United States v. Skrmetti

Docket Number: 23-477
Citation: 605/2
Term: October Term 2024
Argued: December 4, 2024
Decided: June 18, 2025
Lower Court: United States Court of Appeals for the Sixth Circuit
Author: Chief Justice John G. Roberts, Jr.
Concurring: John G. Roberts, Jr., Clarence Thomas, Neil M. Gorsuch, Brett M. Kavanaugh, Amy Coney Barrett, Samuel A. Alito, Jr.
Dissenting: Sonia Sotomayor, Ketanji Brown Jackson, Elena Kagan

Read the official slip opinion (PDF)

AI-Generated Summary

Summary of United States v. Skrmetti (2025)

1. Case Information:

Case Name: United States v. Skrmetti, Attorney General and Reporter for Tennessee, et al.
Docket Number: 23–477
Dates: Argued December 4, 2024; Decided June 18, 2025
Lower Court: United States Court of Appeals for the Sixth Circuit

2. Facts of the Case:

In March 2023, Tennessee enacted Senate Bill 1 (SB1), titled the Prohibition on Medical Procedures Performed on Minors Related to Sexual Identity, which bans healthcare providers from prescribing puberty blockers or hormones to minors for purposes of enabling them to identify with a gender inconsistent with their biological sex or to treat discomfort from gender discordance. The law permits such treatments for other medical conditions like congenital defects or precocious puberty.
Three transgender minors, their parents, and a doctor challenged SB1, alleging it violates the Equal Protection Clause of the Fourteenth Amendment. The United States intervened in the lawsuit.
The District Court partially enjoined SB1, finding it likely unconstitutional under intermediate scrutiny for discriminating based on sex and transgender status. The Sixth Circuit reversed, holding that SB1 does not trigger heightened scrutiny and satisfies rational basis review. The Supreme Court granted certiorari to address whether SB1 violates the Equal Protection Clause.

3. Legal Issues Presented:

Question: Does Tennessee’s SB1 violate the Equal Protection Clause of the Fourteenth Amendment by prohibiting certain medical treatments for transgender minors?
Legal Basis: The case involves interpretation of the Equal Protection Clause, specifically whether SB1’s classifications based on age, medical use, sex, or transgender status warrant heightened scrutiny or only rational basis review.
Main Arguments:
Plaintiffs (United States and private parties): Argued that SB1 discriminates on the basis of sex and transgender status, necessitating intermediate scrutiny, and that it fails to meet this standard as it is not substantially related to an important governmental interest.
Tennessee: Contended that SB1 does not classify based on sex or transgender status but on age and medical use, thus requiring only rational basis review, and that it serves the legitimate interest of protecting minors’ health and welfare.

4. The Court's Decision (Main Opinion):

Author & Type: Chief Justice Roberts delivered the opinion of the Court, representing a Majority Opinion, joined by Justices Thomas, Gorsuch, Kavanaugh, and Barrett, with Justice Alito joining Parts I and II–B.
Holding: Tennessee’s SB1 does not violate the Equal Protection Clause as it is not subject to heightened scrutiny and satisfies rational basis review.
Legal Reasoning:
The Court determined that SB1 classifies based on age and medical use, not sex or transgender status, as it prohibits certain treatments for all minors regardless of sex for specific purposes (treating gender dysphoria) while allowing them for other conditions.
Relying on precedents like Massachusetts Bd. of Retirement v. Murgia (1976) and Vacco v. Quill (1997), classifications based on age and medical use only require rational basis review.
The Court rejected claims of sex-based classification, stating that mere reference to sex or differential impact does not trigger heightened scrutiny absent overt discrimination or invidious purpose, citing Geduldig v. Aiello (1974).
Regarding transgender status, the Court found no classification as SB1 targets specific diagnoses, not individuals based on transgender identity, and declined to extend Bostock v. Clayton County (2020) beyond Title VII.
Under rational basis review, the Court found SB1 rationally related to Tennessee’s interest in protecting minors’ health, given legislative findings on risks of treatments for gender dysphoria and minors’ lack of maturity to consent.
Disposition: The judgment of the Sixth Circuit is affirmed.

5. Concurring Opinion(s):

Justice Thomas (joined by Barrett in full):
Joined the majority opinion but wrote separately to argue against extending Bostock’s reasoning to Equal Protection Clause cases and to caution against judicial deference to medical experts over legislative judgment, emphasizing the lack of consensus on gender-affirming care for minors and ethical concerns about minors’ consent.
Justice Barrett (joined by Thomas):
Concurred with the majority but wrote separately to argue that transgender status does not constitute a suspect or quasi-suspect class under Equal Protection analysis, citing lack of immutable characteristics, discreteness, and historical de jure discrimination as required by precedents like Lyng v. Castillo (1986).
Justice Alito (concurring in part and in judgment):
Joined Parts I and II–B of the majority opinion but provided a separate analysis on sex classification, agreeing SB1 does not classify by sex as it does not overtly differentiate between males and females. Assumed for argument’s sake that SB1 classifies by transgender status but argued it does not warrant heightened scrutiny due to lack of historical discrimination and immutable characteristics akin to race or sex.

6. Dissenting Opinion(s):

Justice Sotomayor (joined by Jackson in full, and by Kagan as to Parts I–IV):
Argued that SB1 clearly classifies on the basis of sex and transgender status, as it conditions medical treatment on whether it aligns with a minor’s sex at birth, thus requiring intermediate scrutiny under precedents like United States v. Virginia (1996).
Criticized the majority for applying rational basis review, ignoring the statute’s explicit sex-based distinctions and reliance on Geduldig v. Aiello (1974), which she deemed flawed. Asserted that transgender status should be considered a quasi-suspect class due to historical discrimination and political powerlessness.
Contended that the majority’s refusal to apply heightened scrutiny abandons transgender minors to discriminatory legislative whims and fails to assess if SB1’s ban is substantially related to protecting minors’ health.
Justice Kagan:
Joined Parts I–IV of Sotomayor’s dissent, agreeing that SB1 warrants heightened scrutiny due to its sex-based classifications. Took no view on whether SB1 would survive such scrutiny, advocating for remand to lower courts to apply the test, as requested by plaintiffs and the Government.

7. Potential Significance:

The decision establishes a precedent that laws regulating medical treatments for transgender minors based on specific diagnoses or purposes, rather than overt sex or transgender status classifications, are subject to rational basis review rather than heightened scrutiny under the Equal Protection Clause. This may limit judicial oversight of similar state laws restricting gender-affirming care, deferring to legislative judgment in areas of medical uncertainty.
The Court’s refusal to recognize transgender status as a suspect or quasi-suspect class could influence future challenges to laws affecting transgender individuals, potentially reducing the likelihood of successful Equal Protection claims absent evidence of invidious purpose.
The majority’s emphasis on legislative flexibility in areas of scientific debate may encourage states to enact restrictive policies on transgender healthcare without facing rigorous constitutional scrutiny, as long as they can articulate a rational basis for such restrictions.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Key terms: Transgender Minors, Medical Treatments, Equal Protection