The United States is at a critical juncture in the fight for LGBTQ+ equality, as it confronts the balance between individual rights, state authority, and societal norms. On December 4, 2024, the U.S. Supreme Court weighed the future of transgender healthcare in United States v. Skrmetti—a case challenging Tennessee’s 2023 law banning gender-affirming medical care for minors. This decision, expected June 2025, has the potential to significantly influence the legal landscape of transgender rights across the United States, raising questions about equal protection, parental rights, and state regulation of healthcare. Signed by Governor Bill Lee, the law prohibits gender-affirming medical care for individuals under 18. While its supporters claim it protects minors, critics argue it violates constitutional protections against sex-based discrimination.
The Law: Key Provisions and Effects
Tennessee Code Annotated § 68-33-103 bans healthcare providers from administering puberty blockers or hormone treatments if the purpose is to: (1) enable a minor to identify with a gender inconsistent with their sex assigned at birth and (2) treat discomfort stemming from a discordance between their sex and gender identity (T.C.A. § 68-33-103(a)(1)).
The law bans gender-affirming care after March 31, 2024, unless the care started before July 1, 2023 (T.C.A. § 68-33-103(b)(1)(B)). It excludes gender dysphoria from exceptions, defining it outside “medical disease” (T.C.A. § 68-33-103(b)(2)).
Legal Challenges: Equal Protection and Beyond
The case centers on whether the law violates the Equal Protection Clause of the Fourteenth Amendment by targeting transgender minors. The Equal Protection Clause requires that states do not enact laws that treat individuals unequally without sufficient justification. In this case, the plaintiffs argue the law unfairly targets transgender minors by denying them access to medical treatments that are otherwise available to cisgender minors.
Tennessee defends the law by claiming it is neutral, applying uniformly to all minors irrespective of sex or gender identity. According to the state, the law aims to protect children from medical treatments deemed experimental and potentially irreversible. Tennessee insists that prohibiting gender-affirming care is a public health measure, not a discriminatory action. However, the plaintiffs argue that the law creates an unequal burden by specifically banning treatments for gender transition while allowing the same treatments for other purposes. For example, a cisgender boy may receive testosterone to address a medical condition such as delayed puberty, but a transgender boy is prohibited from accessing the same treatment to affirm his gender identity. This distinction, the plaintiffs contend, amounts to sex-based discrimination because it is rooted in whether the treatment aligns with the individual’s sex assigned at birth.
Before appeal to the U.S. Supreme Court in L.W. v. Skrmetti, 83 F.4th 460 (6th Cir. 2023), the Sixth Circuit Court upheld Tennessee’s law under the most lenient standard of review–rational basis–stating that Tennessee had a legitimate interest in regulating these treatments for minors. The court concluded that transgender individuals are not a “suspect class”–a classification warranting heightened judicial scrutiny. Plaintiffs, however, maintain that the law’s selective prohibition on treatments targeting transgender minors inherently discriminates based on sex, requiring the Court to apply intermediate scrutiny, if not strict scrutiny, under established equal protection precedents.
Looking Ahead: Broader Implications
The outcome of this case will not only determine the validity of Tennessee’s law but also set a broader precedent for how courts interpret equal protection in cases involving transgender individuals. Furthermore, the case will set a powerful precedent impacting related state laws, including bans on transgender athletes’ participation in sports and restrictions on facility access. A Supreme Court ruling upholding Tennessee’s law might embolden other states to pass similar measures, while a decision striking it down could invalidate existing bans and affirm protections for transgender rights nationwide.
Additionally, the case touches on the scope of parental autonomy. By restricting parents from pursuing certain medical treatments for their children, the law creates a tension between state authority and parental rights. This dynamic may influence broader debates on medical decision-making and child welfare. Organizations like the ACLU of Tennessee and the Tennessee Equality Project continue to provide resources and advocacy for affected families, while legal scholars anticipate the ripple effects on gender equality jurisprudence.