June 18, 2025 — In a divisive decision, the U.S. Supreme Court ruled 6-3 in United States v. Skrmetti to uphold a Tennessee law banning gender-affirming care for transgender youth, delivering what advocates have called a major blow to civil rights, public health, and medical freedom.
The ruling affirms the Sixth Circuit’s decision allowing Senate Bill 1 to take effect, a law that prohibits doctors from prescribing puberty blockers, hormone therapy, or performing surgeries on minors if done to treat gender dysphoria. The Court concluded that the law does not violate the Equal Protection Clause of the Fourteenth Amendment.
In the majority opinion written by Chief Justice John Roberts, the Court determined that the law’s classifications are based not on sex or gender identity but rather on age and the type of medical diagnosis involved.
The decision subjects the law to rational basis review—the most deferential standard of judicial scrutiny—and finds the statute constitutionally sound under that lens. Roberts wrote that the state legislature has wide discretion in regulating medical treatments and cited ongoing debate in the medical community regarding the long-term impacts of puberty blockers and hormone therapies on minors.
The majority opinion asserted that because the law applies to all minors regardless of their sex and permits these treatments for other conditions such as precocious puberty or congenital defects, it does not discriminate on the basis of sex or transgender status.
“The Equal Protection Clause does not resolve these disagreements,” Roberts wrote, “Nor does it afford us license to decide them as we see best. Our role is not to judge the wisdom, fairness, or logic of the law before us, but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment.”
In a searing dissent, Justice Sonia Sotomayor, joined by Justices Elena Kagan and Ketanji Brown Jackson, condemned the ruling as an abandonment of transgender youth in the face of political hostility.
“In sadness, I dissent,” Sotomayor declared from the bench, an act rarely taken that underscored the depth of her disapproval.
Her opinion argued that Tennessee’s law constitutes explicit discrimination based on sex and transgender status, noting that the same medical treatments banned for trans youth are allowed for cisgender minors with other diagnoses.
Sotomayor wrote that the law penalizes transgender youth for not conforming to sex-based stereotypes and conditions their access to care on their assigned sex at birth. She rejected the majority’s framing that the law merely distinguishes based on age and medical use, contending that the true effect and purpose of the law is to deny medically necessary care to a marginalized group.
“This Court fails the families who relied on its protection. It fails the medical providers who are risking their livelihoods to uphold their oath. And it fails our constitutional tradition of protecting the vulnerable against the will of the majority,” she wrote.
Justice Kagan, in a separate dissent, criticized the Court for failing to apply intermediate scrutiny, the level of review historically used for laws that classify on the basis of sex.
“I take no view on how SB1 would fare under heightened scrutiny,” she wrote, “but the Court is wrong in not subjecting it to that kind of examination. That error requires reversal.”
The decision has immediate and far-reaching consequences. More than 25 states have passed similar bans since 2021, and over 100,000 transgender minors now live in jurisdictions where access to gender-affirming medical care is restricted or prohibited. The ruling gives legal cover to those bans and could embolden efforts to restrict trans health care even further.
The majority’s opinion places significant weight on recent developments in Europe, such as the Cass Review in the United Kingdom and restrictions in Sweden, Finland and Norway, which have called for tighter controls on gender-affirming treatment for minors.
Justice Clarence Thomas, in a concurring opinion, dismissed the notion of a medical consensus on these treatments, warning against judicial reliance on what he called “self-described experts in politically contentious debates.”
The case originated from a lawsuit brought by three transgender teenagers, their parents, and a Memphis-based physician, Dr. Susan Lacy, all of whom argued that the law violated the Equal Protection Clause by denying essential health care to transgender adolescents.
The U.S. Department of Justice initially joined the plaintiffs in challenging the law during the Biden administration, arguing that SB1 amounted to unlawful discrimination.
But following President Donald Trump’s return to office, the federal government reversed its position, aligning with Tennessee and asserting that the law does not violate the Constitution.
In response to the ruling, California Attorney General Rob Bonta issued a statement reaffirming California’s unwavering support for trans youth and their families.
“All Americans, regardless of their gender identity, have the inalienable right to equal protection under the law. This includes the right to access healthcare free from discrimination,” Bonta said. “Across the nation, we’ve seen a rise in hate-fueled violence and intimidation against our LGBTQ+ community, and laws such as Tennessee’s Senate Bill 1 only serve to exacerbate these conditions by blatantly discriminating against transgender youth and denying them access to critical life-saving care. In California, we will continue to promote and protect access to healthcare, not restrict it.”
California State Senator Scott Wiener, author of the state’s landmark “trans refuge” law and sponsor of additional protections under Senate Bill 497, called the ruling “horrifying” and accused the Court of giving extremists a “permission slip” to erase trans people from public life.
