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Dissenting Justice Sonia Sotomayor wrote that "there is no constitutional justification" for the decision, and access to gender-affirming care "can be a question of life or death."
LGBTQ+ advocates decried Wednesday's U.S. Supreme Court decision upholding Tennessee's prohibition on gender-affirming medical treatments for minors as a dangerous green light for states to violate personal privacy and ban healthcare that many transgender people say saved their lives.
Writing for the 6-3 majority in U.S. v. Skrmetti, Chief Justice John Roberts stated that S.B. 1, Tennessee's 2023 ban on gender-affirming care for people under age 18, does not violate the equal protection clause of the 14th Amendment. The majority concurred with a lower court's ruling that S.B. 1 is not subject to heightened scrutiny, a standard of judicial review also known as intermediate scrutiny used to determine a law's constitutionality, especially in cases involving classifications based on sex or gender.
"The Supreme Court is green-lighting the eradication of trans people from society."
"This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field," Roberts wrote. "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."
"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 14th Amendment," the ruling adds. "Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process."
BREAKING: In a 6-3 Roberts decision, the Supreme Court has ruled that Tennessee's ban on gender affirming care is not subject to heightened scrutiny. This decision will strip millions of trans people off their constitutional rights.www.supremecourt.gov/opinions/24p...
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— Alejandra Caraballo (@esqueer.net) June 18, 2025 at 7:17 AM
Roberts was joined in the majority by right-wing Justices Clarence Thomas, Samuel Alito, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett. Liberal Justices Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson dissented.
Sotomayor wrote in her dissent that "there is no constitutional justification" for the decision, which "does irrevocable damage to the equal protection clause and invites 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 continued:
Transgender adolescents' access to hormones and puberty blockers... is not a matter of mere cosmetic preference. To the contrary, access to care can be a question of life or death. Some transgender adolescents suffer from gender dysphoria, a medical condition characterized by clinically significant and persistent distress resulting from incongruence between a person's gender identity and sex identified at birth. If left untreated, gender dysphoria can lead to severe anxiety, depression, eating disorders, substance abuse, self-harm, and suicidality. Suicide, in particular, is a major concern for parents of transgender teenagers, as the lifetime prevalence of suicide attempts among transgender individuals may be as high as 40%. Tragically, studies suggest that as many as one-third of transgender high school students attempt suicide in any given year.
S.B. 1—introduced by Tennessee state Sen. Jack Johnson (R-23)—who was also behind the state's public drag ban—prohibits minors from undergoing hormone therapy or taking prescribed puberty blockers. Three transgender teens and their parents, as well as a Tennessee doctor who treats trans youth, challenged the law, claiming it violated the equal protection clause.
The plaintiffs were joined by the Biden administration along with the national and state ACLU, Lambda Legal, and the law firm Akin Gump Strauss Hauer & Feld LLP in asking the Supreme Court to review the ban after the 6th U.S. Circuit Court of Appeals upheld it in September 2023.
Responding to Wednesday's ruling, Allison Scott of the Campaign for Southern Equality—which manages the Trans Youth Emergency Project (TYEP)—said: "I am heartbroken today. No one should be forced to leave their home state to access healthcare—and it is outrageous to see the U.S. Supreme Court uphold these bans and continue to allow the government to interfere with the personal medical decisions of families."
Scott was alluding to the argument often made by proponents of bans on not only trans healthcare but also abortion and other reproductive rights that people seeking such care are free to go where it is legal—even as some states pass laws banning such travel.
There are approximately 300,000 people aged 13-17 and 1.3 million adults in the United States who identify as transgender, according to the Williams Institute at the University of California, Los Angeles School of Law, which notes that more than two dozen states have passed laws similar to S.B. 1.
(Image: Human Rights Campaign Foundation)
Transgender activist Alejandra Caraballo, a civil rights attorney and instructor at the Harvard Law School Cyberlaw Clinic, said on the social media site Bluesky, "I can't begin to tell you just how incredibly fucked trans people are here."
"This will pour gasoline on the Trump administration's attacks on trans people and they will get even harsher and more cruel," Caraballo added. "The Supreme Court is green-lighting the eradication of trans people from society."
