In United States v. Skrmetti, the Supreme Court upheld which state's ban on gender-affirming medical care for minors?

In a significant ruling on June 18, 2025, the U.S. Supreme Court upheld Tennessee's ban on gender-affirming medical care for minors in the case of United States v. Skrmetti. This decision affirmed a state law, Senate Bill 1 (SB1), which prohibits healthcare providers from prescribing puberty blockers, hormone therapy, or performing surgeries for the purpose of gender transition in individuals under 18. The Court's 6-3 majority opinion determined that the Tennessee law classifies based on age and medical use, rather than sex, meaning it did not warrant heightened scrutiny under the Fourteenth Amendment's Equal Protection Clause. Instead, the law was evaluated under a "rational basis" review, the lowest level of judicial scrutiny, and found to be constitutional.

The case originated in March 2023 when Tennessee Governor Bill Lee signed SB1 into law, leading to a challenge by transgender youth, their parents, and a physician who argued the ban was unconstitutional. A federal district court initially blocked the law, but the U.S. Court of Appeals for the Sixth Circuit later reversed that decision, allowing the ban to take effect. The Supreme Court's ruling in Skrmetti marked the first time the high court directly addressed the constitutionality of state-level bans on gender-affirming care for minors, a politically charged debate with broad implications for transgender youth across the nation.

This landmark decision has far-reaching consequences, as it effectively allows similar bans in other states to remain in force. While the ruling specifically focused on the Equal Protection Clause and the standard of review, it leaves open other constitutional questions regarding protections for transgender individuals. Critics of the decision, including dissenting justices, argue that such bans ignore well-established medical best practices and endanger the lives of transgender young people by denying them access to necessary healthcare.