The U.S. Supreme Court upheld a Tennessee law Wednesday that restricts gender-transition-related medical treatments for minors, marking one of the most significant rulings yet in the national debate over transgender healthcare access.

In a 6–3 decision, the Court determined that Tennessee’s Senate Bill 1 does not violate constitutional equal protection rights, keeping in place restrictions on gender-transition care for children and teens, the Christian Post reported.

The law, passed by the Tennessee General Assembly in March 2023, prohibits healthcare professionals from providing certain gender-related medical treatments to individuals under 18. Specifically, it bans surgeries altering the genitalia and the prescribing of hormones or puberty blockers when intended to treat gender dysphoria.

Tennessee Law Applies Equally to All Minors

Senate Bill 1 only limits the use of these treatments when they are associated with gender identity conditions. The law does permit puberty blockers and hormones when used for other medical conditions not related to gender transition.

Chief Justice John Roberts authored the majority opinion, joined by Justices Clarence Thomas, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett. Justice Samuel Alito concurred separately in the judgment.

Roberts argued that the law treats all minors the same regardless of sex. He wrote that no minor, male or female, may receive hormone therapy or puberty blockers for gender identity-related diagnoses under this law.

Majority Cites State's Interest in Child Welfare

The chief justice emphasized that Tennessee has a substantial interest in safeguarding the physical and emotional well-being of minors. He referred to the treatments as potentially dangerous, invoking concerns about regret and the permanence of such decisions made in adolescence.

Roberts cited international developments to support the ruling, noting the United Kingdom's decision to prohibit these same treatments for minors outside of approved clinical trials. He stated this ban illustrates the serious public health concerns at stake.

“This case touches on serious debates in science and policy,” Roberts wrote. “But the Constitution does not give this Court the role to settle those disputes. That belongs to the people and their elected officials.”

Dissenting Opinion Alleges Discrimination

Justice Sonia Sotomayor dissented, joined by Justice Ketanji Brown Jackson and partially by Justice Elena Kagan. Sotomayor argued the law unfairly targets youth based on both sex and transgender status.

She criticized the majority for applying a relatively weak legal standard to evaluate the law's constitutionality. In her view, more rigorous scrutiny should have been applied to a statute that affects a specific group’s access to medical care.

"The Court turns away from essential judicial review," Sotomayor wrote. "By doing so, it leaves transgender youth and their families at the mercy of shifting politics.”

Legal Challenge and Federal Involvement

The case, United States v. Skrmetti, began after several advocacy groups and families of transgender-identifying minors challenged the law with support from the U.S. Justice Department under the Biden administration. The plaintiffs argued that the law discriminated and would cause harm to transgender youth.

Although a district court initially blocked the legislation from taking effect, the 6th U.S. Circuit Court of Appeals reversed that decision in September 2023. Chief Judge Jeffrey Sutton, writing for the appellate panel, supported the state’s reasoning in defending the law.

The Supreme Court agreed to hear the case and held oral arguments in December 2023. At the time, U.S. Solicitor General Elizabeth Prelogar contended the law was discriminatory but conceded that states hold some right to regulate treatments in this area.

Shift in Federal Position Influenced Outcome

In February 2025, the Trump administration withdrew federal support for the lawsuit. That change in stance followed the administration's broader approach to limiting federal influence on state-level decisions on medical and educational policies.

Senate Bill 1 itself declares that the state sought to shield the medical profession from performing what it described as experimental and potentially unethical procedures. The legislation frames its aims as protecting integrity and preventing psychological and physical harm to youth.

This week’s ruling marks the highest court's first significant interpretation of a state-level restriction on gender-transition care for minors, likely influencing similar laws around the country.