SCOTUS Delivers Major Setback for Transgender Community

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The U.S. Supreme Court on Wednesday upheld a Tennessee law that bars gender-affirming medical care for transgender youth—a major setback for advocates supporting the treatment for the community.

Why It Matters
The 6-3 ruling along ideological lines in U.S. v. Skrmetti effectively protects from legal challenges many efforts by President Donald Trump's Republican administration and state governments to roll back protections for transgender people. The challenge was brought by three transgender adolescents, their families and a Memphis-based medical provider against a Tennessee law banning gender-affirming hormone therapies for transgender people under 18.

What To Know
Senate Bill 1 (SB1), Tennessee legislation that bans gender-affirming care for transgender youth regardless of parental consent and medical recommendation, was signed into law in March 2023.

In April 2023, the American Civil Liberties Union (ACLU), the ACLU of Tennessee, Lambda Legal and Akin Gump Strauss Hauer & Feld LLP sued the state on behalf of families and transgender youth to block the ban. A district court judge later determined that the plaintiffs were likely to succeed on their constitutional claims and issued a preliminary injunction, blocking the law from going into effect.

The district court decision was later appealed to the Sixth Circuit, which reversed the lower court's decision. The plaintiffs filed petitions asking the U.S. Supreme Court to review the reversal. In June 2024, the Supreme Court agreed to take up the petition. Oral arguments were heard on December 4, 2024.

The decision may bolster the legal footing of similar laws in at least 26 other states, many backed by Republican-led legislatures, which have enacted sweeping measures to limit access to puberty blockers, hormone therapy and other medical treatments for minors identifying as transgender.

However, the decision does not affect the 24 states and additional territories that allow the care without restriction—nor the more than a dozen states that have laws to protect access to it.

Writing for the court, Chief Justice John Roberts said that Tennessee's law falls within the bounds of legislative authority and does not discriminate against transgender individuals under federal constitutional standards.

His opinion says in part that 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."

Roberts added that the court's role is "only to ensure that" the law "does not violate" the equal protection clause, which he said "it does not."

"Having concluded that it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process," he added.

Justice Amy Coney Barrett, in a concurring opinion, wrote that transgender status is not marked by the same sort of "'obvious, immutable, or distinguishing characteristics'" as race or sex.

"In particular, it is not defined by a trait that is 'definitively ascertainable at the moment of birth,'" Barrett wrote. "The plaintiffs here, for instance, began to experience gender dysphoria at varying ages—some from a young age, others not until the onset of puberty. Meanwhile, the plaintiffs acknowledge that some transgender individuals 'detransition' later in life—in other words, they begin to identify again with the gender that corresponds to their biological sex."

Justice Sonia Sotomayor, writing in a dissent joined by the court's other liberal justices, condemned the ruling, saying the majority "abandons transgender children and their families to political whims."

"Thus, the majority subjects a law that plainly discriminates on the basis of sex to mere rational-basis review," Sotomayor wrote. "By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent."

Cathryn Oakley, senior director of legal policy at the Human Rights Campaign, told Newsweek that the decision conveys that SB1 does not discriminate on the basis of sex but instead said that it is a medical regulation and that it treats people the same way regardless of their sex, meaning that transgender boys are subjected to the same regulations as transgender girls and therefore they are not being discriminated on the basis of their sex.

Oakley believes it's "a very incorrect analysis of what sex-based discrimination looks like."

"This is a really disappointing and disheartening decision," Oakley said. "It's truly devastating for the many transgender youths who are living not only in in Tennessee but in states like Tennessee, which have passed bans on their ability to access medical care.

"This medical care is best practice, medically necessary health care that is supported by the entire American mainstream medical and mental health establishment. These young folks, they deserve the ability to access that medical care and to be able to thrive and be well. I very strongly disagree with the Supreme Court that this was not discrimination."

Every major medical association supports health care for transgender people and youth, including the American Medical Association, American Academy of Pediatrics, American Association of Clinical Endocrinology, American Psychological Association, Texas Medical Association and World Health Organization.

Oakley, however, is "heartened" by the fact that the Supreme Court only was talking about SB1 but anticipates continued challenges to these health care bans that will likely require other legal approaches in other parts of the nation.

The Campaign for Southern Equality (CSE) manages the national Trans Youth Emergency Project (TYEP) that aids families of transgender youth impacted by laws that prohibit or restrict access to transition-related care for minors. CSE has distributed more than $600,000 in direct emergency grants to more than 1,200 families of transgender youth, in close partnership with state organizations in every state with a ban, dating to the project launch in March 2023.

TYEP says that since 2021, 27 states across the country, concentrated in the South and Midwest, have passed legislation restricting or banning access to gender-affirming health care for transgender youth. Prior to 2020, no state had advanced a law like the one in Tennessee.

What Happens Next
The ruling marks one of the most consequential developments in the growing legal clash over how far states can go in regulating care for transgender youth, and how far courts are willing to allow them to go.