The U.S. Supreme Court has upheld Tennessee’s 2023 ban on gender-affirming care for minors in a 6-3 decision.
The court ruled that the legislation does not violate the 14th Amendment’s equal protection guarantee, with a split along party lines of the six conservative and three liberal justices.
Tennessee is one of 25 states that have introduced restrictions on gender-affirming care for minors. The Supreme Court ruling in U.S. v. Skrmetti opens the door for additional bans in other states to go into effect.
The American Civil Liberties Union of Tennessee, national advocacy groups and a Nashville family filed a lawsuit challenging the law in April 2023. The U.S. Department of Justice stepped in one week later in an attempt to block the law from going into effect, citing the 14th Amendment’s equal protections clause over discrimination “on the basis of both sex and transgender status.” The 6th Circuit U.S. Court of Appeals reversed a temporary partial block, which would allow the ban on surgical procedures but not hormone therapy, permitting the law to go into effect.
Conservative-majority court is expected to rule in the late spring
Chief Justice John Roberts wrote in the court’s opinion: “Our 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."
The law’s path began in October 2022, when to-be sponsor and state Senate Majority Leader Jack Johnson (R-Franklin), U.S. Sen. Marsha Blackburn, Daily Wire conservative media personality Matt Walsh and a number of other right-wing heavyweights took the stage at a Nashville rally advocating for the ban.
Johnson introduced the ban as the first bill of the legislative session. The law puts doctors at risk of losing their license for providing gender-affirming care to minors. It also provides a path for parents to sue if care happens without their consent, and for people who receive gender-affirming care as minors to sue their medical providers as adults. Even if the family involved is satisfied with their child’s care, the state’s attorney general can sue.
“This ruling sends a strong message to the country that states have a clear right and path forward to protect children from irreversible bodily mutilation,” says Johnson in a statement. “Sponsoring SB1 was an honor, but this accomplishment would not have been possible without the determination and support of my fellow Senators.”
Tennessee Attorney General Jonathan Skrmetti adds in a statement, “In today's historic Supreme Court win, the common sense of Tennessee voters prevailed over judicial activism."
Walsh also took aim via social media at the Pediatric Transgender Clinic at Nashville’s Monroe Carell Jr. Children’s Hospital, prompting Gov. Bill Lee to call for an investigation into the clinic. Vanderbilt University Medical Center’s Pediatric Transgender Clinic confirmed that an average of five patients per year, all 16 or older, received surgeries, and none received genital surgeries. VUMC put a pause on surgeries in October 2022 and stopped providing care at the clinic in June 2023, ahead of the law going into effect in July 2023.
Banned gender-affirming health care for youth forces families to flee the state
As the bill was making its way through the state legislature, those with lived experience told the Scene that access to gender-affirming medical procedures including hormone therapy, puberty blockers and surgeries has never been simple, widely accessible or affordable. Families of transgender minors have opted to flee the state too.
“Gender-affirming care is proven to save lives,” says nonprofit the Tennessee Equality Project in a press release. “Major medical associations, including the American Academy of Pediatrics and the American Medical Association, support gender-affirming medical and psychological care because it saves lives and improves mental well-being. Providers, pediatricians, and specialists have been making thoughtful, evidence-based, and age-appropriate health care decisions with families and transgender patients for decades.”
