Supreme Court Upholds Tennessee Ban on Trans Surgeries for Children

The Supreme Court on Wednesday upheld a Tennessee law prohibiting transgender drugs and surgeries for children, a major win for conservative activists and parent groups.

The court ruled 6-3 in United States v. Skrmetti that Tennessee’s law does not violate the 14th Amendment’s Equal Protection Clause. Tennessee Attorney General Jonathan Skrmetti defended the law before the High Court in December, saying it was a matter of “protecting kids from the consequences of decisions that they cannot fully understand.”

Chief Justice John Roberts penned the court’s opinion and said the plaintiffs “contort the meaning of the term ‘medical treatment.'”

“Notably absent from their framing is a key aspect of any medical treatment: the underlying medical concern the treatment is intended to address,” Roberts wrote.

Roberts rejected the plaintiffs’ argument that Tennessee’s law discriminates on the basis of sex.

“The law does not prohibit conduct for one sex that it permits for the other,” Roberts wrote. “Under SB1, no minor may be administered puberty blockers or hormones to treat gender dysphoria, gender identity disorder, or gender incongruence; minors of any sex may be administered puberty blockers or hormones for other purposes.”

Roberts also noted that the number of minors requesting “sex transition treatments” has increased in recent years, while there have been “rising debates regarding the relative risks and benefits of such treatments” including European countries cracking down on these procedures and drugs.

Justice Clarence Thomas wrote a concurring opinion in which he said, “there is no medical consensus on how best to treat gender dysphoria in children,” and “recent revelations suggest that leading voices in this area have relied on questionable evidence, and have allowed ideology to influence their medical guidance.”

Justices Amy Coney Barrett and Samuel Alito also wrote concurring opinions, and Justice Sonia Sotomayor wrote a dissent that was joined by Justices Elena Kagan and Ketanji Brown Jackson.

Sotomayor claimed that “transgender adolescents’ access to hormones and puberty blockers (known as gender-affirming care) is not a matter of mere cosmetic preference. To the contrary, access to care can be a question of life or death.” Advocates have pushed a similar line to parents of trans-identifying children for years.

Tennessee lawmakers were inspired to introduce and pass the law following Daily Wire host Matt Walsh’s explosive investigation into Vanderbilt University’s gender clinic.

Tennessee’s law blocks all transgender medical treatments on children, including puberty blockers, cross-sex hormones, and surgeries. Doctors who offer these treatments risk losing their medical licenses and paying a $25,000 fine. The law also gives children and their families the right to sue if they were harmed by these treatments.

The plaintiffs in the Tennessee case, which include trans-identifying teens and their families, claimed the state’s ban violates the 14th Amendment, which requires that everyone is treated equally under the law, by preventing them from accessing medical treatments that are available to others. They also claimed the ban violates parental rights to make health care decisions for their children.

The law was immediately challenged when it took effect in July, 2023. A Nashville federal district judge blocked the law that same month, but a week later, the Sixth Circuit Court of Appeals combined the Tennessee case with a similar case out of Kentucky and ruled in favor of both bans.

The Biden administration joined the lawsuit against Tennessee and urged the Supreme Court to take up the case, saying the court’s opinion was “urgently needed” since the confusion among federal courts had resulted in “profound uncertainty.”

Federal appeals courts have been divided in recent years on whether state bans on these transgender medical interventions for children are unconstitutional.

This is only the second time the Supreme Court has weighed in on this white-hot culture war issue, having previously avoided many opportunities to get involved.

In April of last year, the court allowed Idaho to enforce its ban on transgender medical interventions for minors except for the two teenagers who sued over the law.

Thursday’s ruling is expected to have broad implications for the other state bans on the same transgender medical interventions for minors. More than 20 states with Republican-led legislatures have similar bans.

Both puberty blockers and cross-sex hormones come with serious health risks. Puberty blockers can affect bone growth and density and cause sexual dysfunction, voice damage, and infertility, among other issues. Cross-sex hormones can cause infertility, deadly blood clots, heart attacks, increased risk of both breast and ovarian cancers, liver dysfunction, worsening psychological illness, and other serious conditions.

Gender surgeries like phalloplasty, vaginoplasty, and double mastectomy are irreversible and often come with serious complications.