Supreme Court upholds Tennessee law limiting use of sex-transition surgeries and hormones for minors
Tennessee’s restrictions on the use of drugs and surgeries to alter children’s sex characteristics are valid and do not violate the Constitution’s Equal Protection Clause, the U.S. Supreme Court has ruled.
The June 18 decision came more than six months after oral arguments. It leaves in place Tennessee’s Senate Bill 1.
That law prohibits the use of drugs or surgeries for those under the age of 18 if those medical treatments are intended to allow “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex.”
The named defendant in the case, Tennessee Attorney Gen. Jonathan Skrmetti, is a member of the Harpeth Hills Church of Christ in Brentwood, south of Nashville.
Chief Justice John Roberts, who wrote the opinion for the six-member majority, said the law’s constitutionality should be subject only to a “rational basis review,” rather than some higher level of judicial scrutiny. That means the court considered whether the law was “rationally related” to a legitimate government interest. Because the law was adopted by lawmakers to protect minors from experimental or irreversible procedures, Roberts wrote, the courts must defer to the discretion of the state legislature.
Jonathan Skrmetti poses for a photo at the attorney general’s office in Nashville.
Previous court decisions have held that laws discriminating based on sex and gender must pass a higher bar — intermediate scrutiny — to be valid under the Equal Protection Clause of the 14th Amendment. Under this standard, the government must show that the law serves an important governmental interest and is substantially related to achieving that objective.
“In the medical context, the mere use of sex‑based language does not sweep a statute within the reach of heightened scrutiny,” Roberts wrote.
Because of the ongoing debate about the appropriateness of surgeries and drugs for children seeking to identify as the opposite sex, the majority opinion said “states must have leeway to effect the judgment of their citizens.”
Justice Sonia Sotomayor and two others dissented, arguing the law was indeed sex-based and subject to intermediate scrutiny. The surgeries and drugs prohibited by Tennessee’s law are “not a matter of mere cosmetic preference. To the contrary, access to care can be a question of life or death.”
In Tennessee, Skrmetti hailed the decision as a win for common sense.
“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,” he said in a statement issued after the decision was released. “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.”
The American Civil Liberties Union, which had joined with the Biden administration two years ago to challenge the Tennessee law, criticized the decision as a “painful setback” for children seeking medical treatments to alter their sex characteristics.
“Today’s ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution.”
The ruling leaves in place similar laws in 25 states that prohibit the use of puberty blockers and hormone treatments for children in similar situations.
KENNETH PYBUS is a professor of journalism and mass communication at Abilene Christian University and a First Amendment attorney. Reach him at [email protected].
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