Reflecting on The Supreme Court's Skrmetti Decision
The Supreme Court rolled out a dud with its Skrmetti decision. The Constitutional and human damage will be immense.
As of this writing (June 18, 2025), the Supreme Court has just issued another awful decision, this time upholding Tennessee’s law banning gender-affirming care for minors. The decision has already sent shockwaves through the LGBTQ community and beyond.
For transgender Americans, especially teenagers, it is a disaster: suddenly, loving families are cut off from essential, even lifesaving, medical support. For Constitutional lawyers, it is a disastrous turn: the Court essentially rewrote equal-protection doctrine to bless their own deeply unpopular ideological agenda.
By trusting the Tennessee legislature’s wording and ignoring both precedent and reality, Chief Justice Roberts’s majority strained to avoid applying any meaningful sex-based scrutiny. In doing so, the Court has turned its back on earlier cases that demanded “exceedingly persuasive” justifications for gender classifications and required sex lines to be substantially related to important state goals. It has embraced the very rationales once rejected as “archaic and overbroad” stereotypes. As a result, thousands of families now must scramble—perhaps moving hundreds, if not thousands of miles—to find care for their trans kids, or face the consequences of being denied the kind of treatment mainstream medicine has deemed safe and necessary.
In the words of one Tennessee mother: “If we didn’t have the care, I don’t think she’d be alive,” describing the trip she makes from Nashville to Ohio and Virginia for her trans daughter’s hormone therapy.
This ruling forces exactly such cruel choices. In a survey of trans Americans, nearly half said they had considered leaving their home state over these bans, and 5% actually moved out of state to access care. Already, pediatricians in Connecticut report a surge of out of state families relocating just to find doctors who can treat their children.
Skrmetti legitimizes this exodus. As advocacy groups have bluntly put it, today’s opinion “took the place of parents and doctors” and abandons transgender youth “to political whims” (Justice Sotomayor’s phrase in her dissent). It “carries irreversible harm,” warns a leading Civil Rights lawyer, because it “politicizes decades of medical consensus” and “ignores the Constitution’s mandate of equal protection”.
In my reporting, I strive to blend rigorous analysis with human stories, putting a face to the issues that matter. This piece will do the same: we’ll break down Skrmetti’s legal reasoning in detail, contrast it with past sex-discrimination cases, and show why it is both an unsound interpretation of Constitutional law—and a massive human tragedy. We’ll explore how the majority’s logic stretches the law to a breaking point, how it breaches equal-protection principles from Craig to VMI, and what it means on the ground for families with trans kids.
Experts from major advocacy groups and legal scholars have decried the ruling, and I’ve included their perspectives along with historical context. We’ll spell out the issues clearly, punctuated by real voices, as well as the law, to underline what’s really at stake here. This is indeed a crisis of Constitutional law, but one with urgent human consequences.
What Happened in Skrmetti v. Doe?
In 2023, the state of Tennessee passed SB1, a sweeping prohibition on gender-affirming medical treatments for minors. The law forbids doctors from prescribing puberty blockers or hormones “for the purpose of enabling a child to identify with, or live as, a purported identity inconsistent with the minor’s biological sex” or to treat “discordance” between sex and identity.
Crucially, the law does not ban these same medications for other medical uses—it explicitly allows puberty blockers and hormones to treat conditions like precocious puberty, congenital defects, or physical injury. In other words, if a teen is cisgender and needs blockers for a medical reason, SB1 lets the doctor prescribe them. If the teen is transgender (for instance, a biologically male child identifying as female) and has gender dysphoria, then no treatment is allowed.
Three transgender adolescents (known in court papers as L.W., B.E.M., and A.O.) and their parents sued, challenging SB1 under the Equal Protection Clause. At trial, the plaintiffs argued that SB1 singled out trans youth for unequal treatment and should therefore be subject to heightened scrutiny (at least intermediate scrutiny, as in past sex-discrimination cases). A federal district court agreed and preliminarily blocked most of SB1, finding that treating transgender minors worse than similarly situated cisgender minors likely violated the Constitution. The Sixth Circuit, however, reversed that injunction, holding the law needed only rational-basis review. The Supreme Court granted review to resolve the split among appeals courts on these bans.
In a 6–3 decision authored by Chief Justice Roberts, the Court upheld SB1. Roberts concluded that Tennessee’s law “is not subject to heightened scrutiny” under the Fourteenth Amendment and survives rational basis review.
