United States v. Skrmetti (2025): The Supreme Court’s New Test for Transgender Rights and Equal Protection

Abstract

The Supreme Court’s decision in United States v. Skrmetti (2025) is a landmark case shaping the future of transgender rights and constitutional law in the United States.

In a 6–3 decision, the Court upheld Tennessee’s Senate Bill 1 (SB 1), which prohibits gender-affirming care—including puberty blockers, cross-sex hormones, and related surgeries—for minors.

The majority opinion, authored by Chief Justice Roberts, applied rational basis review instead of heightened scrutiny, concluding that the law regulates medical procedures and age classifications rather than targeting transgender individuals directly.

This shift in legal reasoning marks a significant departure from precedents like Bostock v. Clayton County (2020).

The dissent, led by Justice Sotomayor, argued that Tennessee’s law functionally discriminates against transgender minors, making heightened scrutiny under the Equal Protection Clause necessary.

The ruling carries broad implications:

1. Empowers states to regulate or restrict gender-affirming healthcare for minors.
2. Signals the Court’s reluctance to expand constitutional protections for gender identity.
3. Establishes a framework where transgender issues may be reframed as “neutral medical regulations” rather than rights-based questions.

Introduction

In 2023, Tennessee passed Senate Bill 1 (SB 1) restricting access to gender-affirming medical care for minors, including:

• Puberty blockers
• Cross-sex hormone treatments
• Surgical interventions

The law framed its purpose as protecting minors from interventions deemed “experimental or insufficiently studied.”

Legal Challenges

• Plaintiffs, including the ACLU and the Human Rights Campaign, argued that SB 1 violated the Equal Protection Clause and substantive due process rights under the Fourteenth Amendment.
• The district court issued a preliminary injunction, blocking enforcement of parts of the law.
• The Sixth Circuit Court of Appeals reversed the injunction, allowing SB 1 to take effect.
• Plaintiffs petitioned the U.S. Supreme Court, which granted certiorari.

Core Constitutional Questions

1. Does SB 1 constitute sex discrimination against transgender minors under the Equal Protection Clause?
2. Should heightened scrutiny apply, or is rational basis review sufficient?
3. How do state interests in regulating medical procedures for minors balance against constitutional rights?

On June 28, 2025, the Supreme Court issued its decision, upholding SB 1 in a 6–3 ruling.

Use of Legal Jargon

Equal Protection Clause

• Part of the Fourteenth Amendment.
• Prohibits states from denying any person equal protection of the laws.
• Petitioners argued SB 1 discriminates against transgender minors.

Rational Basis Review

• Most deferential judicial review standard.
• A law survives if rationally related to a legitimate government interest.
• Applied by the Court in Skrmetti.

Heightened/Intermediate Scrutiny

• Stricter standard than rational basis.
• Used for sex-based classifications.
• Dissent argued it should apply to transgender minors.

Substantive Due Process

• Protects fundamental rights not explicitly listed in the Constitution.
• Plaintiffs argued SB 1 infringed on medical decision-making rights.

Preliminary & Permanent Injunctions

• Preliminary injunctions temporarily block enforcement.
• SB 1 was initially blocked before reinstatement by the Sixth Circuit.

Class-of-One Claim

• Plaintiffs argue adverse treatment without rational basis.
• Not central to Skrmetti, but relevant for equal protection analysis.

Police Powers

• States’ authority to regulate health, safety, and welfare.
• SB 1 defended as an exercise of police power.

Facial vs. As-Applied Challenge

• Facial: unconstitutional in all cases.
• As-applied: unconstitutional in a specific context.
• Skrmetti involved both.

Compelling State Interest

• Justification required for laws infringing rights.
• Majority found Tennessee’s interest legitimate.

Severability

• If part of a law is struck down, the rest may remain valid.
• SB 1 included a severability clause.

The Proof: Data, Arguments & Authority

1. Petitioners’ Arguments

Equal Protection Violation

• SB 1 discriminates against transgender minors.
• Cited Bostock v. Clayton County (2020).

Substantive Due Process

• Parents and minors have a fundamental right to medical decisions.

Scientific Evidence & Harm

• Gender-affirming care reduces depression and suicidal ideation.
• Denial causes irreversible harm.

2. Respondents’ Arguments

Rational Basis

• SB 1 regulates procedures, not identity.
• Neutral, age-based regulation.

State Interest

• Medical uncertainty justifies protecting minors.

Precedent Distinguishing

• Bostock employment protections differ from medical regulations.
• Courts should defer to legislatures in medical matters.

3. Supreme Court Reasoning

Majority (Roberts, 6–3)

• Applied rational basis review.
• Law based on procedure and age, not transgender identity.
• Policy decisions fall within legislature’s domain.

Dissent (Sotomayor, Kagan, Jackson)

• SB 1 targets transgender youth in practice.
• Heightened scrutiny should apply.
• Rational basis review inadequate for vulnerable groups.

Case Law References

1. Bostock v. Clayton County (2020) – sex discrimination under Title VII.
2. Eknes-Tucker v. Ivey (2024) – Alabama’s similar law upheld.
3. Craig v. Boren (1976) – intermediate scrutiny for sex classifications.
4. Dobbs v. Jackson Women’s Health (2022) – state power over healthcare.
5. L.W. v. Skrmetti (6th Cir. 2023) – SB 1 upheld on appeal.
6. Geduldig v. Aiello (1974) – pregnancy exclusion not sex discrimination.
7. Obergefell v. Hodges (2015) – same-sex marriage recognized.
8. Planned Parenthood v. Casey (1992) – balancing state interests vs rights.
9. Harper v. Virginia Bd. of Elections (1966) – strict scrutiny for voting rights

Conclusions

The ruling in United States v. Skrmetti (2025):

• Affirms state authority to regulate minors’ medical care under rational basis review.
• Limits expansion of constitutional protections for transgender youth.
• Prioritizes legislative deference in medical and social policy.
• Highlights tension between majority deference and dissent’s focus on discriminatory harm.

Broader Implications

1. State Authority – Expanded powers to regulate healthcare for minors.
2. Future Litigation – High bar for challengers under rational basis review.
3. Civil Rights – Restrictive laws may limit LGBTQ+ protections.
4. Global Impact – Contributes to worldwide debates on law, health, and gender identity.

References

• United States v. Skrmetti, 602 U.S. ___ (2025)
• Bostock v. Clayton County (2020)
• Dobbs v. Jackson Women’s Health (2022)
• Craig v. Boren (1976)
• Eknes-Tucker v. Ivey (2024)
• AMA & AAP Amicus Briefs (2025)
• Turban et al., Pediatrics (2020)
• Olson et al., Journal of Adolescent Health (2021)
• GLAAD, NCTE, HRC Reports (2024–2025)
• The New York Times (June 28, 2025)
• CNN Law (June 29, 2025)

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