The Supreme Court will hear a landmark case on Wednesday that could impact how transgender youth have access to gender-affirming care nationwide.
Puberty blockers and hormone therapy have been used for decades to treat gender dysphoria, which is defined as the mental distress or discomfort a person experiences when there is a mismatch between their sex assigned at birth and their gender identity. It can lead to anxiety, depression and "an increased risk of self-harm and suicidality," according to the National Institute of Health.
There are currently 26 states that have enacted laws to restrict such gender-affirming care, though some of those bans are tied up in legal challenges. Proponents of these types of laws argue that they're in place to protect the health and welfare of minors.
Tennessee is one of those states, and its law, known as SB1 that was enacted in July 2023, is now up for debate before the 6-3 conservative majority high court. Here's a look at what's at stake.
The players involved in the case
At issue in the case, U.S. v. Skrmetti, is Tennessee's law that bans gender-affirming care, like hormone treatments and gender-transition surgeries, for transgender minors. It also imposes civil penalties for doctors who violate those bans.
The plaintiffs, who filed the case in 2023 to challenge the law, are three transgender adolescents, their parents as well as a medical doctor who treats teens with gender dysphoria. They are being represented by the ACLU and Lambda Legal.
The Biden administration has also been able to join the case in support of the plaintiffs, under a federal law that allows the government to intervene in private cases that allege there are violations of the 14th Amendment.
Meanwhile, Tennessee Attorney General Jonathan Skrmetti and his legal team are defending the state’s law.
The Supreme Court justices will decide whether Tennessee’s law violates the 14th Amendment’s Equal Protection Clause in the Constitution, which states:
“No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”
What each side is saying
U.S. Solicitor General Elizabeth Prelogar, who represents the federal government, argued that SB1 is unconstitutionally discriminatory.
In court documents she says, "...an adolescent assigned female at birth cannot receive puberty blockers or testosterone to live as a male, but an adolescent assigned male at birth can. And that focus on sex and gender conformity is deliberate: SB1 declares that its very purpose is to 'encourag[e] minors to appreciate their sex and to ban treatments 'that might encourage minors to become disdainful of their sex. That is sex discrimination."
Skrmetti argues in the state's brief that the Tennessee law does not violate the constitution, saying it's "not unconstitutional discrimination to say that drugs can be prescribed for one reason but not another." The argument further says that SB1 doesn't categorize people based on their sex, but "creates two groups: minors seeking drugs for gender transition and minors seeking drugs for other medical purposes."
The state’s argument also brings up its concern that more science is needed around gender-affirming care. The plaintiffs, however, have provided examples of major medical organizations that have deemed the treatments safe, even considering them medically necessary.
What’s at stake
If the Supreme Court decides Tennessee's law is unconstitutional, the other 25 state laws banning gender-affirming care could also be held as unconstitutional and discriminatory.
Such a ruling could give advocates for LGBTQ+ rights and civil rights lawyers a powerful precedent to point to in fighting against other anti-trans laws regarding school sports, pronouns and bathroom access.
In turn, if SCOTUS rules that the Tennessee law does not violate the 14th Amendment, it could clear the war for additional laws targeting transgender Americans.
Something else to keep an eye on is how the incoming Trump administration could impact the case. Since the Biden administration intervened against Tennessee's law on behalf of the federal government, the Trump administration could take a different position and tell the court that the federal government is no longer against Tennessee's law. It's uncertain if this would then cause the court to hear new arguments from the ACLU and Lambda Legal who are representing the original plaintiffs.