Supreme Court Upholds Tennessee Law Banning Sex Changes for Minors
The Supreme Court on Monday upheld a Tennessee law banning sex changes for minors.
The high court ruled 6-3, with liberal-leaning justices dissenting, that Tennessee’s Senate Bill 1 does not violate the Equal Protection Clause of the Fourteenth Amendment in the U.S. Constitution, contrary to the claims of transgender activists who sued the state.
“This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field. The voices in these debates raise sincere concerns; the implications for all are profound. The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best. Our role is not to judge the wisdom, fairness, or logic of the law before us, but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment,” Chief Justice John Roberts wrote for the majority.
“Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process. The judgment of the United States Court of Appeals for the Sixth Circuit is affirmed,” he added.
The court ultimately rejected claims brought by the transgender-identifying minors, their parents, and a doctor that Tennessee’s law discriminates on the basis of sex. Instead, the court countered that the state’s law bars sex change drugs and procedures for individuals based on their status as a minor and bars the use of puberty blockers and cross-sex hormones for the purpose of treating gender dysphoria.
The court also found that Tennessee’s law meets the “rational basis inquiry” and noted: “Where there exist plausible reasons for the relevant government action, our inquiry is at an end.”
“SB1 clearly meets this standard. Tennessee determined that administering puberty blockers or hormones to a minor to treat gender dysphoria, gender identity disorder, or gender incongruence can lead to the minor becoming irreversibly sterile, having increased risk of disease and illness, or suffering from adverse and sometimes fatal psychological consequences. It further found that it was likely that not all harmful effects associated with these types of medical procedures when performed on a minor are yet fully known, as many of these procedures, when performed on a minor for such purposes, are experimental in nature and not supported by high quality, long-term medical studies,” Roberts wrote.
“Tennessee determined that minors lack the maturity to fully understand and appreciate the life-altering consequences of such procedures and that many individuals have expressed regret for medical procedures that were performed on or administered to them for such purposes when they were minors,” he continued. “At the same time, Tennessee noted evidence that discordance between sex and gender can be resolved by less invasive approaches that are likely to result in better outcomes for the minor. SB1’s age- and diagnosis-based classifications are plainly rationally related to these findings and the State’s objective of protecting minors’ health and welfare.”
Justice Roberts and Justice Amy Coney Barrett also rejected plaintiffs’ claim that transgender-identifying individuals are a suspect class.
“This Court has not previously held that transgender individuals are a suspect or quasi-suspect class. And this case, in any event, does not raise that question because SB1 does not classify on the basis of transgender status,” Roberts wrote.
Justice Barrett wrote a concurring opinion, joined by Justice Clarence Thomas, to explain, in her view, how “transgender status” does not constitute a suspect class worthy of the same legal protections as immutable characteristics such as race or sex.
“The Sixth Circuit held that transgender individuals do not constitute a suspect class, and it was right to do so. To begin, transgender status is not marked by the same sort of obvious, immutable, or distinguishing characteristics as race or sex. In particular, it is not defined by a trait that is definitively ascertainable at the moment of birth,” Barrett wrote.
She also noted the wide variety of experiences an individual with gender dysphoria can have, including struggling at varying ages and even detransitioning later in life.
“Accordingly, transgender status does not turn on an immutable… characteristi[c],” she wrote. “The boundaries of the group, in other words, are not defined by an easily ascertainable characteristic that is fixed and consistent across the group.”
Justice Thomas wrote his own concurring opinion, in which he detailed, at length, the potential risks and long-term side effects of sex change drugs and surgeries for minors, and slammed the idea that “courts should defer to so-called expert consensus.”
“States have an interest in ensuring that minor patients have the time and capacity to fully understand the irreversible treatments they may undergo. And, despite the supposed expert consensus that young children can consent to irreversible sex-transition treatments, States have good reasons to disagree; as any parent knows, children’s comprehension is limited, and the growing number of detransitioners illustrates the risks of assuming otherwise,” Thomas wrote:
This case carries a simple lesson: In politically contentious debates over matters shrouded in scientific uncertainty, courts should not assume that self-described experts are correct. Deference to legislatures, not experts, is particularly critical here.
