The United States v. Skrmetti gender-affirming care decision by SCOTUS is a major insult to trans Americans and to common sense
The right-wing MAGA Majority on SCOTUS ruled 6-3 to permit Tennessee's heinous anti-trans law (SB1) banning gender-affirming care for trans minors to stand.
On Wednesday morning, 6 right-wing MAGA Majority black robed judicial activists on America’s highest court-- the Supreme Court-- saw fit to rule in favor of terrorizing trans youths across America with their hateful and bigoted United States v. Skrmetti ruling upholding Tennessee’s cruel ban (SB1) on gender-affirming care for trans youths. The ruling could have disastrous impacts for trans youths (and adults) seeking gender-affirming care services.
The 6-3 SCOTUS opinion along party appointment lines in Skrmetti was authored by Chief Justice John Roberts, a Bush 43 appointee.
Orion Rummler and Kate Sosin at The 19th News (06.18.2025):
The Supreme Court on Wednesday ruled that Tennessee’s ban on gender-affirming care for transgender youth should remain in place. The court found that Tennessee’s law restricting certain medical treatments for trans minors does not violate the 14th Amendment’s equal protection clause — a finding that experts worry will set new precedent for how transgender people can be treated under the U.S. Constitution.
This 6-3 opinion, signed by Chief Justice John G. Roberts Jr., will further restrict a form of health care that has been increasingly banned for transgender youth across the country, both by Republican state lawmakers and by the Trump administration. Twenty-five states ban hormone replacement therapy and puberty blockers for trans youth, as well as surgeries, which are rare for minors; two other states ban only surgeries. Of those 25 states, six have made it a felony for medical providers to administer gender-affirming care, according to the Movement Advancement Project, which tracks LGBTQ+ policy.
Roberts wrote that “the voices in these debates raise sincere concerns; the implications for all are profound.” He emphasized, however, that the court’s role is to ensure that the law does not violate the equal protection clause. “Having concluded that it does not,” he added, “we leave questions regarding its policy to the people, their elected representatives, and the democratic process.”
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Although this case impacts specifically Tennessee, the Supreme Court has now signaled that it does not plan to intervene when other states restrict medical care for trans youth. This may embolden more states to ban the care and it could also complicate ongoing lawsuits against current state bans. At least 110,000 transgender youth already live in states that restrict or limit gender-affirming care access, according to the Williams Institute at UCLA School of Law. Many families of trans kids have left these states to find health care elsewhere — and so have the doctors providing it.
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Opponents of gender-affirming care say that teenagers starting hormone replacement therapy — and pre-pubescent children taking puberty blockers — are too young to make these medical decisions. However, opponents often inaccurately portray the care as rushed, sloppy or even akin to mutilation. To obtain gender-affirming care, a young trans person works with their parents and doctors over the course of months or years to prove that medical intervention is right for them. Medical providers stress that there is not a “one-size-fits-all” approach and that side effects, like the risk of decreased bone density when taking puberty blockers, are closely monitored and communicated to patients.
Erin Reed at Erin In The Morning on the impact of the United States v. Skrmetti ruling by SCOTUS (06.18.2025):
Today, the Supreme Court issued a devastating 6-3 ruling in United States v. Skrmetti, upholding Tennessee’s ban on gender-affirming care for minors and delivering a major blow to transgender rights. The case raised foundational constitutional questions: whether transgender people constitute a class triggering higher constitutional scrutiny, whether laws targeting them violate equal protection, and whether the Constitution guarantees their right to access medically necessary treatment. The Court sidestepped nearly all of those questions, instead issuing a narrower opinion that carves out an exception permitting medical discrimination based on “gender dysphoria”—a distinction it bizarrely treats as separate from discrimination against transgender people. The ruling effectively greenlights medical care bans across the country and may pave the way for broader restrictions, including for adults, while leaving lower court rulings on bathrooms, schools, sports, and employment remain intact—for now.
In its ruling, the majority opinion of the Supreme Court states that it does not need to address whether or not discrimination against transgender people is sex discrimination because the Tennessee law banning gender affirming healthcare for trans youth is based on “gender dysphoria.”
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While the ruling is sweeping in its implications for transgender medical care—and could easily be used to justify future restrictions on adult care—the majority sidestepped key constitutional questions. The Court declined to answer whether discrimination against transgender people constitutes sex discrimination, whether transgender people qualify as a protected class warranting heightened scrutiny, or whether the Bostock decision applies beyond the Title VII employment context. A ruling on any of these issues could have turned an already devastating outcome into a catastrophic one, potentially overturning dozens of lower court decisions on bathroom access, forced outing in schools, and participation in sports. Though the majority avoided that outcome, three justices—Justices Samuel Alito, Clarence Thomas, and Amy Coney Barrett—wrote separately to express that they would have gone further, explicitly denying transgender people equal protection under the law.
