Publication Date: June 18, 2025

Overview
On June 18, 2025, the U.S. Supreme Court ruled a that Tennessee’s Senate Bill 1 (SB1) is constitutional. The law prohibits healthcare providers from prescribing or administering puberty blockers or gender-affirming hormones to minors for the purpose of treating gender dysphoria or asserted gender identity.

Writing for the majority, Chief Justice Roberts held that SB1’s age and medical-use classifications warrant only rational basis review and found a conceivable state interest in protecting the health and welfare of minors. The ruling affirms states’ authority to regulate medical treatments amid scientific uncertainty.

Facts

• Enactment of SB1: In 2023, Tennessee enacted SB1, prohibiting healthcare providers from prescribing or administering puberty blockers or hormones to minors for gender-related purposes, while permitting those treatments for congenital defects, precocious puberty, disease, or injury.
• Legal Challenge: Three transgender minors, their parents, and a physician sued under the Equal Protection Clause, alleging that SB1 discriminates based on sex and transgender status and warrants heightened (intermediate) scrutiny.
• Lower Courts’ Rulings: The district court held that transgender individuals are a quasi-suspect class and granted a partial injunction under intermediate scrutiny. A federal appeals court reversed, applying only rational basis review and upholding SB1.
• Supreme Court Majority Holding: The Court held SB1 does not classify based on sex or transgender status and satisfies rational basis review, given Tennessee’s findings of potential irreversible harms and uncertainty regarding gender-affirming treatments for minors.
• Dissent: Justice Sotomayor, joined by Justice Jackson (and Justice Kagan in part), dissented, arguing that SB1’s true effect is to single out transgender minors and enforce sex-stereotyping, meriting heightened scrutiny.

Perspectives

• State of Tennessee (Attorney General Skrmetti & Legislature): Defended SB1 as a rational health-and-safety regulation. Cited legislative findings of irreversible sterility risks, increased disease and psychological harms, and the inability of minors to fully comprehend long-term consequences, justifying a ban on gender-affirming treatments for minors.
• Plaintiffs (Transgender Minors, Parents, Physician): Contended SB1 inflicts unequal treatment by denying medically accepted care to treat gender dysphoria, discriminates on the basis of sex and transgender status, and fails to further any legitimate state interest under intermediate scrutiny.

Considerations

• States retain broad discretion to regulate medical treatments when scientific and medical consensus is evolving, under rational basis review.
• The ruling may embolden similar statutes in other states, influencing nationwide access to gender-affirming care for minors.
• The decision underscores tension between federal constitutional guarantees and state health-and-safety policymaking.
• Medical and scientific communities may adjust guidance to address legislative constraints and inform future research on gender-affirming treatments.
• Ongoing legislative and legal developments could prompt Congress or state assemblies to revisit standards for minors’ access to gender-related healthcare.
• Public policy debates are likely to intensify around age, consent, and the role of parental versus state authority in healthcare decisions for minors.

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