“Major medical associations have been crystal clear that this care is appropriate and medically necessary,” Wiener said. “Only a tiny percentage of trans youth receive this care, and the kids who receive it overwhelmingly do so with the consent and support of their parents. Yet Trump and his cult have created a moral panic based on lies—and the Court has validated their campaign to criminalize parents and doctors.”
National civil rights groups responded to the decision with condemnation and renewed vows to fight back.
Chase Strangio, deputy director for transgender justice at the American Civil Liberties Union, called the ruling “a painful setback,” but emphasized that the Court’s opinion is limited to the specific legal theory under review and does not foreclose future challenges.
“Though this is a painful setback, it does not mean that transgender people and our allies are left with no options to defend our freedom, our health care, or our lives,” Strangio said. “We are as determined as ever to fight for the dignity and equality of every transgender person.”
Sasha Buchert, director of the Nonbinary and Transgender Rights Project at Lambda Legal, said the ruling will “reverberate for years” but vowed continued litigation.
“Make no mistake—gender-affirming care is often life-saving care, and all major medical associations have determined it to be safe, appropriate, and effective,” Buchert said. “We will continue to fight fiercely to protect transgender youth and their families.”
The implications for families are stark. The ACLU of Tennessee, a plaintiff in the case, warned that the decision creates a “class of people who politicians believe deserve healthcare, and a class of people who do not.” The law could force families to leave their home states in order to secure medical care for their children. Others may face prosecution or investigation under new laws that criminalize efforts to seek gender-affirming care across state lines.
Medical experts remain united in their opposition to bans like SB1. The American Medical Association, the American Academy of Pediatrics, and the American Psychiatric Association have all warned that denying gender-affirming care increases the risk of depression, self-harm, and suicide among trans youth. These organizations emphasize that such care is provided only after thorough evaluation and with parental consent, and that surgeries for minors are exceedingly rare.
Despite the overwhelming medical consensus, the Court’s decision underscores a broader trend: growing judicial deference to legislatures in matters of science, medicine, and civil rights—particularly when the groups affected lack political power.
The ruling also reflects a broader strategy by Republican-led states and the Trump administration to restrict transgender rights through executive orders, legislation, and now judicial validation.
In the wake of the decision, progressive states like California and New York have vowed to continue serving as sanctuaries for transgender youth and their families. Lawmakers in both states are advancing measures to protect patient data, shield healthcare providers from out-of-state legal action, and expand access to gender-affirming services.
Great ruling by SCOTUS. I can’t believe the three leftist judges who voted against it. Once again democrats are on the wrong side of another 80 – 20 issue.
How is a ruling where a lawyer overrules the medical community great?
It’s best stated here in Justice Roberts decision:
“Tennessee determined that minors lack the maturity to fully understand and appreciate the life-altering consequences of such procedures and that many individuals have expressed regret for medical procedures that were performed on or administered to them for such purposes when they were minors. At the same time, Tennessee noted evidence that discordance between sex and gender can be resolved by less invasive approaches that are likely to result in better outcomes for the minor. SB1’s age- and diagnosis-based classifications are plainly rationally related to these findings and the State’s objective of protecting minors’ health and welfare.”
As opposed to: Medical experts remain united in their opposition to bans like SB1. The American Medical Association, the American Academy of Pediatrics, and the American Psychiatric Association have all warned that denying gender-affirming care increases the risk of depression, self-harm, and suicide among trans youth. These organizations emphasize that such care is provided only after thorough evaluation and with parental consent, and that surgeries for minors are exceedingly rare.
“Major medical associations have been crystal clear that this care is appropriate and medically necessary,” Wiener said. “Only a tiny percentage of trans youth receive this care, and the kids who receive it overwhelmingly do so with the consent and support of their parents.”
You lost me at “Wiener said”.
You lost me when you quoted Roberts
“Only a tiny percentage of trans youth receive this care . . .”
Does that include kids who take hormone blockers?
And if trans kids “don’t” receive medically-transitioning interventions, what exactly does it mean to be “trans”?
I am surprised, however, at the medical organizations supporting this. Apparently, it’s being increasingly-rejected in Europe.
Maybe you should do some research
“Rates of Suicide Attempts Doubled After Gender-Reassignment Surgery: Study”
https://californiainsider.com/california-news/health/rates-of-suicide-attempts-doubled-after-gender-reassignment-surgery-5616167
Dangerous to cherry-pick. That study is at odds with most of the research – “A landmark study in JAMA Surgery analyzing ~20,000 U.S. trans adults found those who underwent gender-affirming surgery had 42% lower odds of psychological distress and 44% lower odds of suicidal ideation compared to those still waiting for surgery”
https://pmc.ncbi.nlm.nih.gov/articles/PMC10027312
“You lost me when you quoted Roberts”
At least Roberts can define what a woman is.
