Photo Credit: Kevin Dietsch/Getty Images, Photograph of demonstrators outside of the U.S. Supreme Court during arguments regarding a Tennessee law banning controversial gender-affirming care for trans youth in U.S. Department of Justice backs out of Tennessee transgender care case (Dec. 4, 2024), https://tennesseelookout.com/2025/02/07/u-s-department-of-justice-backs-out-of-tennessee-transgender-care-case/.
Authored by: Arielle H. Foster
On March 22, 2023, Tennessee’s Senate Bill 0001 (SB1) was passed, amending the Tennessee Code to prohibit healthcare workers from performing on or administering to a minor certain medical procedures if the purpose of the procedures is to enable the child to “identify with, or live as, a purported identity inconsistent with the minor’s sex.”[1] Following the SB1’s enactment, three families raising transgender youth and a Memphis doctor sued the state of Tennessee in 2023, and the federal government, under President Biden’s administration, stepped in to carry the plaintiff’s challenge. [2] The U.S. Supreme Court heard argument on December 4, 2024 and two months later, the U.S. Department of Justice under President Trump’s administration withdrew their challenge of the Tennessee law stating “the government’s previously stated views no longer represent the United States’ position.”[3] Regardless, the Supreme Court continued toward a ruling, noting that the Government did not request a dismissal and rather requested “prompt resolution” as the ruling will control many pending cases in lower courts.[4]
In a slip opinion decided on June 18, 2025, the U.S. Supreme Court voted in a 6-3 decision to uphold the Tennessee law, ruling that the “law prohibiting certain medical treatments for transgender minors is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment and satisfies rational basis review.”[5] In their opinion, Justice Roberts noted that laws containing “sex-based classifications” are subject to intermediate scrutiny, requiring the State to show the “classification serves important governmental objectives and that the discriminatory means employed are substantially related to the achievement of those objectives.”[6] However, the Court disagreed with Plaintiff’s argument that heightened scrutiny was warranted as this law relies on sex-based classifications, finding that SB1 prohibits the administration of puberty blockers and hormones to “minors for certain medical uses, regardless of a minor’s sex.”[7]
The Supreme Court determined that the only two classifications incorporated in SB1 are (1) based on age, as treatments can be administered to adults, but not minors; and (2) the basis of medical use, as the use of these procedures may be used to treat conditions in minors, but not to treat children for the purpose of treating gender dysphoria or gender identity disorders; both of which are only subject to a rational basis review.[8] Finding that Tennessee established a “legitimate, substantial and compelling interest in protecting minors from physical and emotional harm,” and acknowledges Tennessee’s finding that “the prohibited medical treatments are experimental, can lead to later regret, and are associated with harmful-and sometimes irreversible-risks.”[9]
The plaintiffs further argued that SB1 discriminates against transgender individuals, which constitute a “quasi-suspect class” and thus warrants higher scrutiny, but the Supreme Court again disagreed.[10] The Court emphasized that regulating a medical procedure that only one sex can undergo does not trigger higher scrutiny unless it is a pretext for invidious sex discrimination.[11] This does not qualify as such, because SB1 is not excluding an individual from eligibility because of their sex, “but rather ‘remove[d] one physical condition . . . from the list of compensable disabilities,” ultimately stating that individuals aren’t excluded from medical treatments on the basis of being transgender, it is simply removing those diagnoses from the treatable conditions.[12]
Justice Sotomayor dissented, claiming that the law “expressly classifies on the basis of sex and transgender status.”[13] She was joined by her fellow democratic party appointees, Justices Kagan and Jackson, in explaining that: [i]n addition to discriminating against transgender adolescents, who by definition ‘identify with’ an identity ‘inconsistent’ with their sex, that law conditions the availability of medications on a patient’s sex. Male (but not female) adolescents can receive medicines that help them look like boys, and female (but not male) adolescents can receive medicines that help them look like girls.”[14]
Tennessee is one of 27 states that restrict medical care for transgender youth, and this Supreme Court ruling could affect dozens of states.[15] The Tennessee Attorney General, Jonathan Skrmetti, praised the Supreme Court’s ruling, calling it a “historic Supreme Court win” and further stated, “the common sense of Tennessee voters prevailed over judicial activism.”[16] Alternatively, however, transgender-rights activists called this decision “a punch in the gut for the transgender community,” as she believes the prohibited care in this case is “life-saving” in many cases.[17]
[1] S.B. 0001, 113th Gen. Assemb., 1st Extra.. Sess. (Tenn. 2023), https://legiscan.com/TN/bill/SB0001/2023 (summarizing Senate Bill 0001 as enacted); SB0001 Bill Summary, Tenn. Gen. Assemb., https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=SB0001&ga=113 (last visited Aug. 11, 2025).
[2] Sam Stockard, U.S. Department of Justice backs out of Tennessee transgender care case, Tenn. Lookout, Feb. 7, 2025, https://tennesseelookout.com/2025/02/07/u-s-department-of-justice-backs-out-of-tennessee-transgender-care-case/.
[3] Id.
[4] Id.
[5] United States v. Skrmetti, 145 S. Ct. 1816, 1821 (2025); Greg Stohr, Supreme Court Upholds Curbs on Care for Transgender Minors, Bloomberg News, Jun. 18, 2025, https://www.bloomberglaw.com/product/blaw/bloombergterminalnews/bloomberg-terminal-news/SY2382DWLU68?criteria_id=8ca6b6280b2dc7ead434cbe7e4f43497.
[6] Skrmetti, 145 S. Ct. at 1828-29 (quoting J. Ginsburg in United States v. Virginia, 518 U.S. 515, 533).
[7] Id. at 1829.
[8] Id.
[9] Id. at 1832.
[10] Id.
[11] Id. at 1833.
[12] Skrmetti, 145 S. Ct. at1833.
[13] Id. at 1868; Stohr, supra note 5.
[14] Skrmetti, 145 S. Ct. at 1868.
[15] Stohr, supra note 5.
[16] Id.
[17] Id.
American Journal of Trial Advocacy 