Supreme Court Upholds Tennessee Law Banning Care for Trans Kids

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On Wednesday, the Supreme Court voted 6-3 to uphold a Tennessee law banning gender-affirming care for minors. The ruling in U.S. v. Skrmetti dictates that state laws prohibiting gender-affirming hormone therapies and puberty-pausing medications for transgender youth are constitutional. Notably, the Tennessee law doesn't allow best-practice transition-related medical care for children under the age of 18, while permitting minors who are not transgener to access treatments like hormone therapies and puberty blockers.
Three Tennessee trans youths and their families challenged the state's law, which passed in 2023, arguing that it violates the Equal Protection Clause under the 14th Amendment. 'Rather than leave the state of Tennessee, these young people, their families, [and] healthcare providers tried to challenge that contradiction in best practices and frankly, the totally confusing discrimination on the basis of their sex assigned at birth,' says Kara Ingelhart, clinical assistant professor of law and director of the LGBTQI+ Rights Clinic at Northwestern University. This is the first time the Supreme Court has directly ruled on how the Equal Protection Clause applies to gender-affirming care for minors, according to UCLA's Williams Institute.
'The Equal Protection Clause is designed to protect historically marginalized groups, like trans folks, people of color, women — those who don't have the political power to move legislators in their favor all the time,' Ingelhart explains. 'When we leave questions of minority rights to majoritarian rule, there can be people left behind.'
The Tennessee law, SB1, stipulates that gender-affirming care cannot be used to treat youth with gender dysphoria, prohibiting medical practitioners from providing hormones, puberty blockers, or surgery for the purposes of 'enabling the minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or treating purported discomfort or distress from a discordance between the minor's sex and asserted identity.'
'This is an incredibly painful day for transgender young people and their families who love and support them,' Andy Marra, executive director of Advocates for Trans Equality tells Rolling Stone in an emailed statement. 'The U.S. Supreme Court has failed in its most basic duty — to protect the rights and freedoms of vulnerable people from political overreach. By allowing this cruel and unnecessary ban to stand, the Court has abandoned Tennessee's minors and families in favor of extremist politicians.'
The decision has the potential to impact similar state laws across the country. Currently, Tennessee is one of 25 states with total bans on gender-affirming care for those under 18 — all of which have been enacted since 2018. Tennessee is home to more than 3,000 transgender youth and approximately 28,000 transgender adults, according to estimates from the Williams Institute.
According to Ingelhart, the Skrmetti ruling makes it so that states like Tennessee, that have discriminated against children on the basis of gender identity, can continue having healthcare bans. 'That doesn't mean that there won't continue to be fights in those states, because there are other questions at the lower court right now that other litigation that could succeed on, like the rights of parents — a constitutional right that this court didn't address,' she explains.
Other experts stress that the fight isn't over. 'This ruling is a setback, but it is not the end of the road,' says Heron Greenesmith, deputy director of policy at the Transgender Law Center (TLC). 'We remain steadfast in our belief that access to affirming care and the right to bodily autonomy are constitutional rights. This ruling underscores the urgent need for safe, evidence-based policies that prioritize the health, dignity, and autonomy of all people.'
The decision also impacts doctors who provide gender-affirming care to minors. 'Now, by federal law, it's possible to discriminate on the basis of sex, age, gender, identity, and sexual orientation in the delivery of health care,' says Morissa Ladinsky, MD, a pediatrician providing gender-affirming care and clinical professor at Stanford Medicine. 'It doesn't mean we have to — it just means we can. So my hope is that my colleagues around the nation take the high road.'
All major medical associations, including the American Academy of Pediatrics, American Medical Association, and World Health Organization, have issued statements in support of healthcare for transender youth.
For those who live in states where gender-affirming care for minors is banned, their only opportunity to access the treatments they need is to travel to a state where they're legal. 'It's already a state of crisis in America with regard to health care and socioeconomic status, but it will become a question of whether your family can travel for you to get the affirming care, and whether the state that you live in may want to threaten you for doing so,' Ingelhart says. 'This is life or death for people, [and] whether or not they can be affirmed and get the care they need can mean the difference between risk of suicidality and not. And none of this was ever being considered outside the careful administration and oversight of healthcare providers and parents' consent.'
