Supreme Court Ruling on Transgender Care in Tennessee Raises Concerns

In December 2024, advocates and opponents of transgender rights gathered outside the U.S. Supreme Court as legal and health policy experts engaged in a significant debate regarding health rights. The recent Supreme Court ruling supporting a ban on affirmative care for Tennessee’s youth could have wider implications, potentially opening the door for state-level restrictions on healthcare for various groups.

Legal scholars suggest that this ruling might enable states to implement more regulations concerning gender-related treatments. In the case, US v. Skrmetti, several families and doctors argued that Tennessee’s law banning puberty blockers and hormonal treatment for transgender minors contradicts the equal protection clause in the Constitution. They contended that the law discriminates based on gender, as similar treatments are available to cisgender minors with other medical conditions.

The court evaluated whether the law treats individuals differently and whether it met the criteria for enhanced scrutiny. This level of review requires states to explicitly outline their objectives and explain how the law supports these goals. Yet, a conservative majority on the court ruled last month that the Tennessee ban did not warrant such scrutiny, reasoning that its restrictions are tied to the medical use of specific drugs rather than age or gender. Notably, 26 states have laws akin to Tennessee’s.

Tennessee’s legislation prevents healthcare providers from offering puberty blockers and hormones to minors regardless of their gender. Chief Justice John Roberts noted that the law does not restrict particular medical treatments for one gender while allowing them for another.

During oral arguments, Justice Elena Kagan pushed back against this interpretation, saying, “It’s all soaked into sex. It’s based on sex.” She argued there might be valid reasons for regulation, but it wasn’t accurate to claim that the law was purely medical. Tennessee asserts that it is in the state’s interest to guide minors in understanding their sexuality.

Some experts argue that the court’s rationale in Skrmetti could pave the way for further restrictions on abortion, contraceptive access, and other health services, particularly those related to gender. Jules Gill Petterson, a transgender history professor at Johns Hopkins University, described the ruling as consequential for legal and political vulnerabilities. She believes this case enhances discrimination against women.

Kellan Baker, head of the Institute for Health Research and Policy, expressed concern that legislative bodies could unjustly ban medical treatments that don’t align with political agendas. He predicted that the ruling would have significant political repercussions beyond just the transgender community.

Eric Nieman, a healthcare attorney, echoed the notion that states might be empowered to regulate a wide array of medical practices for individuals of all ages. Ultimately, he suggested the ruling signifies respect for state authority in determining children’s healthcare options.

This decision was influenced by prior rulings and policies, particularly the 2022 Dobbs decision that altered protections regarding reproductive rights. Katie Keith from the O’Neill Institute at Georgetown Law remarked that the current judgment could be scrutinized through the lens of the fallout from previous legal changes.

Leah Litman, a law professor, warned that if conservative justices revive past rulings, they might reopen doors to discrimination based on outdated biological definitions of gender. This decision contrasts sharply with previous court rulings that supported transgender individuals’ access to necessary care.

While some critics of gender-affirming healthcare celebrated the Skrmetti ruling, numerous medical organizations, including the American Academy of Pediatrics, emphasized that such care is crucial for the health and dignity of minors. Dr. Susan J. Cresley stated that denying this access endangers healthcare relationships and patient safety.

In his opinion, Roberts mentioned that this matter prompts legitimate scientific and policy debates. Justice Ketanji Brown Jackson and Sonia Sotomayor pointed out that the majority opinion reflected arguments used historically to justify bans on interracial marriage.

Despite the narrow framing of the ruling, advocates believe it might still allow challenges to the state’s healthcare ban for transgender youth under different grounds, such as parental rights. Proponents argue that while the current ruling focuses on minors, broader protections for transgender adults and access to care remain under threat from ongoing legislative actions.