He’s not a doctor and probably far less informed on this issue than Senator Wiener. Moreover, you completely ignored my first paragraph which paraphrased from the medical community (and you would have read since it was posted prior to the Wiener quote)
I hope democrats keep pushing this narrative so the other side can keep winning elections.
You act as though opinions are set in stone (and should guide issues that are medical and technical in nature)
“Maybe you should do some research.”
Seems to me that the articles/comments are sometimes referring (only) to surgery, while at other times it’s referring to gender-affirming “care” (which would include hormone blockers).
So my question is, what percentage of trans kids are receiving “gender-affirming care” which would include hormone blockers.
My other question is, what does it mean to be “trans”, if one is not pursuing medical interventions to change one’s sex. And ultimately, does it make any logical sense to have a “gender” that’s different than one’s “sex”, especially since a significant number of trans kids DO pursue medical interventions in an attempt to change their sex.
How is sex different than gender, when we’re talking about medical transitions to try to change one’s sex?
To answer one question: To be transgender means that one’s gender identity i.e., their internal sense of being male, female, both, neither, or somewhere along the gender spectrum, does not align with the sex they were assigned at birth. Medical intervention is not required to be transgender. In fact, many trans people do not undergo hormones or surgery. Again, it seems like you should be doing further reading to gain a better understanding of the issues involved as well as the medical evidence.
I’m trying to uncover the logic of this, which I’ve never found in any of the “research”.
What is an “internal sense”, and why would it be different than reality? (Isn’t that more of a sign of something wrong with “internal sense”?)
And if gender is separate from sex, then why do some (most) kids “identify” with their actual sex? What is the biological basis for any of this?
And wouldn’t “gender-affirming care” include “reaffirming care” for those who do identify with their actual sex?
In other words, what’s “wrong” here – the body, or the “mysterious belief” that no one seems able to define?
As Matt Walsh pointed out, it’s circular logic to state that a woman, for example, is someone who identifies as a woman. That’s not a definition.
So if someone claims that they’re a woman (or man) when their bodies don’t align with their beliefs, shouldn’t they at least be able to define what these definitions mean? Whose to say that these people aren’t just mentally ill – and pursuing medical interventions based upon mental illness?
You should start by exploring gender dysphoria and then go to the medical writings.
For an overview, start with this:
https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria
https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Gender-Dysphoria.pdf
https://wpath.org/publications/soc8/soc8-history/
I can already see (and already knew) that these organizations use the same circular logic that I just referred to. Essentially advocating for life-altering medical interventions based upon a “feeling” that they can’t even define.
Psychiatry itself is probably the least-scientific medical field in existence. Psychiatrists routinely prescribe questionable drugs for other conditions, as well. (I suspect that RFK Jr., might have something to say about that – and he might be right.)
It wasn’t so long ago that psychiatry viewed homosexuality as a mental illness. (Not sure if they advocated for permanent, life-altering, medical interventions for that.)
DG: “How is a ruling where a lawyer overrules the medical community great?”
DG: “Wiener said.”
But you’re Ok arguing for a politician overruling a lawyer?
Both you and Keith skipped over the other paragraph where I cited the medical community
August 10, 2022 American Academy of Pediatrics: “There is strong consensus among the most prominent medical organizations worldwide that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate. It can even be lifesaving. The decision of whether and when to start gender-affirming treatment, which does not necessarily lead to hormone therapy or surgery, is personal and involves careful consideration by each patient and their family…
Critics of our gender-affirming care policy mischaracterize it as pushing medical or surgical treatments on youth; in fact, the policy calls for the opposite: a holistic, collaborative, compassionate approach to care with no end goal or agenda… Yet outside of our organization, there is a dangerous movement taking place, led by extremists, targeting youth who are receiving gender-affirming care, and vilifying the pediatricians providing their care. The result has been rampant disinformation about what this care is and real threats of violence against some of our members.
In some states, efforts are underway to restrict access to gender-affirming care and criminalize the pediatricians who provide it. This has already had a chilling effect on access to care in these communities, and other efforts across the country are focused on doing the same. The people who suffer the most from this discrimination are of course the children and teens just trying to live their lives as their true selves. Pediatricians will not stay silent as these lies are waged against our patients and our peers.” – Moira Szilagyi, MD, PhD, FAAP, 2022 president of the American Academy of Pediatrics.
February 23, 2022 – The Endocrine Society
“The treatment of transgender and gender diverse youth should be governed by the best available medical evidence, not politics,’ said Joshua D. Safer, M.D., F.A.C.P., F.A.C.E., co-author of the Society’s Clinical Practice Guideline and position statement on transgender medicine. ‘When caring for transgender and gender diverse youth, physicians and mental health professionals must be able to freely practice and choose the best available treatment options in consultation with the patients and their parents, as they would when treating any other condition.” (April 14, 2021)
February 25, 2022 – The Journal of the American Medical Association published new research on gender-affirming care for trans and nonbinary youth ages 13-20, finding that “including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up.”
