What just happened?
On Wednesday, the U.S. Supreme Court heard oral arguments in United States v. Skrmetti, an important case that will determine whether states have the right to protect children from medical attempts to change their bodies for the purpose of “affirming” gender identity.
What is the case about?
Last year Tennessee passed a law (known as SB1) that declares the state “must take action to protect the health and welfare of minors” and that it has a “compelling interest in encouraging minors to appreciate their sex, particularly as they undergo puberty.” The law prohibits doctors from prescribing puberty blockers and hormone therapy or performing surgery (a ban not at issue before the justices) for the purpose of “affirming” the gender identity of a minor. It does permit doctors to prescribe identical medications for other medical conditions. Physicians can still administer puberty blockers to treat precocious puberty, and hormone therapy remains available for adolescents experiencing delayed onset of puberty.
A legal challenge against the ban was initiated by three transgender adolescents and their families, who sued state officials charged with enforcing the legislation (the named respondent, Jonathan Skrmetti, is attorney general of Tennessee). They contend that the law violates constitutional equal protection rights. The Biden administration subsequently joined the litigation, exercising its authority to intervene in equal protection cases that the U.S. attorney general deems to have broad public significance.
A federal district court in Nashville granted the challengers’ request to temporarily put the ban on hold. On review, the U.S. Court of Appeals for the Sixth Circuit reversed and upheld the ban. It applied a standard known as “rational basis” review, which looks at whether the law is rationally related to a legitimate government interest.
The Biden administration and the three families petitioned the Supreme Court to examine the Sixth Circuit’s ruling. While the Court agreed to hear the federal government’s appeal, it declined to consider the families’ separate petition, which had raised additional questions about parental rights in medical decision-making. An attorney representing the families still presented arguments alongside the government’s case during the oral arguments.
The plaintiffs contend that the ban on puberty blockers and hormone therapy “explicitly classifies based on sex” and is therefore subject to heightened scrutiny—a more demanding level of scrutiny than the rational basis review that the Sixth Circuit applied. They claim it’s similar to the Supreme Court’s landmark 2020 ruling in Bostock v. Clayton County. In that decision, a 6–3 majority, with Justice Gorsuch writing the opinion, established that workplace discrimination protections based on “sex” extend to discrimination against homosexual and transgender employees. Gorsuch reasoned that discrimination against LGBT+ individuals is inherently tied to sex-based discrimination since you cannot have one without the other. The plaintiffs argue this same legal logic naturally extends to the Constitution’s equal protection guarantees.
On the other side of the issue, Tennessee includes several arguments in defense of the law:
- Age-based classification: The state argues the law isn’t an outright ban but rather a classification based on age, focusing on protecting minors younger than 18.
- Protection from risky, unproven treatments: Tennessee claims the law prohibits “risky, unproven gender-transition interventions” for minors.
- Scientific uncertainty: The state points to “scientific uncertainty” surrounding gender-affirming treatments for young people.
- European precedent: Tennessee cites tightened restrictions on such treatments in some European countries to support its position.
- Regret and harm: The state references “firsthand accounts of regret and harm” from individuals who’ve discontinued or reversed gender-affirming treatments.
- Premature decision-making: Tennessee argues its law protects young people from making treatment decisions prematurely.
The state maintains that these arguments justify its position in restricting these medical interventions for minors, framing the law as a protective measure rather than discrimination.
What is the legal question being considered in this case?
This is the question presented before the Supreme Court:
Whether Tennessee Senate Bill 1 (SB1), which prohibits all medical treatments intended to allow “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or to treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity” . . . violates the Equal Protection Clause of the Fourteenth Amendment.
If the law is considered unconstitutional, it could affect similar laws in 23 other states.
What was the reaction of the justices during the oral arguments?
The Court’s liberal justices strongly sided with the Biden administration and the three families. Justice Elena Kagan challenged Tennessee’s core argument—echoed by her conservative colleagues—that the law isn’t sex-based. Meanwhile, Justice Ketanji Brown Jackson repeatedly expressed concern about deferring the issue to legislators.
However, the Court’s conservative wing appeared skeptical during the oral arguments, with several justices suggesting these matters might be better left to state legislatures.
“It seems to me that it’s something where we are extraordinarily bereft of expertise,” said Chief Justice John Roberts.
Justice Brett Kavanaugh aligned with Roberts’s perspective, questioning the courts’ role in this debate. “Why isn’t it best to leave it to the democratic process?” he asked.
Justice Amy Coney Barrett noted that the parents could still pursue their parental rights claim regardless of the Court’s ruling.
Justice Gorsuch didn’t ask any questions.
Why is this case important?
This case represents a critical intersection of religious liberty, parental rights, medical ethics, and the government’s role in health-care decisions. But at its heart, the case is about protecting the welfare of vulnerable children.
Tennessee’s law addresses a troubling shift in pediatric care, where some medical practitioners now advocate interventions that fundamentally alter healthy adolescent development and reproductive capacity. Rather than healing illness, these procedures irreversibly modify healthy bodily functions and tissues, contradicting both traditional medical principles and God’s created order. Labeling such interventions as “medical care” distorts their true nature. As the Family Action Council of Tennessee notes in their amicus curiae brief, “This sort of endeavor is ‘medicine’ only in the sense that doctors, scalpels, and drugs are involved.”
The surge in gender dysphoria diagnoses points not to a medical trend but to a deeper spiritual and cultural crisis. While the medical establishment rushes to normalize these interventions, evidence of their risks continues to mount. For instance, the Cass Review confirms what faith leaders have long maintained: children lack the maturity for such life-altering decisions, and research supporting these procedures remains inadequate.
As Christians, we must be truthful and compassionate. While some adolescents genuinely struggle with their identity, encouraging medical transition serves neither their health nor their ultimate well-being. True healing affirms rather than alters our God-given bodies, and states have a legitimate interest in protecting children from experimental procedures that contradict both sound medicine and sacred truth.
Tennessee’s law provides necessary safeguards for vulnerable youth. The Supreme Court should recognize there is no rational basis for overriding states’ vital role in protecting children from harmful interventions. To rule otherwise would not only exceed the scope of their authority but also force states to stand idle while children undergo irreversible medical procedures they may deeply regret in adulthood. Our children deserve better than to be subjects in a vast social experiment with lifelong consequences.
When will the case be decided?
A decision is expected by the end of June or early July 2025.
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