Labor & Employment Law Daily Wrap Up, INDIVIDUAL RIGHTS—U.S.: Court upholds Tennessee law prohibiting youth gender-affirming care, (Jun 20, 2025)

By Sheila Lynch-Afryl, J.D., M.A.

The Court, applying rational-basis review, found no equal protection violation.

The U.S. Supreme Court ruled 6 to 3 that Tennessee’s law prohibiting gender-affirming medical care for minors does not violate equal protection. The Court rejected minors’ argument that the statute classifies based on sex, which would have required heightened scrutiny, and found that it classifies based on age and medical use, requiring only rational-basis review. Justices Sotomayor, Kagan, and Jackson dissented, arguing that the majority “abandons transgender children and their families to political whims” by “retreating from meaningful judicial review exactly where it matters most.” (United States v. Skrmetti, No. 23-477 (U.S. Jun. 18, 2025)).

Under Tennessee law, a health care provider is prohibited from prescribing, administering, or dispensing a puberty blocker or hormone if it is for the purpose of: (1) enabling a minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or (2) treating purported discomfort or distress from a discordance between the minor's sex and asserted identity. The Sixth Circuit, reversing the district court, applied rational-basis review to conclude that the law does not violate the Equal Protection Clause.

The minors who challenged the law argued that the law classifies based on sex, which would merit intermediate scrutiny under the Fourteenth Amendment, because it frames its prohibition in “explicit sex-based terms” and the application of the law turns on sex. The Supreme Court found, however, that the statute does not classify based on sex, noting that some “medical treatments and procedures are uniquely bound up in sex.” Nor does the application of the law turn on sex because it prohibits certain treatments for minors of one sex while allowing those same treatments for minors of the opposite sex: “Under SB1, no minor may be administered puberty blockers or hormones to treat gender dysphoria, gender identity disorder, or gender incongruence; minors of any sex may be administered puberty blockers or hormones for other purposes.” Instead, the majority concluded, the law makes only two classifications: based on age, prohibiting the administration of puberty blockers or hormones to minors; and on medical use, prohibiting treatment of gender dysphoria, gender identity disorder, or gender incongruence.

The Court also rejected the argument that the law requires heightened scrutiny because it discriminates based on transgender status, which the minors called a quasi-suspect class. The Court “has not previously held that transgender individuals are a suspect or quasi-suspect class.” Further, it found, the law does not classify based on transgender status but instead classifies based on age and medical use. Heightened scrutiny of a law regulating a medical procedure that only one sex can undergo is appropriate only when it is a “mere pretext for invidious sex discrimination.” The law, said the Court, divides minors into two groups: those who might seek puberty blockers or hormones to treat the excluded diagnoses, and those who might seek puberty blockers or hormones to treat other conditions. While only transgender individuals fall into the first category, it found a “lack of identity” between transgender status and the excluded medical diagnoses.

Having found no reason to apply heightened scrutiny, the Court concluded that the law’s “age- and diagnosis-based classifications are plainly rationally related” to the state’s “objective of protecting minors’ health and welfare.”

Finally, though the Supreme Court recognized in Bostock v. Clayton County, 590 U.S. 644 (2020), that discrimination based on gender identity constitutes discrimination on the basis of sex, it declined to consider whether this reasoning should apply beyond the Title VII context.

Justice Thomas wrote a concurring opinion to expand on “problems with appealing and deferring to the authority of the expert class” and clarify that “in constitutional challenges, courts need not engage Bostock at all.” Justices Barrett, joined by Justice Thomas, wrote separately to explain why transgender status does not constitute a suspect class. Justice Alito concurred in the judgment and part of the majority opinion but wrote separately to express that there is a “strong argument” that the law classifies based on transgender status but that such a classification does not merit heightened scrutiny.

Justices Sotomayor, Kagan, and Jackson dissented, arguing that intermediate scrutiny is required because the law “expressly classifies on the basis of sex and transgender status.”

The case is No. 23-477.

Judge: Roberts, C.J.

Attorneys: D. John Sauer, U.S. Department of Justice, for U.S. James Matthew Rice, Office of Tennessee Attorney General, for Jonathan Thomas Skrmetti.

Cases: IndividualRights Discrimination SexDiscrimination SupremeCourtNews