SCOTUS Upholds Tennessee Ban on Gender-Affirming Care for Minors: What Families Need to Know
Overview of the Skrmetti Ruling and SB1
On June 18, 2025, the U.S. Supreme Court issued a 6–3 decision in U.S. v. Skrmetti, upholding Tennessee Senate Bill 1 (SB1) — a law banning all gender-affirming medical care for minors, including puberty blockers and hormone therapy. These treatments, supported by major medical organizations, are often critical for the mental and physical well-being of transgender youth.
The decision not only leaves Tennessee's ban in place but also opens the door for similar laws to stand in over 25 other states, particularly those where such laws were previously halted by lower courts.
What SB1 Says and Why It Matters
Tennessee’s SB1 prohibits providers from prescribing gender-affirming care to minors if the goal is to affirm gender identity. Notably, the same treatments remain legal for other uses — like treating early puberty. This creates a targeted restriction that only impacts trans and nonbinary youth.
Families and physicians challenged the law, citing violations of the Fourteenth Amendment's Equal Protection Clause and parental rights to make medical decisions for their children.
The Court’s Decision and Its Legal Implications
Chief Justice Roberts wrote the majority opinion, applying rational basis review, the lowest level of constitutional scrutiny. The Court found that Tennessee had a "legitimate interest" in restricting these treatments based on alleged "scientific uncertainty" and a desire to protect children from potential long-term risks.
This means:
Courts do not need to apply heightened scrutiny to laws that limit gender-affirming care.
State legislatures now have broad leeway to regulate or ban these treatments.
Challenging these laws under the federal constitution just became much harder.
Justice Sotomayor's Dissent
Justice Sonia Sotomayor, joined by Justices Kagan and Jackson, issued a forceful dissent. She argued the law is discriminatory because it bans specific treatments only when used for gender transition. Her dissent also emphasized the right of parents to make medical decisions, and she criticized the majority for sidestepping both equal protection and parental rights.
Her choice to read the dissent from the bench highlights the perceived gravity of the ruling.
What This Means for Transgender Families Nationwide
This ruling has immediate consequences:
Tennessee’s ban is now fully in effect.
Other states with similar laws are likely to proceed with enforcement.
Legal challenges to these laws are now significantly less likely to succeed in federal court.
Unanswered Legal Questions:
What happens to youth already receiving care?
Can parents cross state lines to seek care, and will states attempt to block that?
How will courts handle custody battles involving affirming and non-affirming parents?
These issues are not hypothetical. They are already being litigated and will continue to evolve in the months ahead.
Legal Tools Families Can Use Now
Even in states with bans, there are proactive steps families can take:
Advance healthcare directives for older teens to express their care preferences.
Custody agreements that include affirming care protections, particularly in co-parenting or interstate situations.
Planning for out-of-state care, including travel logistics and legal authority to consent.
Correcting legal documents (e.g., names, gender markers, IDs) to ensure consistency across systems.
How Our Firm Supports Transgender Youth and Their Families
At Zachary W. Anderson Law, we help families navigate the evolving legal landscape around LGBTQ+ rights in Nebraska and beyond. Our services include:
Transgender name and gender marker changes
Parental and guardianship rights in affirming care
Strategic planning for interstate medical access
This ruling is a setback. But it’s not the end of the conversation, and you are not without options.
If you’re unsure how this decision might impact your family—or if you’re simply trying to stay ahead—we invite you to schedule a consultation. You do not have to wait until the law impacts your child to take protective steps.
Contact us here to get started or call 402-259-0059.
FAQ: Gender-Affirming Care and Legal Rights After U.S. v. Skrmetti
Q: Is gender-affirming care for minors now banned nationwide?
A: No. The ruling upheld Tennessee’s ban but does not create a nationwide prohibition. However, many states are likely to enforce or pass similar laws.
Q: Can I take my child to another state to receive care?
A: In many cases, yes—but legal risks may arise depending on your home state’s laws. It's wise to get legal guidance before doing so.
Q: What happens if my child is already receiving hormone therapy or puberty blockers?
A: Some laws have "grandfather" clauses; others do not. Your provider may need to stop care immediately depending on local enforcement. We recommend legal consultation immediately.
Q: Can I include affirming care protections in my custody agreement?
A: Yes, and doing so may prevent future disputes. This is especially important in cases involving co-parents with differing views on gender-affirming care.
Q: What legal documents can help protect my child’s identity and autonomy?
A: Name changes, gender marker updates, advance directives for minors, and guardianship documents can help create consistency and protection.