Many prominent medical professionals have declared a consensus around the efficacy of treating children’s gender dysphoria with puberty blockers, cross-sex hormones, and surgical interventions, despite mounting evidence to the contrary. They have dismissed grave problems undercutting the assumption that young children can consent to irreversible treatments that may deprive them of their ability to eventually produce children of their own. They have built their medical determinations on concededly weak evidence. And, they have surreptitiously compromised their medical recommendations to achieve political ends.
The Court today reserves to the people, their elected representatives, and the democratic process the power to decide how best to address an area of medical uncertainty and extraordinary importance. That sovereign prerogative does not bow to “major medical organizations.”
He also admonished the World Professional Association for Transgender Health (WPATH) — an organization that sets standards for “gender-affirming care” and promotes sex changes for minors — pointing to “recent revelations” that “might reinforce the conclusion that WPATH’s lodestar is ideology, not science.”
“Worse, recent reporting has exposed that WPATH changed its medical guidance to accommodate external political pressure,” he wrote.
Justice Sonia Sotomayor wrote a dissenting opinion, accusing the majority of “refus[ing] to call a spade a spade.”
“Instead, it obfuscates a sex classification that is plain on the face of this statute, all to avoid the mere possibility that a different court could strike down SB1, or categorical healthcare bans like it. 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,” she wrote. “It also authorizes, without second thought, untold harm to transgender children and the parents and families who love them. Because there is no constitutional justification for that result, I dissent.”
Tennessee passed SB1 in 2023, becoming one of more than 20 states to pass similar legislation. The bill restricts sex change drugs and surgeries for minors “for the purpose of enabling a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex.” Tennessee’s law carries an enforcement mechanism and additionally establishes a private right of action, enabling an injured minor or non-consenting parent of that minor to sue the doctor who violated the law.
Plaintiffs quickly filed a pre-enforcement claim seeking to block the law. A district court blocked part of the law banning sex change drugs for minors, but allowed the ban on surgeries to stand. The U.S. Court of Appeals for the Sixth Circuit reversed that order, allowing the full law to stand. The Supreme Court heard the case in December 2024 and ultimately held up the Sixth Circuit’s ruling.
Tennessee Attorney General Jonathan Skrmetti issued a statement celebrating the ruling.
“In today’s historic Supreme Court win, the common sense of Tennessee voters prevailed over judicial activism,” Skrmetti said. “A bipartisan supermajority of Tennessee’s elected representatives carefully considered the evidence and voted to protect kids from irreversible decisions they cannot yet fully understand. I commend the Tennessee legislature and Governor Lee for their courage in passing this legislation and supporting our litigation despite withering opposition from the Biden administration, LGBT special interest groups, social justice activists, the American Medical Association, the American Bar Association, and even Hollywood.”
“The rapid and unexplained rise in the number of kids seeking these life-altering interventions, despite the lack of supporting evidence, calls for careful scrutiny from our elected leaders,” he added. “This victory transcends politics. It’s about real Tennessee kids facing real struggles. Families across our state and our nation deserve solutions based on science, not ideology. Today’s landmark decision recognizes that the Constitution lets us fulfill society’s highest calling — protecting our kids.”
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Do No Harm, a medical organization dedicated to opposing woke gender and racial ideologies in medicine, also praised the ruling.
“The Supreme Court’s strong decision today is a massive win in the fight to protect children from harmful gender ideology. Transgender treatments for minors is experimental medicine not backed by reliable evidence,” said Kristina Rasmussen, the organization’s executive director. “Do No Harm is proud to have been in the fight to expose this ideology over the last several years and support Tennessee in this case. We will continue to work nationally and in other states to protect children from the harms of sex change treatments.”
The case is United States v. Skrmetti, No. 23-477 in the Supreme Court of the United States.
Katherine Hamilton is a political reporter for Breitbart News. You can follow her on X @thekat_hamilton.
