Skrmetti restores some sanity after years of insanity

On June 18, 2025, the Supreme Court restored a measure of sanity in the debate over transitioning minors. In United States v. Skrmetti the Court upheld Tennessee’s ban on puberty blockers and hormone therapy for minors, recognizing the authority of elected officials to set state policies.

Where it started: Lower Courts

Originally known as L.W. v. Skrmetti, the dispute involved a sixteen-year-old transgender female who received puberty blockers and estrogen therapy; a thirteen-year-old transgender male who took puberty blockers; and a sixteen-year-old transgender male on puberty blockers plus testosterone therapy.

The plaintiffs challenged Senate Bill 1’s ban against medical practitioners providing “gender affirming care” to minors under 18; violations are subject to $25,000 fines and liability for harms that minors experience due to the treatments they received.

A divided Sixth Circuit, recognizing Tennessee’s interest in regulating medical treatments, upheld the statute, reasoning that because the procedures are novel medical treatments, it is best left to the legislature rather than the judiciary to resolve whether they can be used.

The case became known as United States v. Skrmetti because the administration of Joseph Biden intervened on behalf of the plaintiffs. The Supreme Court affirmed in Tennessee’s favor.

The Supreme Court’s judgment

Writing for the Supreme Court in its six-to-three judgment, Chief Justice Roberts’ twenty-four-page opinion was joined in full by Justices Thomas, Gorsuch, Kavanaugh, and Barrett; Justice Alito joined in part. Also, Justices Thomas and Barrett filed concurrences. Justice Sotomayor’s thirty-one-page dissent was joined in full by Justice Jackson, impacting the rights of females (even though she once stated she cannot define what a woman is), and mostly by Justice Kagan, who additionally filed a dissent. I will focus here on the opinions of Chief Justice Roberts and Justice Sotomayor.

Chief Justice Roberts began by identifying the issue before the Court as “whether a Tennessee law banning certain medical care for transgender minors [under 18] violates the Equal Protection Clause of the Fourteenth Amendment” for the “estimated 1.6 million Americans over the age of 13 identify as transgender, meaning that their gender identity does not align with their biological sex,”

At its heart, Roberts’ analysis focused on the appropriate standard of review. He refused to subject House Bill 1 to strict scrutiny, the most stringent level of review, applicable in debates over fundamental rights, because it “does not classify on any bases that warrant heightened review.” Instead, Roberts applied rational basis review, explaining that Senate Bill 1 was constitutional because its “age-and diagnosis-based classifications are plainly rationally related to these findings and the State’s objective of protecting minors’ health and welfare…[amid] ongoing debate among medical experts regarding the risks and benefits associated with administering puberty blockers and hormones to treat gender dysphoria, gender identity disorder, and gender incongruence.”

Rounding out the Court’s opinion, Roberts acknowledged that Skrmetti “carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field. The voices in these debates raise sincere concerns; the implications for all are profound. The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best.”

Roberts added that the Court’s “role is not ‘to judge the wisdom, fairness, or logic’ of the law before us, but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment. Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process.”

Justice Sotomayor argued that Senate Bill 1 “expressly classifies on the basis of sex and transgender status, so the Constitution and settled precedent require the Court to subject it to intermediate scrutiny.”

She concluded that the Court “authorizes, without second thought, untold harm to transgender children and the parents and families who love them.”

A crucial victory

Skrmetti represents a crucial victory for elected legislators, enabling them, not courts, to determine what is in the best interest of the health, mental, and physical well-being of their residents, regardless of their ages, and in light of the vagaries surrounding the needs of minors experiencing gender dysphoria. Individuals over eighteen remain free to engage in “gender affirming care”.

Echoing the Supreme Court’s judgment, Tennessee’s Governor Bill Lee noted that “[p]rotecting children is a fundamental responsibility that we take seriously, and I was proud to sign this bipartisan legislation that lawfully safeguards young people from irreversible, life-altering medical decisions…Voters, through their elected representatives, should have the power to decide what they believe on serious issues like this one.”

Of course, minors experiencing gender dysphoria deserve love, care, support, and understanding. Helping confused minors is complicated, though, because of developments such as in California, which planned to prevent educators from informing parents whose children seek to transition socially. Similarly, the First Circuit decreed that educators in Massachusetts were under no obligation to inform parents whose middle school daughter sought to “transition”.

The push for “transitioning” must be viewed against the reality that advocacy groups interfere in familial relations when parents do not agree to having their children transition socially. It is particularly troublesome that educator activists encourage minors to transition socially without either informing their parents or helping children to better understand the long-term effects of what they seek to do. This is especially the case amid growing concerns over the nonscientific basis behind these treatments, combined with increasing numbers of individuals seeking to detransition.

Because minors under eighteen cannot, among other restrictions, vote, purchase alcohol or cigarettes, or get tattooed, and probably lack full awareness of what they are undergoing or will experience by taking medications and submitting to experimental life-altering transition procedures, it is unclear why there is such a headlong rush to have them proceed. With counseling and therapy for minors in conjunction with the aid of their families, prudence dictates that impressionable children confused about their gender and their parents should act cautiously.

Amid debates over “gender affirming care”, a report from the American College of Pediatrics, citing the the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, reported that “98% of gender confused boys and 88% of gender confused girls eventually accept their biological sex after naturally passing through puberty.” Another study, from the Netherlands, revealed that 78% of people never experience gender dysphoria. In light of such evidence, combined with the growing number of European nations, notably Denmark, England, Finland, France, and Sweden, limiting or cautioning against transitioning. Skrmetti is thus a needed caution to parents who, often with the support of medical professionals, seek to subject their children to undergo medical treatments with questionable (or worse) outcomes.

The Supreme Court’s judgment in Skrmetti, upholding the constitutionality of Senate Bill 1, likely validates similar statutes in twenty-seven states restricting or banning access to what is euphemistically referred to as “gender affirming care”.

Conversely, at least fourteen states permit these practices for minors identifying as transgender or questioning their sexuality.

Skrmetti achieved two other important ends.

First, as in Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade’s having discovered a heretofore unknown constitutional right to abortion, its originalist members represented by the six-justice majority, recognized the proper balance between states and the federal government. The Court thereby eschewed judicial activism under which jurists interpret laws, basically setting policy based on their personal views rather than how statutes and constitutional provisions are written. Skrmetti demonstrates judicial deference to the democratic process and federalism by respecting the rights of elected legislators to adopt laws they believe are in the best interests of their residents. Second, however unintentionally, the Court preserved the balance in nature as reflected in Genesis that God “created them male and female.”