United States v. Skrmetti

In 2023, Tennessee enacted SB1, which prohibited certain medical treatments for transgender minors. Among other things, SB1 barred healthcare providers from prescribing puberty blockers or hormones to address gender dysphoria, gender identity disorder, or gender incongruence. SB1 did not prevent healthcare providers from administering treatments to individuals aged 18 and older, nor did it prevent the use of puberty blockers or hormones in minors to treat other conditions. In enacting SB1, the Tennessee legislature cited the potential negative physical and psychological effects of the barred medical treatments. The legislature believed that minors were not mature enough to appreciate those consequences and found that gender dysphoria in minors could be resolved by less-invasive approaches. The legislature also noted a lack of certainty about the treatments’ effects, changing guidelines regarding the treatments, and increased restrictions on the treatments in other countries. Three transgender minors, their parents, and a doctor (the challengers) (plaintiffs) sued Tennessee Attorney General Jonathan Skrmetti (defendant) in federal court to prevent enforcement of SB1, asserting that SB1 violated the Equal Protection Clause of the Fourteenth Amendment. The challengers described the negative effects of gender dysphoria on transgender minors and their families and presented evidence that multiple professional organizations considered the banned treatments to be appropriate and medically necessary. The United States (plaintiff) intervened in the action to challenge SB1. The district court enjoined SB1’s ban on puberty blockers and hormone treatments, finding that SB1 discriminated based on sex and transgender status and likely would not survive intermediate-scrutiny review. The appellate court reversed, finding that transgender individuals were not a suspect class and that SB1 did not discriminate based on sex. The appellate court thus analyzed SB1 using rational-basis review and held that SB1 met that standard. The United States Supreme Court granted certiorari.