In plain terms, the majority said: SB1 does not literally classify on the basis of sex or transgender status. It simply draws two classifications on its face – one by age (minors vs. adults) and one by medical use (certain diagnoses vs. others) – and neither of those categories triggers suspect scrutiny.
Because SB1 applies equally to boys and girls (both are barred from care for gender dysphoria, and both may receive blockers for medical reasons), the majority insisted, the law isn’t really about sex. And because it similarly “removes” a set of conditions (gender dysphoria, gender identity disorder, etc.) from allowable treatment but includes both transgender and non-transgender kids in the non-excluded group, the Court said SB1 isn’t expressly targeted at transgender people either. In the majority’s view, then, SB1 is akin to a neutral health regulation that bars a certain type of therapy for any minor – regardless of whether that minor is a boy or a girl – so long as the purpose is “gender transition.” That, they concluded, is a rational policy choice (they even implied it could be justified as a kind of experimental caution or moral stance) and one that doesn’t require any special explanation under the Equal Protection Clause.
This narrow interpretation was backed by a familiar formula: “any reasonably conceivable state of facts” could justify SB1 under rational basis review. It notes that Tennessee’s legislature made findings expressing concern about the risks of “medical transition” for minors, but the Court downplayed whether those findings made sense, focusing instead on the law’s text.
The majority explicitly declined to say anything about whether SB1 was motivated by bias or “animus” toward transgender people—it treated that question as unraised and unnecessary if the law’s written classifications were gender-neutral. Justice Sotomayor’s dissent saw things differently, but Sotomayor is in the minority, so the majority’s framing now stands as official law, at least for now.
In short, the Court said nothing about transgender rights beyond Tennessee, applied rational-basis analysis, and dismissed any sex-based equal-protection challenge.
That means not only this Tennessee law, but 24 similar state bans on puberty blockers or hormones now carry the Court’s blessing—unless later courts distinguish this case narrowly. In a separate one-line opinion, Justice Kagan noted that even under Roberts’s standards, a majority of the Court might have invalidated SB1 under an elevated review, but she limited her opinion to rejecting the majority’s premise. (Kagan joined Sotomayor’s view that SB1 is sex-based and would fail intermediate scrutiny, but she parted ways on remedy.) The resulting ruling is a clear victory for states that have passed such bans, and serves as the Court’s repudiation of the argument that gender identity discrimination is protected.
Legal Red Flags
Roberts’s opinion rests on a premise at odds with many lower court rulings: the notion that SB1’s penalties are not a “sex-based classification.” Modern equal-protection doctrine recognizes sex as a quasi-suspect category. Since Craig v. Boren (1976) and especially since United States v. Virginia (1996) (the VMI case), any law that treats males and females differently must meet intermediate scrutiny (though Virginia in practice demanded an “exceedingly persuasive” justification beyond the usual test).
As Craig v. Boren famously explained, a state must prove that any gender-based classification “serves important governmental objectives” and that the classification is “substantially related” to achieving those objectives. In VMI, the Court struck down an all-male military academy, emphatically holding that a state “must have an exceedingly persuasive justification” for any law restricting an opportunity to one sex. This heightened standard was devised to ensure that sexist assumptions or stereotypes can’t mask discrimination. The rule is well-known: carving out rights or opportunities for only men, or only women, triggers skeptical judicial review.
Roberts’s majority opinion barely engages this framework. It applies none of the “exceedingly persuasive justification” or “substantial relationship” tests to SB1. Instead, the Court simply concludes that SB1 does not facially classify on sex at all—so why apply heightened scrutiny?
The majority reasoned that SB1’s effect on boys and girls is equal: both a 16-year-old boy and a 16-year-old girl with gender dysphoria are forbidden the same treatments. On its face, SB1 bans “minors” and groups them by their medical diagnosis, without “prohibiting certain medical treatments for minors of one sex while allowing those same treatments for minors of the opposite sex,” as the opinion notes. (It insisted that the law does not mask sex-based classes.)
That analysis drew immediate objections. Critics note a glaring twist: SB1 still creates an unequal opportunity. Under SB1, a boy who is cisgender and experiences precocious puberty could get blockers; a boy who is transgender and has gender dysphoria cannot. Likewise for girls. The law covers all minors for the dysphoria condition. In practice, it withdraws care precisely from those with mismatched gender identity—a group defined by birth sex and gender identity together.
When transgender advocates pointed this out, the majority brushed it aside as a neutral denial. The Court essentially said: “Yes, only transgender kids seek treatment for gender dysphoria, but that fact alone doesn’t make it a transgender-specific law.” In Justice Roberts’s view (echoing Geduldig v. Aiello and Bray v. Alexandria Women’s Health Clinic), removing one condition from a list of treatments is not necessarily sex-based unless it’s a mere pretext for discrimination.
