Supreme Court Upholds Ban on Transgender Surgeries for Minors

By Michael Ippolito

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In a landmark decision, the Supreme Court upheld a Tennessee law banning “gender-affirming” care for minors. In United States v. Skrmetti, the Court ruled that the restriction of certain medical care to minors did not violate the 14th amendment because the prohibition is not based of sex, but rather the prohibition is based on age and medical use.  

The recent ruling not only protects minors from dangerous life-altering surgeries, but it also provides protections for religious liberty. The Court’s decision allows states to ban “gender-affirming” care for minors, which will protect children and religious communities from the harm of these procedures.  

In 2023, Tennessee enacted law (SB1) restricting sex transition treatments, such as cosmetic surgeries and hormone replacement therapies, for minors. The legislature found that while confusion about one’s gender can cause “discomfort or distress,” the treatments pose a grave concern to the well-being and safety of minors.  

Three minors, their parents, and doctors sued the state claiming the law violated the Equal Protection Clause of the 14th Amendment. Following lower court decisions that upheld the Tennessee law, the United States, under the Biden administration, appealed the decisions.  

The Court ruled the lower court rulings were correct, stating that the legislature only needs to show a legitimate reason for the law to be constitutional.

Chief Justice John Roberts, writing for the majority, argued that SB1 “clearly does not classify on the basis of sex.” Roberts stated that the two classifications were that “healthcare providers may not administer puberty blockers or hormones to minors a classification based on age to treat gender dysphoria, gender identity disorder, or gender incongruence (a classification based on medical use).” Roberts explained that “there is a ‘lack of identity’ between transgender status and the excluded diagnoses.”

Since the statute excluded access to medical treatments based on age and medical use, the Court found that the prohibitions did not “exclude any individuals on the basis of transgender status,” which allows the Court to uphold the statute so long as the legislature provides a legitimate reason.  

Finally, Roberts rejected the applicability of the reasoning of the 2020 Bostock decision, which interpreted discrimination “because of sex” to including sexual orientation and gender identity for employment discrimination claims under Title VII of the Civil Rights Act. The Court in Skrmetti refused to extend the logic in Bostock because “sex” is “simply not a but-for cause of [the Tennessee law’s] operation.” Fortunately, Skrmetti refuses to continue the problematic trend of including sexual orientation and gender identity in the definition of “sex.”

Justice Clarence Thomas agreed with this point in his concurrence writing that Bostock’s majority opinion “fails on its own terms” and applying Bostock to this issue “would depart dramatically from this Court’s Equal Protection Clause jurisprudence,” so the “courts need not engage Bostock at all.” Thomas also cited research that supported Tennessee’s legitimate interest since the surgeries pose harmful risks to minors.  

Justice Samuel Alito defends the decision not to include transgenderism as a classification suspect to a form of heightened scrutiny because it is not “sufficiently similar to race, national origin, or sex to warrant a higher level of scrutiny.” Unlike the latter categories, Alito argues that transgenderism is “not an immutable characteristic” that would requires courts to be more suspicious of laws that “discriminate” on issues regarding sexual orientation and gender identity. Alito does not deny any discrimination that transgender people have faced, but states there is no “extraordinary showing that [transgenders] are entitled to a higher level of constitutional scrutiny.”  

In dissent, the three liberal justices on the court lamented the decision stating that “the Court today renders transgender Americans doubly vulnerable to state sanctioned discrimination.”  

States now have the ability to ban life-altering surgeries for minors, with sufficient judicial precedent to support their efforts.  

Thomas wrote in his concurrence that “the Court today reserves to the people, their elected representatives, and the democratic process the power to decide how best to address an area of medical uncertainty and extraordinary importance. That sovereign prerogative does not bow to ‘major medical organizations.’”

While Skrmetti provides a victory against the threat that “gender-affirming” surgeries pose to the safety of children, it is also a victory for religious communities. Parents will no longer have to worry about their children being offered life-altering surgeries that violate their fundamental beliefs regarding the human person. Additionally, states are now free to enact laws in accordance with a proper understanding of sex and human nature.

The decision now empowers the state legislature to take substantial action to protect children and religious communities from dangerous life-altering surgeries.