The Supreme Court announced on Monday that it will examine whether a Tennessee law banning gender-affirming health care for transgender minors is constitutional. This case could lead to a significant ruling on transgender rights in the next term.
Lower court decision under review
The justices agreed to review a lower court decision that upheld Tennessee’s ban, a decision challenged by the Justice Department and transgender youth. They argue that the law violates the 14th Amendment. The Supreme Court will hear arguments in its next term beginning in October, with a decision expected by June 2025. This case places the court at the heart of a contentious issue that has spurred numerous legislative actions by state lawmakers.
Nationwide impact
The outcome could affect more than 20 states that have enacted laws restricting treatments such as puberty blockers, hormone therapy, and surgeries for minors with gender dysphoria in recent years. The Supreme Court has not previously ruled directly on the constitutionality of these bans, although it has intervened in related cases on an emergency basis.
Previous rulings
In April, the court allowed Idaho to enforce a statewide ban on gender-affirming medical care for nearly all transgender minors while narrowing a lower court’s order that blocked the law from taking effect. This order did not apply to two transgender teenagers who challenged the restrictions.
In a separate case, the Supreme Court declined to allow West Virginia officials to enforce a law banning transgender athletes from female sports teams while legal proceedings continue.
The Tennessee law
The Tennessee law, SB1, enacted in March 2023, prohibits health care providers from administering puberty blockers or hormones to minors for the purpose of enabling them to identify with a gender different from their sex assigned at birth. Surgical procedures for this purpose are also banned, but this restriction is not at issue in the current case. Puberty blockers and hormones can still be administered for other medical conditions like precocious puberty, disease, or physical injuries.
Violators of the law face civil penalties of $25,000, professional discipline, and potential civil liability. The law took effect on July 1, 2023, but allowed treatments started before then to continue until March 31.
Challenging the ban
Three transgender minors diagnosed with gender dysphoria, along with a doctor treating transgender patients, challenged the ban, arguing it violates the Equal Protection Clause of the 14th Amendment. The Justice Department supported the challenge. A federal district court initially blocked the law, deeming it likely unconstitutional for specifically targeting transgender individuals and recognizing the established benefits of the banned medical procedures.
However, the U.S. Court of Appeals for the 6th Circuit reversed the injunction, upholding Tennessee’s law and a similar ban in Kentucky. Chief Judge Jeffrey Sutton emphasized the evolving nature of gender dysphoria diagnoses and treatments, arguing that judges should be cautious about imposing new substantive due process or equal protection rights in such complex matters.
The Justice Department and transgender teenagers appealed to the Supreme Court. Solicitor General Elizabeth Prelogar highlighted the legislative activity in nearly half the states banning gender-affirming care for transgender minors. She warned of severe consequences for families in states like Tennessee if the bans are upheld, potentially forcing them to relocate for necessary medical care.
The American Civil Liberties Union (ACLU), representing transgender adolescents and their families, pointed out that courts are divided over the constitutionality of such bans and the appropriate level of scrutiny for laws targeting transgender individuals.
Arguments for the ban
Tennessee’s lawyers argued that hormonal and surgical interventions for minors with gender dysphoria pose serious risks and that the ban is intended to protect children until they can fully understand the lifelong consequences or until science provides clearer evidence of the treatments’ efficacy. They asserted that decisions on medical regulations for minors should be made by elected representatives.
“Tennessee acted rationally, reasonably, and compassionately to protect its children, and the Act survives any level of review,” the state’s lawyers wrote. “Nothing in the Constitution deputizes petitioners to override the legislature’s judgment and demand a policy they believe to be more favorable.”
This landmark case will be closely watched as it addresses fundamental questions about medical care, constitutional rights, and the role of state regulation in the lives of transgender minors.