Consider Bray v. Alexandria Women’s Health Clinic (1993), which the majority opinion cites approvingly. In Bray, the Court said that since “It is true that only women can become pregnant,” that does not mean “every legislative classification concerning pregnancy is a sex-based classification”.
It held that a law singling out pregnancy (and hence only women) might still survive rational basis unless plaintiffs show it was a hidden attempt to discriminate based on sex. By similar logic, Roberts reasons that SB1’s targeting of “gender dysphoria” (a condition only trans youth experience) isn’t automatically a classification by sex or transgender status, absent a smoking gun of animus. The majority analogizes gender dysphoria to pregnancy: just because only one sex experiences it, why call every law about it “sex-based”?
Legal scholars will groan at this. In modern equal-protection law, both race and sex are viewed as so fundamental that laws drawing lines on those bases can’t simply be hidden behind facial neutrality. The Bray/Geduldig line of cases is narrow and controversial. It is essentially a liberalization of equal protection that says some apparently sex-based exclusions can get away with only rational basis unless they are a conscious pretext for sexism.
Many judges and scholars have warned that this approach was deeply flawed: it allows lawmakers to evade heightened scrutiny by clever drafting. Chief Justice Roberts’s opinion falls squarely in that tradition, choosing to see only the superficial categories of age and diagnosis. The law reads that way, so he says: age and medical diagnosis “are subject to only rational basis review”, and SB1 “does not turn on sex” even if its effects do.
By ignoring any purpose behind SB1, the majority avoids asking if legislators enacted it out of concern that “boys should not become girls, and girls should not become boys.” Instead, it emphasizes that SB1’s findings do not explicitly reference stereotypes or animus. This is precisely the sort of formalism that George Orwell warned against: if a law’s text does not overtly say “girls only” or “boys only,” then it escapes scrutiny. Under this logic, SB1 is treated as if it were the scalding summer sun itself: blindingly obvious discrimination can be hidden in an apparently equal-opportunity formula.
In this way, the majority effectively rewrote gender-equality doctrine. No longer do we start with the question of who wins and who loses under a law’s actual operation. Instead, we infer from the wording whether it looks biased, and if it “looks” neutral, we rubber-stamp it.
By finding SB1 facially neutral, the Court seems prepared to uphold any law so long as it applies equally in text to both boys and girls – no matter how devastating the practical disparity.
This is exactly the opposite of Craig and Virginia. In Craig, the Court struck down an Oklahoma law that let 18-year-old women buy 3.2% beer but forced 18–20-year-old men to wait until 21, finding that a weak fit between the legislature’s statistical evidence and its claimed goal of traffic safety cannot justify a gender line. Even though the law purported to treat men and women differently for the same act, Craig applied heightened scrutiny because it was openly a sex-based rule – it obviously benefited women. Roberts’s opinion would render that framework meaningless: in his world, SB1 is somehow not a sex-based rule because it covers all minors at face value.
And in Virginia, the Court demanded that Virginia show why women alone should be denied the unique citizen-soldier training at VMI. Virginia could not meet that burden; the Court found “no exceedingly persuasive justification” for excluding women.
Now imagine if Virginia had tried to argue, as Tennessee did: “We let any adult women attend VMI with a different program, and we admit no minors at all”—would the Court have accepted that? Of course not. Here, Tennessee says “we let minors of any sex get blockers for precocious puberty; we only ban them for gender dysphoria,” and the Court nods. The contrast with Virginia is stark. There, even an all-male school (obvious on the face of it) was struck down. Here, a law that only hurts one gender’s transition no longer triggers any tough scrutiny.
In fact, the majority never explicitly applied any intermediate-scrutiny test of the form “important objective, substantially related means.” It simply marched past those precedents. Only in a truncated footnote did it contend that even if higher review applied, SB1 might pass (but the Court did not settle that question).
This half-measure undercuts the majority’s promise that “any reasonably conceivable justification” suffices: when the Court can’t even specify the state’s important interest clearly, rational basis looms as the default. Tennessee itself vaguely invokes “medical caution” and “gender stereotypes,” but the Court waves those off as not in the record (even when many lawmakers overtly argued that kids should stick to “God’s design”). The net effect is that SB1 is rubber-stamped under the lowest standard.