Several rulings in recent months will remain unaffected by the Court’s decision.
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The decision will send shockwaves through the transgender community. By embedding discrimination into Supreme Court precedent, the justices have ensured that transgender Americans will likely spend a generation clawing back rights now imperiled. And yet, the ruling leaves cracks in the foundation—enough space, for now, to regroup and keep fighting. Protective laws in many states remain on the books. Key court victories still stand. It is in those openings, however narrow, that hope persists—and where the fight continues.
Ryan Grenoble at HuffPost on SCOTUS Justice Sonia Sotomayor’s Skrmetti dissent for the ages (06.18.2025):
Supreme Court Justice Sonia Sotomayor issued a bitter dissent Wednesday, reading it aloud from the bench after the Supreme Court upheld a Tennessee law that bans gender-affirming care for minors on a 6-3 vote.
“By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent,” said Sotomayor.
“Transgender adolescents’ access to hormones and puberty blockers (known as gender-affirming care) is not a matter of mere cosmetic preference. To the contrary, access to care can be a question of life or death.”
Transgender people already have to contend with structural discrimination, noted Sotomayor, because they’re extremely underrepresented in government and therefore unable to use political power to ward off discriminatory treatment.
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The justice said the court’s willful ignorance of that fact “does irrevocable damage to the Equal Protection Clause” and invites state legislatures to “engage in discrimination by hiding blatant sex classifications in plain sight.”
“It also authorizes, without second thought, untold harm to transgender children and the parents and families who love them,” she said in closing. “Because there is no constitutional justification for that result, I dissent.”
Ray Hartmann pulls no punches on the cruelty of the Skrmetti ruling in his Substack column (06.18.2025):
The U.S. Supreme Court signed some death warrants today.
By a partisan 6-3 majority, SCOTUS allowed to stand a Tennessee law that bans gender-affirming care for transgender minors. Even when those kids have the full support of their parents and doctors.
That will in turn unleash similar attacks on trans kids and their families in at least 25 other states, including Missouri. The victims will be the kids who comprise one of the most vulnerable subgroups in America—with shocking rates of suicidal thoughts and attempts.
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Real kids in the real world will die because of today’s decision. If that comment offends you, so be it. It’s the truth.
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When it comes to healthcare, there are no competing civil-liberties issues. When a child receives puberty blockers or other gender-affirming care that’s approved and recommended by an overwhelming majority of medical professionals, no other person’s liberty is compromised.
Trans people aren’t hurting a soul when they receive medical care to help them live their lives to the fullest, as they and their parents see fit. Today, they are victims of a judicial system that should have protected them from the vagaries of our darkest politics.
Hartmann is 100% correct on the trans health issue.
Molly Sprayregen at LGBTQ Nation on how SCOTUS Justices Amy Coney Barrett and Clarence Thomas’ concurrence in Skrmetti would have been even more harmful to trans people (06.18.2025):
While Chief Justice John Roberts wrote the opinion for the majority, Justice Amy Coney Barrett wrote a concurring opinion with Justice Clarence Thomas that is causing extreme concern.
Roberts, in the majority opinion, wrote that the Tennessee’s ban doesn’t discriminate on the basis of sex or on the basis of transgender status, saying that it only makes distinctions based on a diagnosis of gender dysphoria, but Barrett and Thomas said they believe that even if a law merely outright targeted trans people, it still would not trigger heightened scrutiny since trans people should not be a considered a suspect class since “the boundaries of the group… are not defined by an easily ascertainable characteristic that is fixed and consistent across the group.”
S. Baum at Erin In The Morning on the impacts of the Trump Regime’s anti-trans policies and the Skrmetti ruling it has for trans health clinics, in which too many of them have preemptively complied (06.19.2025):
It is among the latest gender care facility to cease or restrict its care amidst the Trumpian anti-trans wave, which resulted in a series of executive orders signed at the beginning of his second term. Subsequently, the Centers for Medicare and Medicaid Services sent a May 28 letter to hospitals across the country pushing a pseudoscientific report on trans-affirming health care, penned by an anonymous panel of government “experts.” It demanded that, within 30 days, gender-affirming care providers have to fork over detailed financial records pertaining to the care of trans patients. It also directed providers to create new treatment guidelines replacing globally-renowned best practices with the recommendations of Trump’s highly propagandized report.
A recent statement by the World Professional Association for Transgender Health (WPATH) denounced this report in the strongest terms, arguing that while ongoing research is still vital, Trump’s report is both dangerous and wrong.
