Supreme Court Upholds Tennessee's Ban on Gender-Affirming Care for Minors

United States v. Skrmetti reviewed Tennessee's Senate Bill 1, which bars specified medical treatments when used to help a minor identify with or live as a gender inconsistent with their sex assigned at birth. The federal government and transgender adolescents and their families argued the law discriminated based on sex and transgender status in violation of the Equal Protection Clause.

Writing for the majority, Chief Justice John Roberts concluded that the law classifies on the basis of age and medical use rather than sex, and therefore need only satisfy rational-basis review, the most deferential standard. Under that test, the Court held, Tennessee's asserted interests in regulating pediatric medicine were sufficient to sustain the ban. Justices Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson dissented.

The ruling is foundational because it declined to recognize transgender status as a classification demanding heightened judicial protection, a question that had divided lower courts for years. Its reasoning shaped later decisions, including the Court's 2026 approval of state transgender sports bans.

Because the decision leaves regulation to the political process, it validated the roughly two dozen states that had enacted similar restrictions and left families in those states to seek care elsewhere. It did not require any state to ban treatment, nor did it address care for transgender adults.