Caraballo and others including the ACLU and trans rights activist Erin Reed noted that the decision is somewhat limited because it leaves previous rulings against anti-trans laws intact. However, Caraballo warned that "while the decision didn't explicitly say heightened scrutiny doesn't apply to all contexts involving trans people, it held that it was on the basis of medical diagnosis."
Therefore, "the government could just do whatever it wants to trans people based on gender dysphoria," she wrote. "For instance, they could strip everyone with gender dysphoria of security clearance in the government. Declare everyone with gender dysphoria a national security threat and purge them from the government entirely. The trans military ban will be upheld under this."
"Most importantly, states can now just ban gender-affirming care for everyone, including adults," Caraballo added. "We'll likely see that coming soon in addition to federal government efforts to eliminate access for all trans people."
"This will pour gasoline on the Trump administration's attacks on trans people."
U.S. President Donald Trump has renewed and expanded his first-term attacks on transgender people, including by issuing a day one executive order declaring that only two genders exist, another order advocating action against educators who "facilitate the social transition of a minor," and yet another directing the Department of Education—which he has vowed to abolish—to notify school districts that allowing transgender girls and women to compete on female teams violates Title IX, the federal law prohibiting discrimination on the basis of sex in education.
Trump also appointed a transphobe to head the Justice Department's civil rights office, ordered the removal transgender people and issues from federal agency websites, and reinstated his first-term ban on new military enlistment by trans people, who—according to the White House—cannot lead an "honorable, truthful, and disciplined lifestyle."
"Every day I speak with families of transgender youth who are worried about the future," TYEP patient navigator Van Bailey said after Wednesday's ruling. "Many are panicking, unsure of where or when they'll get the medicine that their child needs to continue leading a healthy, happy life. These laws are cruelly thrusting families into impossible choices, and it is deeply unfair."
As we wait for legal guidance from our partners at @aclu.org and @lambdalegal.org, we want to share what we already know:The Supreme Court’s decision in U.S. v. Skrmetti is devastating, and we will not stop fighting.
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— Christopher Street Project (@christopherstreet.bsky.social) June 18, 2025 at 8:34 AM
ACLU LGBTQ & HIV Project co-director Chase Strangio—the first openly trans attorney to argue before the Supreme Court—said that "today's ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution."
However, Strangio also noted that "the court left undisturbed Supreme Court and lower court precedent that other examples of discrimination against transgender people are unlawful."
"We are as determined as ever to fight for the dignity and equality of every transgender person and we will continue to do so with defiant strength, a restless resolve, and a lasting commitment to our families, our communities, and the freedom we all deserve," he added.
Jennifer Levi, senior director of transgender and queer rights at GLAD Law, said in a statement that "the court today failed to do its job."
"When the political system breaks down and legislatures bow to popular hostility, the judiciary must be the Constitution's backbone," Levi added. "Instead, it chose to look away, abandoning both vulnerable children and the parents who love them. No parent should be forced to watch their child suffer while proven medical care sits beyond their reach because of politics."
"When the political system breaks down and legislatures bow to popular hostility, the judiciary must be the Constitution's backbone."
National Center for LGBTQ Rights legal director Shannon Minter asserted: "The court's ruling abandons transgender youth and their families to political attacks. It ignored clear discrimination and disregarded its own legal precedent by letting lawmakers target young people for being transgender."
"Healthcare decisions belong with families, not politicians," Minter added. "This decision will cause real harm."
Sasha Buchert, counsel and director of the Nonbinary and Transgender Rights Project at Lambda Legal, called the ruling "heartbreaking" and contended it will make it "more difficult for transgender youth to escape the danger and trauma of being denied their ability to live and thrive."
"But we will continue to fight fiercely to protect them," Buchert added. "Make no mistake, gender-affirming care is often lifesaving care, and all major medical associations have determined it to be safe, appropriate, and effective. This is a sad day, and the implications will reverberate for years and across the country, but it does not shake our resolve to continue fighting."
The Supreme Court’s Skrmetti decision is a pivotal moment in our fight for LGBTQ+ equality. Here are three ways to TAKE ACTION:
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— Human Rights Campaign (@hrc.org) June 18, 2025 at 9:26 AM
Human Rights Campaign (HRC), Lambda Legal, and other advocacy organizations are planning to hold a "decision day" rally at noon Wednesday outside the Supreme Court in Washington, D.C.
HRC lamented that Skrmetti "sets a dangerous precedent and threatens access to care for trans people across the country."
