 1.5," the mom said while protesting a Tennessee law banning child sex changes.

Today, the Supreme Court ruled states are allowed to protect… pic.twitter.com/NLFdSFGycy

— Elizabeth Troutman Mitchell (@TheElizMitchell) June 18, 2025

Barrett has figured out that there is no coherent definition of a "trans person." Once you understand this, everything else unravels. https://t.co/BwfWTQEMaj

— Wesley Yang (@wesyang) June 18, 2025

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