605 U.S. 495 (2025) · 2025
United States v. Skrmetti
Equal Protectiontransgender rightshealth careyouth medical carestate regulationLGBTQ rightsLandmark
Summary
The United States and private plaintiffs challenged Tennessee SB1, which prohibits puberty blockers and hormone therapy for minors when used to treat gender dysphoria or help a minor live inconsistent with sex assigned at birth. The Supreme Court held that the law is not subject to heightened scrutiny under Equal Protection and survives rational-basis review.
Background & Context
Tennessee SB1 restricts certain medical treatments for minors when used for gender-transition purposes. The case came after families, medical providers, and the United States argued the law violated Equal Protection. The Court focused on whether heightened scrutiny applied and whether the law passed rational-basis review.
The Question Before the Court
Does Tennessee SB1 violate the Equal Protection Clause by banning certain gender-affirming medical treatments for minors?
Petitioner
United States
Party asking the Court to review or reverse
Argued
- The law classifies based on sex and transgender status.
- Heightened scrutiny should apply.
Respondent
Skrmetti
Party defending the judgment below
Argued
- The law regulates medical treatment, not a protected class.
- The state may regulate uncertain medical treatments for minors.
The Holding
Tennessee's SB1 does not classify based on sex or transgender status for Equal Protection purposes and is subject to rational-basis review, which it satisfies.
The Court
How the justices lined up in this decision.
6-3
Vote
Joined decision
6 justicesAC
Amy Barrett
Majority
BK
Brett Kavanaugh
Majority
CT
Clarence Thomas
Majority
JR
John Roberts
Majority
NG
Neil Gorsuch
Majority
SA
Samuel Alito
Majority
Dissented
3 justicesEK
Elena Kagan
Dissent
KB
Ketanji Jackson
Dissent
SS
Sonia Sotomayor
Dissent
What this means for you
The ruling allows Tennessee's law to remain in effect and makes Equal Protection challenges to similar state bans harder. The people most directly affected are transgender minors, their parents, and clinicians. Families in states with similar bans may have to travel, delay care, or go without treatment that major U.S. medical associations have supported for some youth with gender dysphoria.
Key Takeaways
- The Court upheld Tennessee SB1 under rational-basis review.
- The majority rejected the argument that the law classifies based on sex or transgender status for heightened scrutiny purposes.
- The dissent argued the law discriminates against transgender minors and uses sex-based classifications.
- The decision affects similar bans in many states.
- The ruling did not decide the medical wisdom of gender-affirming care; it resolved the constitutional standard and challenge before the Court.
Decision
6-3 majority opinion
- Citation
- 605 U.S. 495 (2025)
- Vote
- 6-3
- Decision type
- Majority opinion
- Argued
- December 4, 2024
- Decided
- June 18, 2025
- Term
- 2024
- Opinion author
- John Roberts
Chief Justice Roberts wrote the Court's opinion. Justices Thomas and Barrett filed concurrences; Justice Alito concurred in part and in the judgment. Justice Sotomayor dissented, joined by Justice Jackson and in large part by Justice Kagan; Justice Kagan also dissented separately.