The result is doctrinally incoherent. As Rutgers law professor Joan Herman notes, “we once lived in a world where gender-based classifications needed strong justification.” Now, because SB1 affects boys and girls the same way on paper, Roberts says no justification is needed at all.
In broader terms, the decision suggests that any law touching transgender people, or indeed any issue tangled with biology, can hide behind that façade. If this reasoning stands, even race-based or religion-based disparities could arguably be proclaimed neutral if cleverly worded. (Justice Sotomayor pointed out in her dissent that the majority’s logic might let discriminatory laws pass that “bear the identical hallmark of racism”—a law pretextually aimed at a religious or ethnic group.) By sweeping aside all but the most technical view of classification, Skrmetti resets equality doctrine in a disturbing way.
Lost Precedents: A Departure from Civil Rights Tradition
To appreciate how radical this is, recall some key cases. In United States v. Virginia (1996), the Court invalidated male-only admission at VMI because Virginia’s reasons (like an untested separate women’s program) fell short. Justice Ginsburg famously held that “neither the goal of producing citizen-soldiers nor [VMI’s] training methodology is inherently unsuitable to women,” so there was “no exceedingly persuasive justification” for exclusion.
The Court did not hesitate to apply a standard tougher than ordinary intermediate scrutiny – effectively a “close to strict scrutiny” that required genuine actual benefits, not stereotypes. SB1 offers no such rigorous justification. Tennessee’s legislature simply asserted vague medical concerns, then banned the very care that the American Medical Association, American Academy of Pediatrics, and dozens of other medical bodies agree is safe and essential for kids with gender dysphoria. In Virginia, even singular, concrete reasons were insufficient. Here, the Court accepts scattered concerns (and even some false claims) at face value, without the “skeptical scrutiny” this Court once said sex classifications require.
Similarly, Craig v. Boren (1976) mandated that statistical justifications be substantial. Oklahoma’s data showed a small difference in drunk-driving arrests between young men and women, but the Court found the gender-based age line in sales of low-alcohol beer was not substantially related to traffic safety. It was the first case to articulate what we now call “intermediate scrutiny”: a state must identify an important objective and then show its gender line closely furthers that objective.
By that standard, most trans-care bans would fail easily: no evidence has ever shown that allowing puberty blockers to one group of kids but not another meaningfully advances safety, since those same hormones are given for medical reasons to any kid when needed. Not one serious study associates trans-affirming medication with injury. By contrast, Craig demanded more than thin rationales like “stereotypes about young men drink more” (just as Reed v. Reed had rebuffed “administrative convenience” arguments).
Yet Roberts’s opinion treats SB1’s disparate impact as inconsequential. The majority opinion cites Craig only to say “we have never suggested mere reference to sex is enough to trigger heightened scrutiny”. In context, that means they would not automatically require intermediate scrutiny just because SB1 mentions “gender dysphoria” (which includes words like “gender identity” and “biological sex”). The majority refuses to view SB1 as an “overt gender criterion,” even though Craig and Reed teach us that if a law discriminates on gender at all, it demands justification.
Bray (1993) is more obscure but also telling. There, protesters who had blocked an abortion clinic challenged a civil-rights law on equal-protection grounds, arguing opposition to abortion was really hostility toward women. The Court rejected that, saying again: only because only women get pregnant doesn’t make every anti-abortion measure by definition a sex discrimination. Roberts leans on this idea to dismiss plaintiffs’ arguments that SB1 enshrines a stereotype (e.g. “boys should not become girls”).
If a mere prohibition on pregnancy-related insurance (as in Geduldig) or on abortion protests (Bray) can pass muster absent a smoking gun, then courts “are Constitutionally free” to legislate about sex-related conditions on rational bases. Indeed, the majority repeats the exact Geduldig quote: unless you show pretext or animus, excluding one condition (“pregnancy”) is not sex discrimination.
In Bray, the Court explicitly said a classification is sex-based only if it is a pretext for discrimination against women as a class. The Skrmetti majority adopts that idea wholesale, shifting the burden to plaintiffs to prove “invidious intent.” Absent evidence of a conspiratorial purpose, the majority insists SB1 was just an honest scientific choice by Tennessee.
This reliance on Geduldig/Bray is a redirection from more mainstream cases. Notably, the majority does not cite Reed v. Reed (1971) or Frontiero v. Richardson (1973) or Hooper v. Bernal (1988), all of which reinforce that you cannot broadly deny an equal benefit or opportunity on gender stereotypes alone. Nor does it engage with Mississippi Univ. for Women v. Hogan (1982), in which the Court invalidated a male-only nursing program despite the state’s claim of aiding women (it was a “patch-job” in the Court’s words).
