Court upholds Tennessee’s ban on certain medical treatments for transgender minors

The Supreme Court on Wednesday upheld Tennessee’s ban on puberty blockers and hormone therapy for transgender teenagers. By a vote of 6-3, the justices rejected an argument by three transgender teens (along with their parents and a Memphis doctor) that the law violates their constitutional right to equal protection and should be scrutinized using a more stringent standard than the one used by a federal appeals court in Cincinnati. 

Writing for the majority, Chief Justice John Roberts acknowledged that the dispute “carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field.” But the court’s only role, he said, is to ensure that the Tennessee law does not violate the Constitution’s guarantee of equal protection. “Having concluded that it does not,” he wrote, “we leave questions regarding its policy to the people, their elected representatives, and the democratic process.” 

The court’s Democratic appointees dissented from the decision. Justice Sonia Sotomayor wrote that the court’s ruling “authorizes, without second thought, untold harm to transgender children and the parents and families who love them.” 

According to KFF, more than half the states have laws similar to Tennessee’s. The decision also comes just under five months after President Donald Trump signed a series of executive orders affecting the rights of LGBTQ+ people – and, in particular, transgender people. One such order, signed on Jan. 28, seeks to restrict the availability of certain gender-transition treatment for young people under the age of 19. 

The Biden administration joined the transgender teens in their challenge to the Tennessee law. But in early February, the Trump administration took a different position, telling the justices that it had determined that the law does not violate the right to equal protection. It “would not have intervened to challenge” the law, much less asked the Supreme Court to weigh in, it wrote in a letter on Feb. 7. 

Tennessee’s legislature passed the law, known as SB1, in 2023. SB1 emphasizes that the state has a “legitimate, substantial, and compelling interest in encouraging minors to appreciate their sex, particularly as they undergo puberty.” It prohibits (as relevant here) the use of puberty blockers and hormone therapy for transgender teens while allowing the use of the same treatments for other purposes. 

U.S. District Judge Eli Richardson put the ban on hold. He concluded that the treatments at the center of the dispute are “safe, effective, and comparable in both risk profile and efficacy to many other forms of pediatric medicine that Tennessee permits.” 

The U.S. Court of Appeals for the 6th Circuit reversed Richardson’s ruling and upheld the ban. It relied on a less stringent standard of review, known as “rational basis” review, which asks whether the law is rationally related to a legitimate government interest. 

On Wednesday, the Supreme Court affirmed the 6th Circuit’s ruling. In a 24-page opinion, Roberts and the majority agreed with the court of appeals that the Tennessee law is not subject to heightened scrutiny, because it classifies based on age and how the medicine is used, rather than on the basis of sex. 

Therefore, Roberts wrote, the law is subject to rational basis review, which it meets: “Tennessee concluded that there is an ongoing debate among medical experts regarding the risks and benefits associated with administering puberty blockers and hormones to treat gender dysphoria, gender identity disorder, and gender incongruence.” The Tennessee law’s “ban on such treatments responds directly to that uncertainty.” 

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