U.S. Supreme Court: States May Ban Treatment

On June 18, 2025, the U.S. Supreme Court issued its ruling in United States v. Skrmetti. The Court held that the state of Tennessee may ban puberty blockers and hormones for minors with gender dysphoria.

The Case

In 2023, Tennessee passed a law prohibiting doctors from treating minors with gender dysphoria with blockers or hormones. Three adolescents, their parents, and a doctor challenged the law with the support of the Biden administration. They argued that the law discriminates on the basis of sex and therefore violates the Constitution.

The Ruling

A majority of six of the nine justices rejected that argument. According to the Court, the law distinguishes on the basis of age and medical purpose, not sex. When there is scientific uncertainty about a treatment, the majority held, it is up to the legislature, not the courts, to weigh the considerations.

The Consequences

As a result of the ruling, similar laws in more than twenty other states remain in effect. Nothing changes in states without such a law: the Court has not banned the treatment, but has ruled that states may do so. In Colorado, voters will decide in 2026 whether to ban gender surgery for minors; see the news article about Proposition 135. On June 30, 2026, the Court also ruled that states may bar transgender girls and women from girls' and women's sports; see the news article about that ruling.

The Legal Question

The case was not about whether the treatment is beneficial or harmful, but about how strictly courts should review a law like Tennessee's. U.S. law provides several standards for this. A law that distinguishes on the basis of sex must meet demanding requirements: the state must demonstrate that the distinction serves an important objective. For other laws, it is sufficient for there to be a rational basis. The plaintiffs argued that the law distinguishes on the basis of sex because a boy may receive testosterone for delayed puberty, while a girl with gender dysphoria may not. The Court rejected that reasoning and applied the less stringent standard of review.

The Majority and the Dissent

Chief Justice John Roberts wrote the majority opinion. He noted that health authorities in Finland, Sweden, Norway, the United Kingdom, and elsewhere have expressed doubts about the treatment, and that lawmakers have room to make a choice in such a situation. Justice Sonia Sotomayor wrote on behalf of the three dissenting justices that the Court is leaving transgender adolescents and their parents at the mercy of the political majority of the moment.

The Change in Administration

The case was brought with the support of the Biden administration. Between the hearing in December 2024 and the ruling, the Trump administration took office, reversing the federal government's position and supporting Tennessee's law instead. The Court nevertheless decided to resolve the case.

What the Court Did Not Decide

The Court left open whether transgender people as a group are entitled to special protection against discrimination. The question of whether parents have a constitutional right to decide on their child's medical treatment was also not before the Court. Lower courts continue to consider those questions.

Significance

The ruling put an end to years of conflicting decisions by lower courts, which had suspended the bans in some states and allowed them to take effect in others. For families, it means that the care available to them depends on where they live. Some travel to another state or relocate.

In Europe, care for minors has been adjusted by medical authorities following an assessment of the evidence. In the United States, it has primarily become a matter for lawmakers and the courts. The ruling came one month after the report by the U.S. Department of Health and Human Services.