The U.S. Supreme Court has upheld Tennessee’s law prohibiting doctors from providing puberty blockers, hormone treatments, and certain surgeries to minors for the purpose of gender transition. The ruling, delivered by Chief Justice John Roberts, affirms the state’s authority to restrict such medical interventions for individuals under 18, rejecting constitutional challenges brought under the Equal Protection Clause of the Fourteenth Amendment.
Tennessee’s Senate Bill 1 (SB1), enacted in 2023, bans healthcare providers from prescribing or administering puberty blockers or hormones to minors if the purpose is to enable the minor to identify with a gender different from their biological sex or to treat distress arising from such discordance. The law, however, allows these treatments for other medical conditions, such as congenital defects or precocious puberty.
The law was challenged by three transgender minors, their parents, and a doctor, who argued that SB1 discriminates on the basis of sex and transgender status, thus violating the Equal Protection Clause. A federal district court initially blocked the law, but the Sixth Circuit Court of Appeals reversed that decision, leading to Supreme Court review.
The Court held that SB1 does not warrant heightened constitutional scrutiny because it does not classify individuals by sex or transgender status in a manner that triggers such review. Instead, the law was found to make age- and diagnosis-based distinctions, which are subject only to rational basis review, the most deferential standard of judicial scrutiny.
The Court further rejected arguments that the law was a pretext for sex-based or transgender-based discrimination, noting that the statute’s classifications are tied to medical uses rather than identity or status. The majority also declined to extend the logic of Bostock v. Clayton County, which interpreted Title VII’s employment protections for transgender individuals, to the constitutional context of medical regulation for minors.
Justice Sotomayor, joined by Justices Jackson and Kagan (in part), dissented, arguing that the law does discriminate based on sex and transgender status and should be subject to heightened scrutiny. The dissent warned that the ruling could embolden further legislative restrictions on transgender rights and access to healthcare for minors.
The decision is expected to have nationwide impact, as over 20 states have enacted similar laws in recent years. The ruling clarifies that, at least under the Equal Protection Clause, states have broad latitude to regulate or ban gender-affirming medical care for minors.