Chase Strangio, a lawyer for the American Civil Liberties Union representing the plaintiffs in U.S. v. Skrmetti — and first openly transgender individual to present oral arguments before the Supreme Court — released a statement on Instagram indicating that 'there will be more to say soon,' noting that 'the Court got it wrong, but they left many open avenues — both doctrinal and extra-legal — for us to fight.'
Other advocates, like Ben Greene, also worry that the Skrmetti decision will affect trans youth across the country. 'More than anything, the ruling attempts to send a hateful message to transgender young people and their families that says 'We don't see you. We don't protect you,'' says Greene, the author of the book My Child Is Trans, Now What?: A Joy-Centered Approach to Support.
Not only do laws like the one in Tennessee limit a person's bodily autonomy, they're also a major blow to their mental health. A 2024 Trevor Project study found that between 2018 and 2022 — during which time 48 anti-transgender laws were enacted in 19 different states — suicide attempts among transgender and nonbinary youth increased by as much as 72 percent.
In a recent report from Human Rights Watch on bans on gender-affirming care in the U.S., Kai, a 14-year-old trans boy in a state with a ban in effect, explains that he has experienced suicidal ideation almost all of his life as a result of gender dysphoria, and more recently, the anti-trans laws that are being enacted across the country. 'I don't even recognize the person I see in the mirror,' he told Human Rights Watch in the report. 'Why should I even live this life that isn't mine? And with the ramping up of anti-trans legislation… I felt more suicidal.'
The rights of trans youths have been under attack since Donald Trump took office, starting with his Jan. 28 executive order outlining his plans to eliminate gender-affirming medical treatments for transgender children. The Department of Health and Human Services followed that up in May with a 400-page report recommending that gender dysphoria be treated with 'exploratory therapy,' which experts say is simply a rebranding of conversion therapy.
'Since Trump was inaugurated, I've noticed more people being negative toward me,' Jenny, a 17-year-old trans girl in a state where gender-affirming care is banned, told Human Rights Watch in a recent report. 'People are more bold now. I've faced more harassment from my peers.'
Even with state bans on gender-affirming care for trans youths, Jenny said that under the Biden administration, she at least felt some protection from the federal government. 'Now it feels like every level of government is turning against us,' she says. 'It's hard to feel safe in your own country, in your own community and that's terrifying.'
In a 2023 declaration asking a federal judge to put the ban on hold, Ryan Roe, a 17-year-old trans boy and one of the plaintiffs in Skrmetti, said that gender-affirming care saved his life, and if he were to lose access to it, his mental health would suffer. 'Since the bill passed, my family and I have had a lot of hard conversations,' he wrote. 'We have to talk about regularly traveling out of state to get me care, or even moving away from our home. I feel terrible when I think about what that would mean, not just for me, but for my parents, too. I feel like in a sense I am losing my childhood because I have to spend so much time worrying and planning.'
But as discouraging as the decision may be, Ingelhart says that it isn't a doomsday scenario. 'It's important to know that trans folks aren't fighting this alone — that advocates across civil rights movements are there to support them,' she says.
Greene echoes this sentiment. 'This small handful of judges do not speak for the American people, and I hope that transgender young people, their families, their doctors, and those that love them know that they have hundreds of thousands, if not millions of people who are prepared to stand with them, protect them, and fight for them at every turn,' he says.
In fact, organizations like the ACLU, TLC, and Lamba Legal are 'planning actions across the country today and this weekend to stand in defiance of the ruling and in solidarity with one another,' Greenesmith says.
While the decision isn't what Dylan Thomas Cotter hoped for, he's not giving up. 'To be a transgender American at this point in history is to be a fighter,' says Cotter, a publicist, author, and transgender rights activist. 'We, as proud transgender Americans, know this will take time and are in it for the long haul. It's important to hold on to the fact that tomorrow is a new day and there are many transgender people and allies that remain on the frontlines of fighting the good fight for all.
June 18, 3:25 p.m.: This story has been updated to include comment from Heron Greenesmith of the Transgender Law Center.
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