Instead, by channeling the pregnancy exception cases, the majority avoided developing any analysis of transgender status per se as a protected trait. (Interestingly, just last year a federal judge in Minnesota questioned whether transgender status should be treated as a quasi-suspect class like sex; the Supreme Court here sidestepped that question entirely.)
Skrmetti represents the first time the Supreme Court has affirmatively upheld a law taking away a basic service on grounds tied to gender identity.
Contrast that with Romer v. Evans (1996), where the Court struck down a Colorado ballot measure singling out gays and lesbians for disfavored treatment. Even though Romer involved animus at the ballot-box level, the Court struck it as irrational. Today, animus can be ignored if the labels are right.
In law schools, we used to learn that precedents like VMI or Craig meant that gender discrimination had to pass muster under at least intermediate scrutiny. One might have thought the Supreme Court would similarly protect the rights of those facing legislated stigma. Instead, the new message from Skrmetti is that if a law looks neutral, courts will pretend it really is neutral, even if only one sex or one identity group can be affected.
This backward step echoes some dangerous moments in history – for instance, how racial segregation was once upheld by claiming laws were race-neutral on their face. In future fights over gender or sexuality, one wonders if legislators can now rely on this case to thumb their nose at equality, secure that a federal majority has blessed this warped reading of equal protection.
From Words to Real Impact
When we strip away all the legalese, the Supreme Court’s decision has very tangible, real world consequences. For transgender teens and their families, the result is immediate and painful. All across the country, states with bans now stand on sure footing—meaning kids who were receiving puberty blockers or testosterone shots will have to stop, and families seeking care for the first time will be turned away. These families face grim alternatives: forego care, risking mental health and other health crises, or pack up their entire lives and move to another state.
It was predictable: very soon after the ruling, cases have already been filed to relocate families and providers to safe states. We quoted one stat above: 5% of trans individuals have already relocated at least once to obtain care. Media reports and surveys over the past year foreshadowed this wave.
An April 2024 report found gas, airfare, lodging and other expenses to cross state lines could cost thousands of dollars. One Tennessee mother told reporters her family spent thousands of dollars traveling just for telehealth appointments, doing “whatever it takes” to keep their child healthy. Another Texas mother canceled trips to local doctors and had to call on advocacy groups to find out-of-state care for her daughter—but not everyone has friends who can help book flights and hotels. These are regular families at the end of their rope. One said, helplessly, “We are in a position that we could afford plane tickets and a hotel…but for a lot of people, that’s not an option.”
We might imagine some lawyers discussing Constitutional tests, but real families experience this as life or death. When outpatient clinics are legal only in faraway states, even telemedicine requires a car ride or flight.
A pediatric psychologist in Connecticut reports seeing dozens of families with trans teens moving in—“30 families in the past month,” she said—from Texas, Florida, Missouri, Idaho and other states whose lawmakers have shut off care. Many of those teens exhibit the classic signs: before care, severe depression and suicidal ideation; afterwards, “the mental health issues went away completely,” one mother reports. Like a child with diabetes needing insulin, these kids literally necessitate medical treatment—cutting that off is hardly a harmless experiment.
Anyone who says the Court’s decision is mere “politics as usual” should hear from health experts. The American Medical Association and the American Psychiatric Association are unanimous that gender-affirming care is evidence based and lifesaving for children with gender dysphoria.
Stanford pediatrician Jack Turban, and others, emphasize that delaying or denying puberty blockers greatly heightens the risk of self-harm and suicide, risks that are predictable and preventable. The dissent in Skrmetti pointed out these real-world stakes: hormones “help to align transgender adolescents’ physical appearance with their gender identity” in the same way puberty blockers help any kid with precocious development, and leaving dysphoria untreated can devastate a young person.
The majority doesn’t dispute these facts; it sidesteps them by saying “we are not philosophers of medicine.” But by deferring to state authority on this question, the Court effectively says: Your child’s life is secondary to the state’s line-drawing. If a child in Tennessee needs medication and a child in Alabama does too, only the Tennessee child is forbidden. And why? Because Tennessee believes “transitioning” for minors is bad. The Supreme Court had an opportunity to affirm that Constitutional rights do not evaporate when issues become politicized. It completely blew that chance.