“Policies affecting transgender health must be informed by recognized experts and guided by clinical evidence, not ideology,” it said.
Nonetheless, new closures and restrictions may be imminent in the aftermath of Wednesday’s Skrmetti decision, in which SCOTUS greenlit anti-trans health care bans for youth.
Moira Donegan wrote in The Guardian that the Skrmetti ruling undermines gender equality, in addition to undermining the trans community (06.19.2025):
The justices decided to start by attacking vulnerable children. In a 6-3 split, the court’s conservatives ruled on Wednesday that Tennessee’s law banning transition-related healthcare for minors can remain in effect. The law prohibits hormone therapies and surgeries only for their use in treating gender dysphoria; cisgender minors retain access to these drugs. The statute is on its face sex-specific and designed to mandate certain forms of gender conformity: the care that it bans, it bans on the basis of a patient’s sex. This is in straightforward violation of the 14th amendment’s equal protection clause, which has long been interpreted to ban facially sex-discriminatory laws and those that encourage sex-role stereotyping. The court decided to ignore this precedent and the plain intent of Tennessee’s statute, and in the process it both imposed a cruel and needless deprivation on trans children and their families, and also substantially weakened constitutional guarantees of equal protection of the sexes.
The ruling in United States v Skrmetti is likely to shield other bans on transition-related healthcare for minors, which are now on the books in most states. That alone will have a devastating impact on trans children, whom studies consistently show fare best under an affirmative model of care that retains the option to delay puberty or pursue cross-sex hormones – options that the court has now removed from these children and their parents. But the opinion’s reasoning suggests something broader, and darker, about the status of trans people under the law – with dire implications for queer people, women and anyone else not interested in or suited to living a neatly gender-conforming life. For in seeking to uphold Tennessee’s care ban, the court circumvented sex equality provisions in a way that seems to render moot much of the 14th amendment’s applicability to sex discrimination cases. Facially sex-discriminatory statutes are now broadly permissible, the court suggests, so long as they impose gendered limits on the conduct of people of both sexes.
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Skrmetti, after all, would not be possible without Dobbs, the supreme court’s most sweeping bigoted assertion that there is no sex discrimination in place when a medical procedure that is only needed on the basis of sex is prohibited to those who do and do not require it alike.
Skrmetti, which erodes sex equality under the 14th amendment, does not take aim at Bostock, the 2020 decision that found that discrimination based on sexual orientation and gender identity were prohibited under the sex equality provision of Title VII of the 1964 Civil Rights Act. But it is hard to imagine that a court with so much hostility towards the civil rights claims of the historically marginalized will continue to find that gay and trans people can claim protection from discrimination under that law, either. It is not hard to imagine Skrmetti, along with Dobbs, being the opening salvos in a broader legal assault on the status of women and queer people – one that removes our rights one by one, making us more and more vulnerable, and sanctioning more and more of our derision, degradation and unfreedom. At the very least, this week, the court ruled that gender conformity can be enforced, at least on children, by the state. All queer people – and all cis women who aspire to be free – have had their dignity demeaned as a result.
Chris Geidner wrote in Law Dork on why there isn’t more outrage over the harmful Skrmetti decision (06.19.2025):
But Wednesday was the result of a long-term campaign that ultimately succeeded. As same-sex couples succeeded in obtaining marriage equality in 2015, the far-right organizations who had used their opposition to those couples’ marriage rights to fund their work needed a new cause.
The far right moved on to attacking transgender people. The animosity from the right — and others — toward trans people wasn’t new, but as the marriage outcome became clear, the shift of focus began.
They went after trans people’s use of bathrooms. North Carolina’s 2016 “bathroom bill“ backfired. Gov. Pat McCrory lost re-election, and the swing state has been led by Democratic governors since. But, bathrooms have always been targets for moral panic, so the issue eventually returned.
Starting in Idaho in 2020, they went after trans people’s participation in sports. That got some traction, particularly as the campaign moved on.
Then, starting in Arkansas the next year, they went after trans kids’ medical care.
They were just going to keep going until they got something that pushed them into the spotlight.
Even when lawmakers started passing bans on gender-affirming medical care for transgender minors, however, judges of all stripes started blocking them as likely unconstitutional.
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But, as that political effort was happening, something else was going on as well.
The right wanted to turn these issues — largely non-issues in the vast majority of people’s lives — into Big Issues of Major Concern. They tried for years care of the right-wing noise machine, and that pushed the stories out. Then, however, the people who wanted to make trans kids’ lives an issue convinced some mainstream publications to pick up this as their issue.