"We are showing up loud and clear: We will not go back," HRC said. "We will not be erased."
"This order will kill kids, there's no other way to say it," asserted one critic.
In his administration's latest attack on LGBTQ+ Americans, Republican U.S. President Donald Trump on Tuesday issued an executive order banning the federal government from supporting a wide range of gender-affirming healthcare for transgender youth.
Trump's order—titled "Protecting Children From Chemical and Surgical Mutilation"—states that the federal government "will not fund, sponsor, promote, assist, or support the so-called 'transition' of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures."
"Child" is defined in the order as anyone younger than 19—including 18-year-old adults. The directive covers treatments and procedures including gender-affirming surgeries, puberty blockers, and hormone replacement therapy. The ban will adversely affect people who rely upon federal programs including Medicare, Medicaid, and TRICARE, through which the Department of Defense provides health coverage for nearly 2 million youth dependents.
This order will kill kids, there's no other way to say it. It's the government forcibly taking control of the bodies of thousands of children.
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— Katelyn Burns (@katelynburns.com) January 28, 2025 at 3:19 PM
Furthermore, the order—which is almost certain to be challenged in court—places hospitals, clinics, and other providers of gender-affirming care at risk of losing federal funding.
"This executive order is a brazen attempt to put politicians in between people and their doctors, preventing them from accessing evidence-based healthcare supported by every major medical association in the country," Kelly Robinson, president of the LGBTQ+ advocacy group Human Rights Campaign, said in a statement. "It is deeply unfair to play politics with people's lives and strip transgender young people, their families, and their providers of the freedom to make necessary healthcare decisions."
"Questions about this care should be answered by doctors—not politicians—and decisions must rest with families, doctors, and the patient," Robinson added. "Everyone deserves the freedom to make deeply personal healthcare decisions for themselves and their families—no matter your income, zip code, or health coverage."
Trump made opposing rights for transgender people—especially children—a major part of his 2024 campaign, as it was during his first term.
The president's executive order claims that "medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child's sex through a series of irreversible medical interventions."
"This dangerous trend will be a stain on our nation's history, and it must end," asserts the directive, which dubiously claims that "countless children soon regret that they have been mutilated and begin to grasp the horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding."
However, trans advocate Erin Reed pushed back, noting on social media that "detransition is rare, 1-4% in most studies, and regret even lower."
Furthermore, many doctors and medical experts agree that gender-affirming care saves the lives of trans youth, who are at higher risk of suicide and other self-harm, partly due to discrimination, bullying, and other societal pressures.
Trans people and their allies are already fighting back against Trump's policies. On Tuesday, half a dozen active-duty transgender U.S. troops and two people seeking to join the military sued to block a revival of the president's first-term ban on trans people enlisting in the armed forces.
The previous day, a transgender woman inmate in a federal women's prison sued the Trump administration over a recent executive order narrowly defining sex, arguing it is motivated by hate, violates the Constitution's ban on cruel and unusual punishment, and places her in mortal danger if she is transferred to a men's facility as ordered by the government.
In stark contrast with the direction in which Trump is steering the U.S., health officials in Thailand—which last year became the first nation in Southeast Asia to legalize same-sex marriage equality—this week announced a multimillion-dollar initiative to provide gender-affirming care for 200,000 transgender people in the country.
Thai Prime Minister Paetongtarn Shinawatra said last week that the marriage equality law, which went into effect this month, "marks the beginning of Thai society's greater awareness of gender diversity, and our embrace of everyone regardless of sexual orientation, race, or religion—our affirmation that everyone is entitled to equal rights and dignity."
"We do not need to spend almost a trillion dollars on the military, while half a million Americans are homeless and children go hungry," said Sen. Bernie Sanders.
The United States Senate overwhelmingly passed an $895 billion military funding bill on Wednesday as critics blasted what many called misplaced spending priorities and highly controversial provisions that ban gender-affirming health coverage for children of active-duty service members and prohibit the Pentagon from citing casualty figures issued by the Gaza Ministry of Health.
