SCOTUS Upholds Tennessee Ban on Gender-Affirming Care for Minors: What Families Need to Know
On June 18, 2025, the U.S. Supreme Court released a 6–3 decision in U.S. v. Skrmetti, upholding Tennessee Senate Bill 1 (SB1)—a law that prohibits all gender-affirming medical care for minors under the age of 18.
That includes puberty blockers and hormone therapy—treatments that are not only supported by major medical associations but have been life-saving for many transgender youth.
This is a deeply consequential ruling. It keeps Tennessee’s ban in place and opens the door for similar laws to take hold—or be revived—in over half the country.
Let’s walk through what happened, what this ruling means, and what you can still do to protect your child.
What Tennessee’s Law Says
SB1 bars healthcare providers from prescribing puberty blockers or hormone therapy to any minor if the purpose is to affirm gender identity. The law doesn’t ban those same treatments for other diagnoses—just when it involves transgender youth.
That distinction is key. And it was central to the legal challenge filed by three transgender teens, their parents, and a physician. They argued that the law violated the Equal Protection Clause of the Fourteenth Amendment by targeting trans youth for unequal treatment and interfering with parents’ rights to make medical decisions for their children.
What the Supreme Court Decided
The majority opinion, written by Chief Justice John Roberts, upheld the law. The Court declined to apply heightened scrutiny—which is typically used when a law targets a protected class or fundamental right.
Instead, the Court used the lowest level of constitutional review: rational basis. Under that standard, the state only needs to show a legitimate purpose for the law—and the Court found that Tennessee met that threshold by pointing to “scientific uncertainty” and a desire to protect children from potential long-term harms.
In short, the Court deferred to the legislature. It framed this as a policy question that belongs in the hands of elected officials, not the judiciary.
By affirming rational basis as the standard of review for laws that restrict gender-affirming care, the Court has made it significantly harder to challenge similar laws in other states under federal constitutional grounds.
The Dissent
Justice Sonia Sotomayor dissented, joined by Justices Kagan and Jackson. She read her dissent from the bench—something the Court’s liberal justices do rarely and only when they want to underscore the gravity of a decision.
The dissent argued that SB1 clearly discriminates based on both sex and gender identity, and that it violates the constitutional rights of both minors and their parents.
Sotomayor emphasized that the law allows the same treatments for other uses (like early puberty or hormonal imbalances), but bans them when used for gender transition—which is exactly what makes it discriminatory.
She also strongly underscored the constitutional right of parents to make medical decisions for their children. That’s a central issue here—and one the majority opinion largely dismissed by granting the state broad deference.
What This Means Going Forward
This decision leaves Tennessee’s law in full effect. It also sends a clear message to other states with similar laws: go ahead. The Supreme Court won’t stand in the way.
More than 25 states have already passed or proposed bans on gender-affirming care for minors. Some had been blocked by lower courts. Many of those blocks will likely fall away in the wake of this ruling.
This also raises pressing legal questions the Court didn’t answer:
What happens to minors already receiving treatment?
Can parents travel out of state to access care, and will states try to stop them?
What happens in custody disputes between affirming and non-affirming parents?
Those questions aren’t theoretical—they’re going to be litigated, hard.
What This Means for Families
If you’re a parent of a transgender or nonbinary child, this ruling is more than just legal doctrine. It’s personal. It’s about being told that the care your child needs—the care you may already be providing—is now criminalized in your home state.
And let’s be honest: that’s terrifying. And exhausting.
But there are still tools that can help families take action and prepare for what comes next. For example:
Advanced healthcare directives for minors can ensure your child’s wishes around medical care are honored—especially for older teens approaching adulthood.
Planning for out-of-state care might become necessary if you live in a ban state. It’s worth understanding the legal logistics of that now, before it becomes urgent.
Affirming legal documents like updated ID, name changes, and gender marker corrections can offer critical protection and help minimize misgendering across systems.
Custody and co-parenting agreements may need to include specific language around gender-affirming care to avoid future legal challenges—especially in interstate cases.
In other words, this isn’t just about access to healthcare anymore—it’s about legal survival.
You Still Have Options. Let’s Talk About Them.
This decision is a massive setback. But it’s not the end.
If you’re not sure what to do next—if you’re scared, furious, overwhelmed, or just trying to stay ahead of the next crisis—I want you to know you’re not alone.
Whether it’s figuring out your legal options, updating your documents, or building a plan to protect your child, I can help walk you through what’s still possible.
You don’t have to wait until the law comes for your family.