BREAKING SUPREME COURT DECISION

U.S. Supreme Court Upholds Tennessee Law Restricting Transgender Medical Treatments for Minors

Date of Decision: June 18, 2025
Author: Jeremy D. Hollingshead, Esq.
Firm: Hollingshead & Dudley

In one of its most closely watched rulings this year, the U.S. Supreme Court upheld a Tennessee law banning certain medical treatments for transgender minors. This law prohibits the use of puberty blockers and hormone treatments when used specifically for gender transition purposes in children. The Court’s decision is notable not just for its outcome, but also for how it reached that outcome—and what it means going forward for states, medical professionals, families, and the LGBTQ+ community.

What Was This Case About?

Tennessee passed a law—Senate Bill 1 (SB1)—that bars doctors from prescribing puberty blockers or hormones to minors for the purpose of gender transition. It does, however, allow those same medications to be used for other reasons, like treating early puberty or certain medical conditions.

Several families and a doctor sued, claiming that this law violated the Equal Protection Clause of the U.S. Constitution. A lower federal court initially blocked the law, but the Sixth Circuit Court of Appeals reversed that decision. The Supreme Court then took the case to decide if Tennessee’s law was constitutional.

What Did the Supreme Court Decide?

The Supreme Court ruled that Tennessee’s law does not violate the Equal Protection Clause. The majority opinion, written by Chief Justice John Roberts, found that the law doesn’t unfairly single out transgender individuals. Because the law applies based on the type of medical condition being treated—not the person’s identity—it was reviewed using a legal test called “rational basis review.”

What Is Rational Basis Review—and Why Does It Matter?

Courts use different levels of scrutiny when deciding if a law treats people unfairly. The higher the level of scrutiny, the harder it is for the law to survive. Here’s an analogy: imagine you’re a teacher grading students’ essays. With rational basis, you’re just checking that the student followed basic instructions—it’s a very low bar. Intermediate scrutiny is like looking for solid grammar and coherent structure. Strict scrutiny is like expecting a near-perfect essay.

In this case, the Court decided to use the lowest bar—rational basis review. That means Tennessee just had to show a reasonable explanation for the law. The Court said the state had valid concerns about the risks of medical treatments for minors, especially when the science is still evolving. Had the Court chosen a higher level of scrutiny, the outcome could have been very different.

Why Did the Court Uphold the Law?

The majority opinion said SB1 doesn’t target people based on their sex or transgender identity. Instead, it regulates which medical conditions puberty blockers and hormones can be used to treat. The Court compared this to previous rulings, like one involving pregnancy, where the Court said not all laws that impact only one group (like women) are necessarily discriminatory.

The Court also said that because medical professionals and researchers still disagree about the long-term effects of these treatments on minors, it’s reasonable for states to take a cautious approach. That’s especially true when it comes to protecting the health and safety of children.

What Did Other Justices Say?

Several Justices wrote their own opinions to explain their additional thoughts on the matter. Justice Thomas emphasized that the Equal Protection Clause and Title VII of the Civil Rights Act (used in past LGBTQ+ cases) are legally different and shouldn’t be treated the same. Justice Barrett, joined by Thomas, noted that the law doesn’t treat transgender people differently just because they’re transgender—it depends on the medical diagnosis. Justice Alito agreed with the result but had slightly different reasoning.

These concurring opinions suggest that while the Court was unified in upholding Tennessee’s law, they might differ in future cases depending on how particular laws are written or what specific rights are involved. That could influence how other courts apply this decision going forward.

What Did the Dissenting Justices Say?

Justice Sotomayor, joined by Justices Jackson and Kagan (in part), strongly disagreed with the majority. They argued that the law does discriminate against transgender youth and that it unfairly limits their ability to access treatments supported by several major medical organizations. They were concerned that the majority’s approach could invite more laws that restrict medical care based on political views rather than medical expertise.

What Does This Mean for the Real World?

This decision opens the door for other states to pass similar laws regulating transgender medical care for minors. It also provides a roadmap for defending those laws in court—specifically by framing them as protecting health and safety rather than targeting a specific group.

For families, this means access to certain gender-affirming treatments for minors may vary widely by state. For healthcare providers, it introduces new legal risks in states with these laws. And for the legal community, it signals that the Court is willing to apply the most lenient legal standard (rational basis) to cases involving transgender issues—at least for now.

Need Help Understanding Your Rights?

This area of law is evolving quickly. If you’re unsure how this ruling affects your rights—or your responsibilities—contact Hollingshead & Dudley. We help clients across Missouri navigate complex constitutional, employment, and healthcare-related legal issues.

📞 Call (314) 480-5474 or visit our Employment Law page