The Atlantic put its “just asking questions” story about trans kids on their cover in the summer of 2018. Seeing smoke, The New York Times began looking for fire with a series of longform stories targeting trans youth care. They weren’t alone. (Even on other trans issues, ahem.) In the end, so-called “thought leader” publications played key roles in bringing forth this week, giving oxygen to extremists and creating a story.
Yesterday the Supreme Court declared that trans people don’t have any rights that the government is obliged to respect.
Many others are parsing the legal ramifications and the exact consequences for trans people in red states and across the nation. I don’t really have the heart or expertise for that.
So instead, I just wanted to say: it is good that trans people exist. Trans people make the world a better place.
We are all better off in a world where people can become who they are, even if who they become surprises their parents, friends, teachers, employers, and political representatives. We are better off in a world where human flourishing takes many forms, and where people are allowed to find the form and shape and life that fits them. We are all better off when we recognize that other people’s expectations and assumptions and rigid categories don’t define us, and that only we can define ourselves.
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The Supreme Court has a lot of power; fascists have a lot of power. They can in fact harm people. They can harm trans people; they can harm their families; they can harm everyone who benefits from trans people living and flourishing, which is everyone.
What they can’t do is make trans people disappear. Trans people have always existed and they will always exist. It’s up to everyone to make a world in which they can flourish, not least because that’s the only world in which we all can flourish.
My Substack post on Trump’s war on trans people (01.30.2025):
Tuesday afternoon, anti-trans bully Donald Trump signed a wickedly bigoted and transphobic executive order banning federal funding and support for gender-affirming care for minors under 19. This hateful executive order contradicts many medical associations and was premised on the false basis of “protecting” children from “mutilation” and “sterilization.”
This extreme EO will impact hospitals, health insurance, and more. This is yet another attack on blue states, which should consider defying this nonsense EO and potentially consider secession.
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Trump’s extreme prejudiced and un-Christian policies harming trans people serve one purpose: to erase trans existence from public spaces.
My Substack post on Skrmetti’s impacts on trans people (12.03.2024):
Tomorrow, there is a big case on the docket at SCOTUS that will be heard for oral arguments and the biggest one this term: United States v. Skrmetti. The Skrmetti case deals with gender-affirming care, more specifically Tennessee SB1 which bans GAC in the state for trans minors. We are hoping and praying that the MAGA Majority on SCOTUS sees the wisdom of protecting trans children by ruling against Tennessee’s short-sighted ban on gender-affirming care for minors.
If the MAGA Majority on SCOTUS rules in favor of Tennessee in Skrmetti, then there is a serious risk for a nationwide ban on gender-affirming healthcare for trans youths (and possibly even adults) that will get forced upon Blue states like Minnesota, Illinois, and California, such a move would be good cause for Blue states to resist such a lawless ruling and be a step towards Blue state secession.
Joel Zapata wrote in Time Magazine on how the modern Lavender Scare ties into the Skrmetti ruling and attacks on LGBTQ+ rights (06.20.2025):
The rollback of LGBTQ rights and inclusion echoes an often overlooked, but deeply consequential, chapter of American history: the Lavender Scare. During the Cold War, U.S. officials branded gay and lesbian Americans as national security threats, fueling a moral panic that reshaped American society and stigmatized countless individuals. The legacy of the Lavender Scare era continues to influence America’s culture and political landscape.
The Lavender Scare emerged in the early 1950s alongside the Red Scare. But while Red Scare proponents like Senator Joseph McCarthy and others linked homosexuality to communism, the campaign against LGBTQ Americans operated on distinct ideological grounds. A 1950 State Department memo, titled “Problem of Homosexuals and Sex Perverts in the Department of State,” linked tolerance of “homosexuality with the accompanying decline of the Egyptian, Greek and Roman Empires” and argued that the United States, as the modern global power, had to purge gay and lesbian individuals to survive the Cold War. The State Department took heed of such harmful, and ahistorical, rhetoric.
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The Lavender Scare devastated the lives of queer people and for decades redefined American ideas of citizenship and belonging along narrower parameters. Today’s political efforts to purge queer people and curtail their rights are not new—they are part of a longer history of exclusion and marginalization. Understanding that history is essential to confronting the present.
The Skrmetti decision is a nightmare for trans youths across America, but it could have been much more fatal if Thomas and Coney Barrett had gotten their way.
Still, this decision is nothing more than a sickening gut punch for trans Americans and their family members that use gender-affirming care services, as Sotomayor’s dissent said it best: “access to care can be a question of life or death.”
The trans community and their allies will continue to fight for trans equality, even after this setback by SCOTUS.
And as always, protect trans kids!
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