Washington, D.C. — The U.S. Supreme Court has charted new territory regarding the equal protection principles as they relate to transgender individuals in its recent decision on a Tennessee law that bans gender-affirming care for minors. In the case of United States v. Skrmetti, the Court’s conservative majority upheld the law, marking a pivotal moment for transgender rights and the future of sex discrimination laws.
The ruling centers on how constitutional standards should be applied to laws discriminating against transgender individuals. LGBTQ+ advocates had hoped the Court would adopt a more stringent review standard. Instead, the majority opinion, authored by Chief Justice John Roberts, applied a lower standard of review, disregarding arguments that the law discriminates based on sex.
Tennessee’s law prohibits medical treatments aimed at helping minors align their physical characteristics with their gender identity, framing its intention as promoting acceptance of assigned sex. Despite allowing similar treatments for other medical conditions, such as precocious puberty, the law effectively blocks access to health care for transgender minors, according to the groups challenging the legislation.
The plaintiffs in the case, including three transgender teenagers and a physician, argued that the law unconstitutionally creates disparities based on sex. For example, a boy could receive testosterone, but a girl could not get the same treatment if it is intended for gender-affirming purposes. Advocates insisted that intermediate scrutiny should apply—this higher standard of review is used when a law involves sex discrimination.
The majority, however, asserted that the law is focused on age and "medical use" rather than sex or gender identity. The ruling maintains that there is no discrimination because the law applies universally, banning specific treatments regardless of a minor’s biological sex. This reading incorrectly diminishes the significance of the law’s discriminatory impact on transgender minors, according to dissenting opinions.
Justice Sonia Sotomayor’s dissent strongly criticized the majority’s reasoning, drawing a parallel to religious discrimination. She argued that if the law restricted minors’ participation in religious activities based on gender identity, it would no longer be viewed as neutral. The dissent highlights the dangers of the majority’s reasoning in potentially undermining existing frameworks of sex discrimination law that disallow penalties for deviating from traditional gender roles.
The majority’s decision to use rational-basis review, the least stringent standard, hinged on the perception of public debates surrounding the safety of gender-affirming treatments. By framing the conversation around legislative intent and the evolving medical landscape, the Court aims to defer policy decisions to state legislatures rather than judicial interpretation.
The implications of the ruling extend beyond gender-affirming care, threatening to reshape how courts approach sex discrimination altogether. Justice Sotomayor noted that laws which would nominally treat everyone equally may still be discriminatory at their core, drawing on precedents like Loving v. Virginia to illustrate her point.
While Skrmetti represents a setback for the LGBTQ+ community and advocates for sex discrimination law, it does not signal an end to the fight for equality. The Court is set to hear additional cases challenging state laws concerning transgender athletes, suggesting ongoing opportunities for legal challenges that address issues left unresolved by this ruling.
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