The U.S. Supreme Court ruled 6–3 on June 18, 2025, to uphold a Tennessee law banning gender-affirming medical treatments for minors. In a decision that turned on what “standard of review” applied rather than direct engagement with the rights of transgender individuals, the Court concluded that the law does not violate the Equal Protection Clause of the Fourteenth Amendment.
The law, known as Senate Bill 1 (SB1), prohibits the use of puberty blockers and hormone therapy for minors when used to treat gender dysphoria, gender identity disorder, or gender incongruence. It allows the same medications to be used for other conditions, such as precocious puberty or hormone disorders.
Three transgender minors, their parents, and a physician challenged the law, arguing that it discriminates based on sex and transgender status. Under traditional equal protection analysis, laws that classify based on sex—or target a group historically subject to discrimination—are reviewed with heightened scrutiny, meaning courts demand a stronger justification from the government. But the Court declined to use that higher standard here.
Writing for the majority, Chief Justice John Roberts said the law was neutral on its face. It applies to all minors, he wrote, and limits only the use of certain treatments for particular medical diagnoses. Roberts reasoned that because the law does not differentiate based on sex or transgender status—but instead on the purpose of the treatment—it should be evaluated under “rational basis review,” the most deferential level of constitutional scrutiny. Under that test, a law is upheld as long as there is any reasonable justification for it.
This legal framing allowed the Court to validate the law without weighing in on the central, contested question of whether transgender minors have a right to receive gender-affirming medical care. Instead, the majority accepted Tennessee’s justification that the treatments involve medical uncertainty, long-term risks, and potential for regret. The Court pointed to recent policy changes in several European countries that have reevaluated such care, including the U.K.’s decision to limit access to puberty blockers.
Justice Clarence Thomas wrote separately to argue that equal protection law has gone too far in recognizing suspect classifications like sex, and that rational basis should be the default. Justices Amy Coney Barrett and Samuel Alito also filed concurring opinions, emphasizing judicial restraint and the legislature’s role in making medical policy.
In dissent, Justice Sonia Sotomayor, joined in full by Justice Ketanji Brown Jackson and in part by Justice Elena Kagan, accused the majority of turning a blind eye to how the law operates in reality. She argued that the statute clearly targets transgender minors, because it only bans treatment when a child’s gender identity doesn’t align with their assigned sex. She compared it to a law banning people from attending religious services that don’t match their birth religion—nominally neutral but functionally discriminatory.
The underlying legal doctrine in this case—“standards of review”—rarely draws public attention. But by classifying SB1 as a law about medical purpose rather than identity, the Court used a legal workaround: it sidestepped any ruling on the rights of transgender individuals and instead upheld the law based on how it was framed.
So instead of addressing whether minors have a constitutional right to gender-affirming care, the Court simply asked whether Tennessee had any plausible reason for restricting certain treatments. That posture on this issue may encourage other states to draft similarly narrow laws without triggering more demanding constitutional review.
Also, of note, the Biden administration had initially joined the case, arguing the law was unconstitutional. But after the 2024 election, the Trump administration reversed that position. In a letter to the Court, the Justice Department said it no longer believed the law violated equal protection, though it remained a party to the case. The Court acknowledged the letter but it is unlikely that this changed the Court’s decision.
The ruling leaves SB1 in effect and is likely to bolster similar laws passed in more than 20 states. Further challenges could emerge under other constitutional provisions or with different factual records, but the Court’s decision signals that it will not apply heightened scrutiny to laws that regulate medical treatment for gender dysphoria—as long as those laws avoid explicit classifications.