Supreme Court Upholds Denial of Gender Affirming Care for Minors

In United States v Skrmetti, the Supreme Court upheld a Tennessee law that bans gender affirming care to minors.

The 6-3 decision was based on the lowest form of judicial scrutiny, rational basis. It held that the Tennessee law does not violate the 14th Amendment promise of equal protection, which is the second sentence in Section 1:

No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

Although the ruling has no effect in states where gender affirming care is legal, it establishes that states can prohibit such care. States can also pass laws to protect such care.

The doctor, parents and transgender teens who brought the case argued Tennessee’s law selectively denied medical care to transgender minors that is allowed for other minors, and that this discriminates based on sex and gender status. As an example, the state law allows gender affirming care for a minor with a medical condition that would otherwise have effect contrary to gender identity assigned at birth, such as treating a hormone imbalance that causes enlarged breasts on a boy. The same treatment is banned when the patient is transgender.

The ruling used a convoluted route to reach its conclusion that this is not discriminatory. It said the law does not discriminate because it “prohibits healthcare providers from administering puberty blockers or hormones to any minor to treat gender dysphoria, gender identity disorder, or gender incongruence, regardless of the minor’s sex.” The ruling said Tennessee does not exclude anyone from medical treatment based on transgender status, even though that is the overt purpose of the law. “Rather, it removes one set of diagnoses—gender dysphoria, gender identity disorder, and gender incongruence—from the range of treatable conditions.”

Justice Sonia Sotomayor wrote an extensive, detailed dissent of 31 pages. She summed it up eloquently:

By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent.

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