Skip to content

Supreme Court tees up case on state youth transgender care ban

Biden administration argues Tennessee’s law unconstitutionally targets transgender youth

Storm clouds hang over the Supreme Court building.
Storm clouds hang over the Supreme Court building. (Bill Clark/CQ Roll Call file photo)

The Supreme Court will decide whether Tennessee’s law restricting gender-affirming care for minors violates the Constitution, amid a broader push from states that have passed similar laws and others that target transgender individuals.

The justices announced Monday they agreed to decide United States v. Jonathan Skrmetti et al., presumably in the next term that starts in October with a decision by the end of June 2025.

The appeal brought by the Biden administration could be nationally significant on an issue that has become a cultural and political battleground, as Tennessee and more than a dozen states have enacted restrictions on gender-affirming care.

“Those laws, and the conflicting court decisions about their validity, are creating profound uncertainty for transgender adolescents and their families around the Nation — and inflicting particularly acute harms in Tennessee and other States where the laws have been allowed to take effect,” the Biden administration wrote in a petition in the case.

The Tennessee law, which is currently in effect, prohibits the prescription of puberty blockers, hormones and surgery for minors for the purpose of “enabling a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex.”

Each violation carries a $25,000 penalty and potential professional discipline and civil liability, according to court records. Only the puberty blockers and hormones provisions are part of the Biden administration’s challenge.

The Supreme Court agreed to review a decision from the U.S. Court of Appeals for the 6th Circuit that upheld the Tennessee law and found that discrimination against transgender individuals did not violate the Equal Protection Clause.

The Biden administration said the state law’s main purpose was to “enforce conformity” with state legislators’ ideas about sex and gender, and that it violates the 14th Amendment because it relies on sex-based classifications and discriminates based on transgender status.

Tennessee officials, in court filings, argued that the number of minors receiving transition care has “exploded” in recent years and claimed that treatments were “unproven and risky.”

“The question here is whether the Constitution prohibits Tennessee from acting to protect minors who may not fully grasp the lifelong implications of these interventions,” the state wrote.

The state defended the 6th Circuit decision and argued that the law does not target individuals based on their sex.

The Biden administration said Tennessee explicitly targeted the transgender community in passing the law, separate from any medical concerns. For instance, the Biden administration pointed out that Tennessee’s law still allows measures like testosterone prescriptions for patients assigned male at birth, but not for those assigned female at birth.

The same treatments are available to patients with delayed or precocious puberty, polycystic ovarian syndrome and other conditions, but not transgender patients, the Biden administration’s brief said.

The Biden administration pointed out that more than a dozen national medical organizations support providing gender-affirming care to minors, to prevent the harms associated with gender dysphoria.

Numerous civil rights groups highlighted the stakes at play in the case, including the ACLU, which has been involved in the challenges to Tennessee’s law. Chase Strangio, a deputy director at the group’s LGBTQ & HIV Project, said the laws were the result of an “openly political effort to wage war” on a vulnerable group and fundamental freedoms like the ability to choose medical care.

“These bans represent a dangerous and discriminatory affront to the well-being of transgender youth across the country and their Constitutional right to equal protection under the law,” Strangio said.

The Biden administration challenged the law in federal court in Tennessee, which initially blocked its enforcement.

A district court judge found the record did not support the state’s asserted interest in protecting the welfare of transgender adolescents, the Biden administration wrote.

“To the contrary, the evidence established that the benefits of gender-affirming care outweigh any risks associated with such treatment — consistent with the consensus within the medical community endorsing such care, in appropriate cases, to treat gender dysphoria in adolescents,” the Biden administration petition states.

A divided 6th Circuit panel then reversed that finding and allowed the law to go into effect.

The Biden administration pointed out in the petition that other federal appeals courts have issued conflicting rulings on challenges to similar bans in other states.

The Supreme Court in 2020 ruled that the federal Civil Rights Act prohibited discrimination against transgender individuals in the workplace in Gerald Bostock v. Clayton County.

But this case will interpret the Constitution, not a law, and the court’s makeup has shifted more conservative since then.