Every June, along with the start of summer and Pride celebrations, the U.S. Supreme Court releases important decisions that can affect many people. This year, one of the most important and controversial cases is about gender-affirming medical care for transgender minors — treatments like puberty blockers or hormone therapy that help transgender youth transition. The case is called U.S. v. Skrmetti and challenges Tennessee’s 2023 law that bans doctors from providing these kinds of treatments to minors.
The Biden administration argued during oral arguments in December 2024 that the law treats patients differently based on the sex they were assigned at birth. For example, if someone was assigned female at birth, giving them estrogen therapy is allowed, but it is not allowed if the person was assigned male at birth. On the other hand, Tennessee says the law doesn’t focus on a person’s sex or transgender status but rather the reason why the treatment is given. For instance, puberty blockers might be okay if used to treat early puberty, but not if used to delay puberty while a child explores their gender identity.
Even though the Trump administration believes the law doesn’t violate the Equal Protection Clause of the Constitution, it still wants the Supreme Court to make a decision. The main question the Court must answer is whether transgender people are protected from discrimination under the Constitution — and if so, whether that protection is because of their sex or if transgender identity should be considered a new protected category.
This case is very important because no matter how the Court rules, it will impact access to gender-affirming care for transgender youth and adults. It could also change important anti-discrimination laws that protect many groups of people. Experts warn that if the Court rules against transgender rights, it could lead to more harm for a community of fewer than two million people who are already facing many attacks from state laws and federal actions.
However, Rutgers law professor Katie Eyer, who studies anti-discrimination law, offers some hope. She says that although four of the conservative justices may vote against transgender rights, Justice Amy Coney Barrett’s thoughtful questions during oral arguments and Justice Neil Gorsuch’s previous support for LGBTQ+ rights suggest that the plaintiffs could still win. And even if the Court rules against transgender youth this time, history shows the LGBTQ+ community has survived setbacks before and fought back.
The state argues that its law is based on the medical purpose of the treatments, not on sex or gender identity. But this is not true because the law does not say anything about medical reasons for treatment. For example, a cisgender child in Tennessee can get breast enhancement surgery for non-medical reasons, but a transgender child cannot get hormone therapy to transition. This shows the law is unfair and discriminatory.
The Supreme Court’s decision will focus on two big questions: First, should discrimination against transgender people get special legal attention and be reviewed more carefully by the courts? Second, is the Tennessee law itself legal? Even if the Court decides to give the law closer scrutiny, it might send the case back to lower courts to review again.
This case is not only about transgender minors. The Biden administration’s executive orders show that attacks on gender-affirming care are expanding to adults under 19, which means a decision supporting Tennessee’s law could hurt many transgender adults as well. The ruling could also affect other laws that target transgender people, like bans on transgender people serving in the military or restrictions on transgender students in schools.
The case also has bigger implications beyond transgender rights. If the Court accepts Tennessee’s argument that banning certain treatments is not sex discrimination because it applies equally to boys and girls, it would follow a dangerous logic similar to old racist laws during segregation. Those laws argued that segregation wasn’t discriminatory because it applied to both Black and white people, which the Supreme Court rejected decades ago. Justice Ketanji Brown Jackson even brought this up during oral arguments, warning about the connection.
Another question is whether transgender people should be recognized as a group deserving special legal protection. Tennessee wants the Court to say “no,” which would make it harder for any new groups to get protection against discrimination in the future. This would be a major setback for equality.
At the oral arguments, most experts expect the Court to rule against transgender rights. But there is still a chance for a win because justices like Barrett and Gorsuch seem open to protecting transgender people under the law. Barrett’s questions showed she is carefully considering whether transgender people deserve “heightened scrutiny,” meaning closer examination of laws that discriminate against them.
The ruling will come at an important moment — Pride Month — when the LGBTQ+ community is fighting many attacks, including bans on Pride events and weakening of diversity and inclusion policies. A decision in favor of transgender rights would be a bright moment of hope. But a ruling against could be very painful and damaging emotionally for many transgender people.
Still, the LGBTQ+ community is known for being strong and creative. It has faced difficult times before, like in 1986 when the Court allowed states to criminalize gay sex during the AIDS crisis. Although that was a terrible decision, the community fought back and overturned it less than 20 years later. Even now, despite new challenges, the community continues to organize and resist.
In short, this Supreme Court decision will shape the future of transgender rights, healthcare access, and anti-discrimination protections for many years to come. Whether it brings hope or hardship, the fight for equality will continue.
