The Supreme Court upheld a Tennessee law banning transgender procedures for minors on Wednesday, finding it does not violate the equal protection clause of the 14th Amendment.
Chief Justice John Roberts wrote the majority opinion in the 6-3 decision upholding Tennessee Senate Bill 1, which prohibits the use of puberty blockers, cross-sex hormones, and surgical procedures to treat gender dysphoria and related conditions in minors.
The other conservative justices, Clarence Thomas, Samuel Alito, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett, joined the majority decision, while the three liberal justices, Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson, dissented.
In the majority opinion, Roberts said opponents of the law, who argued that it discriminated on the basis of transgender identity, misunderstood the medical context in which a particular course of treatment is used for a specific ailment.
“SB1 does not exclude any individual from medical treatments on the basis of transgender status,” Roberts wrote in the majority opinion. “Rather, it removes one set of diagnoses–gender dysphoria, gender identity disorder, and gender incongruence–from the range of treatable conditions.”
Roberts and the other conservative justices contend that the bill “clearly does not classify on the basis of sex” but rather applies the law, which regulates the course of treatment acceptable for a particular condition, in this case, gender identity matters, evenly to both sexes.
“Under SB1, no minor may be administered puberty blockers or hormones to treat gender dysphoria, gender identity disorder, or gender incongruence; minors of any sex may be administered puberty blockers or hormones for other purposes,” Roberts wrote.
Several of the concurring majority opinions highlighted the rapid rise in adolescents and young adults identifying as transgender or suffering from gender dysphoria and related conditions.
Thomas, in a concurring opinion, outlined in detail the deleterious side effects of puberty blockers and cross-sex hormones prescribed to adolescents to treat gender dysphoria, including permanent changes in vocal cords, infertility, and heightened risk of certain cancers.
Thomas also cited the British National Health Service’s meta review of the medical literature on cross-sex hormones and puberty blockers. The Cass Review, conducted by pediatrician Hilary Cass and published in 2024, found that there is no rigorous, long-term evidence regarding the safety of hormonal therapies to treat gender dysphoria in minors.
The concurring opinions did not make reference to the similar meta review recently published by the office of Health and Human Services Secretary Robert F. Kennedy Jr., which also found weak evidentiary foundations undergirding recommendations for hormonal and surgical interventions to treat gender dysphoria.
The liberal justices, however, did not rely as much on the medical aspects of the complicated case, but rather on whether transgender people deserve the same type of protections against discrimination as other protected classes, such as race and sex.
Sotomayor, who wrote a dissent joined fully by Jackson and mostly by Kagan, said the majority opinion “contorts logic and precedent” by ruling that the Tennessee law did not need to face additional scrutiny under the Equal Protection Clause.
“The majority subjects a law that plainly discriminates on the basis of sex to mere rational-basis review,” Sotomayor wrote in her dissent. “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.”
Sotomayor also said the majority opinion “does irrevocable damage to the Equal Protection Clause and invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight.”
Kagan said in her dissent that she agreed largely with Sotomayor’s dissent but took “no view on how SB1 would fare under heightened scrutiny.”
“Both the plaintiffs and the Government asked this Court not to itself apply heightened scrutiny, but only to remand that inquiry to the lower courts,” Kagan said. “So I would both start and stop at the question of what test SB1 must satisfy. As Justice Sotomayor shows, it is heightened scrutiny.”
The outcome of the case will have ramifications for more than 20 other states that have similar laws banning transgender procedures for minors.
Dr. Stanley Goldfarb, chairman of Do No Harm, an organization that has lobbied against transgender procedures for minors, said in a statement Wednesday that the decision protects states that enact “commonsense policies that protect children from dangerous medical procedures.”
“The decision should end the debate over laws like Tennessee’s, and it could have important ramifications for other commonsense policies that resist radical gender ideology,” Goldfarb said.
Tennessee Attorney General Jonathan Skrmetti, whose name is in the case title, said with the decision, “the common sense of Tennessee voters prevailed over judicial activism.”
“This victory transcends politics,” Skrmetti said Wednesday. “It’s about real Tennessee kids facing real struggles. Families across our state and our nation deserve solutions based on science, not ideology. Today’s landmark decision recognizes that the Constitution lets us fulfill society’s highest calling – protecting our kids.”
TOP CASES THE SUPREME COURT WILL DECIDE AT THE END OF THIS TERM
Chase Strangio, a transgender lawyer with the American Civil Liberties Union’s LGBT & HIV Rights Project who argued before the high court during oral arguments in December 2024, called Wednesday’s ruling a “devastating loss.”
“Though this is a painful setback, it does not mean that transgender people and our allies are left with no options to defend our freedom, our health care, or our lives,” Strangio said.
