The U.S. Supreme Court.
WASHINGTON (BP) — In a historic decision, the U.S. Supreme Court ruled Wednesday (June 18) that a Tennessee law banning gender transition medical treatments for minors is constitutional.
The case, United States v. Skrmetti, involved a suit brought by three transgender teenagers and the Biden administration against Tennessee officials seeking to bar the state from enforcing its ban on gender transition interventions, or so-called “gender affirming care,” for minors.
Tennessee Attorney General Jonathan Skrmetti was named the defendant in the case. Oral arguments, which hinted at today’s decision, were heard in December 2024.
The Supreme Court ruled that Tennessee’s law, known as Senate Bill 1 (S.B. 1), does not violate the Equal Protection Clause of the 14th Amendment and is subject only to rational basis review, rather than heightened or strict scrutiny review.
The 6-3 decision, presented by Chief Justice John Roberts, argues that S.B. 1 incorporates two classifications — age and medical use.
The law does not completely ban these treatments or procedures for other uses in children besides gender transitions and does not prevent consenting adults in the state from undergoing these procedures for gender transition purposes.
Therefore, the challengers’ “sex discrimination” argument does not hold. Justices Sotomayor, Jackson and Kagan dissented from the majority.
The High Court’s ruling provides necessary clarity for legal challenges to similar laws in 26 other states.
Brent Leatherwood, president of the Ethics & Religious Liberty Commission (ERLC), called the decision a “landmark ruling.
“When a child needs to be protected, states have a right to step in with common-sense laws to save that child from harm,” Leatherwood said.
“That is the essence of today’s landmark ruling from the Supreme Court, and it aligns with a view long held by Southern Baptists. The protection of children from harmful transgender surgeries and interventions is not only an entirely appropriate action by the state, it is desperately needed in a culture that believes a person’s identity can be divorced from biological realities simply on a whim.
“Southern Baptists have been unequivocally clear about the dangers of ‘gender transition’ procedures and interventions on minors and the devastating effects they have on children.”
The case was the ERLC’s highest judicial priority for this term of the Court, with Leatherwood previously saying the decision’s impact would be “monumental.”
Last year the ERLC, alongside the Tennessee Baptist Mission Board (TBMB), filed an amicus brief in the case supporting the Tennessee law.
TBMB President Randy Davis called the decision “a monumental statement in favor of protecting our youth and children.
“We live in an age where human sexuality is under attack from all quarters. I am thankful for our state attorney general and Tennessee representatives who stood in the gap for Tennessee’s children,” Davis told the Baptist and Reflector.
The ERLC hosted an event at the 2025 Southern Baptist Convention (SBC) annual meeting featuring Skrmetti, along with Alliance Defending Freedom Senior Vice President Ryan Bangert, discussing the monumental nature of the case and the potential effects of the upcoming decision on churches.
“This is all about protecting kids,” Skrmetti said at the event. “We are in the middle of a massive informational, ideological and theological era that is very confusing and complicated. In a situation like that where there’s uncertainty and a huge amount of risk to children, the government absolutely has a job to do in order to protect kids.”
Tennessee’s law, passed in 2023, prevents health care providers from prescribing medication or performing procedures on minors in order to “transition” them to an identity opposite of their biological sex. The law required doctors to cease all current gender procedures on minors by March 2024.
After the legislation passed, three transgender teenagers, along with their parents and the American Civil Liberties Union (ACLU), quickly filed a lawsuit alleging Tennessee violated the Equal Protection Clause and the Due Process Clause of the 14th Amendment.
The Biden administration’s Department of Justice joined the suit arguing the U.S. has a vested national interest in preventing the law from taking effect.
The plaintiffs alleged the law intentionally targets transgender individuals and is therefore sex-based discrimination that interferes with parents’ ability to make medical decisions for their children.
The Tennessee District Court issued an injunction to prevent the state’s ban on hormone therapy and puberty blockers from taking effect, but ruled that the plaintiffs did not have legal right to challenge the ban on gender-transition surgeries because they had not indicated that they wanted to undergo such surgeries.
The state of Tennessee later appealed the injunction to the U.S. Court of Appeals, where the judges rendered a split-decision ruling that the law is not discriminatory on the basis of sex, permitting it to take effect.
The challengers quickly went to the Supreme Court, which announced last June that it would hear the case. Oral arguments for the case lasted more than two hours.
Elizabeth Prelogar, former solicitor general of the U.S., spoke on behalf of the Biden administration in the case.
“This case is about access to medications that have been safely prescribed for decades to treat many conditions, including gender dysphoria,” Prelogar said. “S.B. 1 singles out and bans one particular use. In Tennessee, these medications can’t be prescribed to allow a minor to identify with or live as a gender inconsistent with the minor’s sex.”
Tennessee’s law would apply equally regardless of sex, and the discrimination component of the Prelogar’s argument is based on the High Court’s 2020 Bostock decision, which reinterpreted sex-based discrimination to include gender identity.
Matthew Rice, solicitor general for the state of Tennessee, said the state’s law is not discriminatory and instead focuses on banning the use of the medications and procedures on minors for safety or medical reasons.
“Tennessee lawmakers enacted S.B. 1 to protect minors from risky, unproven medical interventions,” Rice said. “The law imposes an across-the-board rule that allows the use of drugs and surgeries for some medical purposes but not for others. That is not sex discrimination.
“Just as using morphine to manage pain differs from using it to assist suicide, using hormones and puberty blockers to address a physical condition is far different from using it to address psychological distress associated with one’s body.
“The Equal Protection Clause does not require the states to blind themselves to medical reality or to treat unlike things the same, and it does not constitutionalize one side’s view of a disputed medical question.”
The case is one of several religious liberty cases the High Court is expected to rule on this summer in which the ERLC is actively engaged.
(EDITOR’S NOTE — Timothy Cockes is news editor at New Orleans Baptist Theological Seminary.)
