Health Law Monitor
Supreme Court Decision Impacts Availability of Gender-Affirming Care For Minors
June 30, 2025
By: Lindsay D. Petrosky and Eli Whitehair
On June 19, 2025, the United States Supreme Court issued a landmark decision that will significantly impact the availability of gender-affirming care for minors. By a 6-3 decision in United States v. Skrmetti,[1] the Supreme Court upheld Tennessee’s restriction on sex transition treatments for minors, finding that the law did not violate the Equal Protection Clause of The Fourteenth Amendment. Notably, the Supreme Court declined to apply strict scrutiny, instead applying rational basis review, finding that restricting certain medical procedures to all minor children does not give rise to heightened constitutional scrutiny. The result essentially removes any restriction on a state’s ability to enact and enforce laws that ban or severely restrict gender affirming care for minors.
Analysis of the Holding
The Tennessee law at issue was Tenn. Code Ann. § 68-33-103, which in pertinent part prohibits:
[a] healthcare provider . . . [from] knowingly perform[ing] or offer[ing] to perform on a minor . . . a medical procedure if the performance or administration of the procedure is for the purpose of:
(A) Enabling a minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or
(B) Treating purported discomfort or distress from a discordance between the minor's sex and asserted identity.
The Supreme Court determined that the Tennessee law applied (1) to all minors (as opposed to only males or only females), which it describes as a “classification based on age,” and (2) to conditions that cannot be treated, which it describes as a “classification based on medical use.” Id. at *26. Neither of these are considered protected classes that give rise to a heightened standard of constitutional scrutiny, and thus the Supreme Court determined that rational basis review was the appropriate standard.
The Supreme Court also determined that Tennessee satisfied this standard, pointing to the state’s legislative findings regarding these medical procedures. Namely, the legislature concluded that the prohibited medical procedures were “experimental in nature and not supported by high-quality, long-term medical studies,” and often minors lack maturity to make such a decision, and “often a minor’s discordance can be resolved by less invasive approaches that are likely to result in better outcomes.” Id. at *32-33.
Potential Impact of the Decision
Skrmetti comes down at a time when many states have enacted restrictions on the medical procedures in question. Furthermore, the position and direction of the current federal administration is largely in support of these state laws. For example, Presidential Executive Order No. 14187 established the administration’s policy against funding, promoting, assisting, or sponsoring the medical procedures at issue. The Order adds that the United States will “rigorously enforce all laws that prohibit or limit” these procedures. Additionally, the United States Attorney General, Pam Bondi, issued a memorandum on April 22, 2025, titled “Preventing the Mutilation of American Children,” which established a firm DOJ position against these medical procedures.
Given this backdrop, Skrmetti’s legal authority both provides states with a clear path forward to restrict gender-affirming care for minors and supports the current administration’s clear policy directives on the issue. Moreover, under Skrmetti, challenging one of these restrictions would likely be a significant undertaking, given that rational basis review is a deferential, easier standard for the government to meet.
Consequently, affected healthcare providers must be aware, informed, and prepared to adapt to this changing legal and political landscape particularly in the approximately 25 states with laws similar to that of Tennessee, including West Virginia, Indiana, Kentucky, and Ohio, just in Jackson Kelly’s footprint.
[1] 2025 U.S. LEXIS 2377 (2025)