Senators voted 85-14 for the National Defense Authorization Act (NDAA) for fiscal year 2025. The following senators voted against the legislation: Tammy Baldwin (D-Wis.), Cory Booker (D-N.J.), Mike Braun (R-Ind.), Andy Kim (D-N.J.), Mike Lee (R-Utah), Ed Markey (D-Mass.), Jeff Merkley (D-Ore.), Rand Paul (R-Ky.), Bernie Sanders (I-Vt.), Adam Schiff (D-Calif.), Debbie Stabenow (D-Mich.), Elizabeth Warren (D-Mass.), Peter Welch (D-Vt.), and Ron Wyden (D-Ore.). Sen. JD Vance (R-Ohio), the vice president-elect, did not vote on the bill.
"We do not need to spend almost a trillion dollars on the military, while half a million Americans are homeless and children go hungry," Sanders explained earlier this month.
The peace group CodePink said it was "disappointed" by the Senate's passage of the NDAA, "which allocates nearly $1 trillion in taxpayer dollars to weapons and warfare while essential services like healthcare, education, food, and housing remain underfunded."
"Half of the budget will go directly to the pockets of private military companies in the form of contracts and weapons deals," the group continued. "On top of the massive topline and the large allocation to private companies, the Pentagon has never been able to pass an audit. Much like every Pentagon budget before, this money will be largely unaccounted for, with very little transparency."
"This budget is a huge slap in the face to working-class families who are struggling to make ends meet," CodePink added.
An amendment introduced on Monday by Baldwin and co-sponsored by two dozen of her Democratic colleagues "to remove language that would strip away service members' parental rights to access medically necessary healthcare for their transgender children" failed to pass.
Speaking on the Senate floor on Tuesday, Baldwin said that Congress has "broken" its commitment to the troops "because some Republicans decided that gutting the rights of our service members to score cheap political points was more worthy."
"We're talking about parents who are serving our country in uniform, having the right to consult their family's doctor and get the healthcare they want and need for their transgender children," she added. "Some folks poisoned this bill and turned their backs on those in service and the people that we represent."
Olivia Hunt, director of federal policy at Advocates for Trans Equality, said in a statement Wednesday that "every military family deserves respect and access to essential healthcare—free from the interference of political agendas."
Hunt continued:
Denying lifesaving, medically necessary care to trans members of military families creates profound hardships, forcing service members to make impossible choices between their duty and the health and well-being of their loved ones. Politicizing access to evidence-based healthcare undermines the principles of fairness, dignity, and respect that our nation aspires to. No one should have to choose between their duty and protecting their family.
By passing this harmful legislation, the Senate has failed our service members and their families. This decision prioritizes political gamesmanship over the dignity, rights, and well-being of those who serve our nation and sets a dangerous precedent of governmental overreach into decisions that should remain between doctors and families.
Some advocates including Hunt want President Joe Biden to veto the bill.
"If signed by the president, the passage of the NDAA will mark the first piece of federal legislation to restrict access to medically necessary healthcare for transgender adolescents," Hunt added. "It would be heartbreaking for an administration that has sought to advance the rights of LGBTQI+ Americans more than any other to date, to enact a law that would endanger countless trans youth. We urge President Biden to take a strong stance for trans youth and their families and veto this bill."
Congress has passed the NDAA, which contained a provision banning the coverage of gender affirming care for the children of active duty military. This is the first anti-LGBTQ bill to pass congress in almost 3 decades but certainly won't be the last. This will be Biden's legacy.
— Alejandra Caraballo ( @esqueer.net) December 18, 2024 at 10:02 AM
Human Rights Campaign president Kelley Robinson said that "President Biden has the power to put a stop to this cruelty."
"He should make good on his promises to protect LGBTQ+ Americans, defend military service members and their families, and ensure this country's politics reflect the best of who we are," Robinson added. "President Biden must veto this bill."
The NDAA also contains a provision prohibiting the Department of Defense from officially citing "fatality figures that are derived by United States-designated terrorist organizations" or governmental entities or organizations that rely upon such data. Critics say the measure is meant to censor the truth about Israel's 14-month assault on Gaza, which has left more than 162,000 Palestinians dead, maimed, or missing. Various United Nations agencies, international charities and rights groups, and even the Israeli military and U.S. State Department have cited Gaza Health Ministry casualty figures, which have been deemed accurate—and likely an undercount—by experts around the world, including Israeli military intelligence and U.S. officials.
"In other words," Security Policy Reform Institute co-founder Stephen Semler said of the provision, "it's effectively a ban on talking about deaths in Gaza."