American Psychiatric Association: Our organizations, which represent nearly 600,000 physicians and medical students, oppose any laws and regulations that discriminate against transgender and gender-diverse individuals or interfere in the confidential relationship between a patient and their physician. That confidentiality is critical to allow patients to trust physicians to properly counsel, diagnose and treat. Our organizations are strongly opposed to any legislation or regulation that would interfere with the provision of evidence-based patient care for any patient, affirming our commitment to patient safety. We recognize health as a basic human right for every person, regardless of gender identity or sexual orientation.” (Joint statement with the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Obstetricians and Gynecologists, American Osteopathic Association; April 2, 2021)
American Academy of Pediatrics: “The American Academy of Pediatrics recommends that youth who identify as transgender have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space..” (March 16, 2021)
Pediatric Endocrine Society: “Treatment for prepubertal transgender and gender diverse children never includes medical or surgical interventions however it is helpful for them to be supported in living in their desired gender role.” (December 16, 2020)
American Academy of Child and Adolescent Psychiatry: “(AACAP) supports the use of current evidence-based clinical care with minors. AACAP strongly opposes any efforts – legal, legislative, and otherwise – to block access to these recognized interventions. Blocking access to timely care has been shown to increase youths’ risk for suicidal ideation and other negative mental health outcomes. Consistent with AACAP’s policy against conversion therapy, AACAP recommends that youth and their families formulate an individualized treatment plan with their clinician that addresses the youth’s unique mental health needs under the premise that all gender identities and expressions are not inherently pathological.” (November 8, 2019)
SCOTUS is right about this, chidren
should not be making life altering decisions of surgery or hormone therapy until they’re over the age of 18.
“The rational part of a teen’s brain isn’t fully developed and won’t be until age 25 or so.”
https://www.stanfordchildrens.org/en/topic/default?id=understanding-the-teen-brain-1-3051
David Greenwald, guess who wrote this:
“This natural desistance is backed by biology. The prefrontal cortex—the part of the brain responsible for impulse control, long-term planning, and moral reasoning—doesn’t fully develop until a person’s mid-20s. Young people are more likely to act recklessly, respond to peer pressure, and fail to anticipate consequences.
As people mature, they become more stable, more reflective, and more risk-averse.”
https://davisvanguard.org/2025/05/america-punishment-system-failing/
Keith trying to out-doctor, the doctors
So you don’t believe in your own words?
I don’t believe they apply here
LOL, nice try.
You didn’t exactly refute it, you just made a wise crack
I’m just using the words you wrote. It’s not up to me to refute it. I happen to agree with you here.
Here’s what you wrote again:
“This natural desistance is backed by biology. The prefrontal cortex—the part of the brain responsible for impulse control, long-term planning, and moral reasoning—doesn’t fully develop until a person’s mid-20s. Young people are more likely to act recklessly, respond to peer pressure, and fail to anticipate consequences.
As people mature, they become more stable, more reflective, and more risk-averse.”
But you’re taking words I used in a very different context and applying them in a situation that doesn’t apply to
I agree especially with this sentence that you wrote and think it can also totally apply to a minor wanting hormonal therapy or surgical mutilation.
“Young people are more likely to act recklessly, respond to peer pressure, and fail to anticipate consequences.”
That’s why doctors and parents are involved whereas the other situation relates to level of culpability (which is reduced not zero). This is complicated and you’ve pulled it out of context
“surgical mutilation.”
This is an unacceptable term which should not be allowed on the Vanguard.
I think it can totally apply to this situation and many other instances where children’s brains have not developed enough to make life altering decisions.
Remember, the Internet is forever.
“CMS is alerting providers to the dangerous chemical and surgical mutilation of children, including interventions that cause sterilization.”
https://www.cms.gov/files/document/qssam-25-02-hospitals.pdf
You can join the military at 17 and be sent to war.
Individuals under 18 can get married in California with a court order. That emancipates them. In fact, California apparently has no specific minimum age for marriage.
Cosmetic surgery can be performed under age 18 with parental consent.
Minors can become emancipated, usually at 16 but allowed as young as 14 in California.
Adolescent patients can and should participate in their own medical decisions. Their extent of participation increases with age and their fuller understanding of the risks and benefits. But they are the patients, not their parents.
The people who should not be making medical decisions for minors? People who don’t know them and don’t have their medical histories, and most especially religious conservatives. Some parents should not have medical authority over their children for this same reason.
DG say: “Keith trying to out-doctor, the doctors”
What about (-ism) all the doctors in several European countries? Usually this stuff comes from Europe to America, so why is America lagging? And more importantly, are human beings different over there in this regard? Is there a reason America continues, while Europe has clawed back?