What to Know About the Supreme Court’s Gender-Affirming Care Decision
The Supreme Court dealt a major blow to trans rights on Wednesday, ruling in United States v. Skrmetti that a Tennessee law banning gender-affirming care for minors is constitutional. “Today’s decision is deeply disappointing,” says Jennifer Levi, senior director of transgender and queer rights at GLBTQ Legal Advocates & Defenders. “It’s gonna cause real harm to families who simply wanna access medical care for their children.”
Conservative lawmakers have introduced hundreds of bills in recent years that seek to limit trans adolescents’ ability to access health care and participate in public life. So far, Tennessee and 26 other states have outlawed gender-affirming care for minors, affecting nearly 40 percent of all trans youth in the country, according to the Human Rights Campaign. President Donald Trump also signed an executive order banning gender-affirming care for trans people under age 19, although that order has been blocked by a federal judge. These policies have been enacted despite protests from leading medical organizations, such as the American Medical Association, the American Psychiatric Association, and the American Academy of Pediatrics, who say that this care is medically necessary and safe.
Though the Skrmetti ruling is devastating for trans kids living in states where they’re not allowed to access the health care they need, it is also a narrow decision that won’t trigger any immediate changes nationwide, according to Cathryn Oakley, senior director of legal policy at the Human Rights Campaign. “No state that currently allows gender-affirming care is impacted by today’s decision,” she adds. “This is not a ban on gender-affirming care for places that did not already have it.” Here’s everything you need to know about the implications of the court’s ruling.
What was United States v. Skrmetti about?
The case centered around Tennessee’s Senate Bill 1, which became law in 2023. SB1 banned treatments for transgender minors including puberty blockers, hormone therapy, and surgery. The law did not prohibit cisgender youth from pursuing the same treatments, however. Several people sued, arguing that SB1 discriminated against trans youth and violated their equal protection rights under the 14th Amendment. The plaintiffs included L.W., a 16-year-old transgender girl; her parents; two other families; and Dr. Susan Lacy, a health provider in Memphis who treated trans youth.
Tennessee officials had argued that it’s “not unconstitutional discrimination to say that drugs can be prescribed for one reason but not another.” State lawyers added that SB1 wasn’t discriminating against people based on sex, and instead created two separate groups, “minors seeking drugs for gender transition and minors seeking drugs for other medical purposes.”
What did the justices say?
The Court’s six conservative justices upheld the law, ruling that SB1 does not discriminate against trans youth. In the majority opinion, Chief Justice John Roberts wrote that the “Court’s role is not ‘to judge the wisdom, fairness, or logic’ of SB1, but only to ensure that the law does not violate equal protection guarantees. It does not. Questions regarding the law’s policy are thus appropriately left to the people, their elected representatives, and the democratic process.”
The Court’s three liberal justices — Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson — dissented. In her opinion, Sotomayor argued that Tennessee’s ban discriminates on the basis of sex and that the conservative supermajority shied away from ruling as such in order to prevent other “categorical healthcare bans” like it from being struck down by lower courts. “The Court’s willingness to do so here does irrevocable damage to the Equal Protection Clause and invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight,” Sotomayor continued. “It also authorizes, without second thought, untold harm to transgender children and the parents and families who love them.”
What does this decision mean for trans kids?
The ruling does not ban gender-affirming care nationwide and shouldn’t have an immediate impact on minors’ ability to obtain it, according to Levi. Patients in states that have banned treatment for trans youth will remain unable to access care at home, she says, while those in states where care is legal and protected won’t be affected.
And does the decision have any implications for trans adults?
Since the case focused solely on SB1’s constitutionality, trans adults who are undergoing gender-affirming care won’t be impacted directly by the decision, says Oakley.
Will the ruling prevent lawsuits against other pieces of anti-trans legislation?
No, according to Oakley, who says the Court didn’t rule on what kind of scrutiny an anti-trans bill should be subjected to in the future. She adds that because the Court’s decision was about SB1 specifically, it didn’t touch on the constitutionality of many other anti-trans attacks we’re seeing at the state level, such as school sports bans and bathroom bans.
“It is really important to say how limited this decision is, because this is only related to SB1,” she says. She adds that plaintiffs in ongoing or future cases related to trans health care still have other legal avenues to challenge bans, such as on the basis of parental rights. “None of those were at issue in this case,” she says.
What happens next?
The legal battles over the rights of transgender youth and adults are far from over, says Levi. The Trump administration has been sued over several of its anti-trans policies, including ending gender-affirming care for incarcerated people, banning trans people from serving in the military, withholding federal funding from hospitals that treat trans patients under the age of 19, and preventing trans people from updating the sex marker on their passports to match their gender identity.
“The ruling really coincides with an escalation in targeting transgender people by the federal government through policy,” she says. “It just adds to the hostile climate that transgender people are experiencing nationally.”
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