Outrage from Advocates and Allies
In the wake of the decision, LGBTQ organizations and legal experts unleashed furious criticism, reminding us of what’s at stake. Human Rights Campaign and GLAAD issued statements decrying the choice as “a chilling step toward unchecked government overreach.” GLAAD’s president Sarah Kate Ellis said the Court “stripped away parents’ ability to make private, lifesaving decisions,” adding that “every family deserves the freedom to make the medical decisions that are right for them and their children”.
The American Civil Liberties Union and Lambda Legal likewise blasted the outcome. ACLU attorney Chase Strangio called it “a devastating loss for transgender people, our families, and everyone who cares about the Constitution,” but vowed to keep fighting for health care access. Lambda Legal’s Sasha Buchert warned that “gender-affirming care is often life-saving care,” lamenting “this sad day” and pledging to continue the fight for trans youth.
At the ACLU of Tennessee, Lucas Cameron-Vaughn put it bluntly: “This ruling creates a class of people who politicians believe deserve health care, and a class of people who do not.”
Historian Heather Cox Richardson has noted how this decision represents a new low in the Court’s relationship to civil rights: the Court is “marching backwards” to an earlier era, turning its back on principles of equality.
Coincidentally, Heather Cox Richardson has been chronicling how the same Court is allowing dark money to influence elections and wiping out reproductive rights; in her view, these threads are all part of a Conservative effort to dismantle the protective role of the federal judiciary. Political strategist Brian Derrick called it “a very sad day for America when the Supreme Court green lights sex discrimination.”
Scholar Douglas NeJaime notes that Skrmetti “flips the script” on precedent: whereas earlier courts protected discrete classes, the new majority embraces broad deference. NeJaime and others worry this could eviscerate important protections for any minority group, not just transgender people. It undermines the idea that constitutional rights are a check on majority sentiment. As Democracy Forward’s Skye Perryman put it, the majority “turned its back on youth and their families” and on “the Constitution’s mandate of equal protection”.
Each voice, from parents to professionals, from advocates to academics, underscores a truth: the ruling matters in human terms. It’s not a legal technicality. It means kids who have built trust with a doctor will lose access to that doctor and proper medical treatment. It means a teenager who was stabilizing under therapy will once again face instability and trauma. And for anyone who cares about the Constitution, it casts doubt on the extent to which our founding document can protect vulnerable minorities from a rogue Supreme Court.
Constitutional Context and the Court’s Role
To see why this matters so deeply, we must recall the Supreme Court’s historic role in Civil Rights. Over the past century, the Court occasionally stepped in to protect groups that were politically powerless. From the desegregation at the end of Brown v. Board, to the women’s rights in Reed v. Reed and beyond, to the landmark recognition of same-sex marriage in Obergefell, the Justices have sometimes resisted popular prejudice.
Skrmetti suggests a retreat from that tradition. The state of Tennessee was more powerful in the Court’s eyes than a class of citizens seeking equal justice. By deferring to the legislature’s solution and ignoring the Equal Protection Clause’s guardrails, the Court let ideology masquerade as law.
History is unforgiving: there have been dark times when majorities marched against minorities, and the Court went along—remember Plessy and Korematsu, for example. Today’s majority tries to distinguish the cases, but the pattern is hard to miss. The day Skrmetti was decided, the dissent noted, “the Court abandons transgender children and their families to political whims” (Sotomayor, dissent, slip op.)
This is strong language. We recall that only two terms ago, Bostock v. Clayton County expanded the idea that LGBTQ people are protected from sex-based discrimination under federal law. Skrmetti winds the clock backwards, leaving Bostock essentially tucked away as a workplace-only rule, which the majority explicitly declined to extend. With Dobbs overturning Roe already on the books, many see a pattern: the new Conservative majority is saying that social policy on sensitive issues is for state legislatures—and only for them—to decide. The Constitution, they say, has little to say.
From a Constitutional perspective, this is a staggering development. The Equal Protection Clause was meant to bar arbitrary classifications that target people with “animosity” or “stereotypes”. Roberts’s majority essentially says: not if you write carefully. Trans youth might as well have no Constitutional rights over their gender, at least not under this Court’s rule.
The majority opinion repeatedly cites rational basis precedents like Massachusetts Board of Retirement v. Murgia and Vacco v. Quill — cases involving profoundly different contexts (old age, assisted suicide) — as if SB1 were just another social regulation. But it is not “just another social regulation.” It is an explicit carve-out from care for a vulnerable group.
In the months ahead, lower courts will test the limits of Skrmetti. Will some aspect of discrimination law survive? The majority insisted that its narrow, record-based ruling does not “extend to other cases concerning discrimination based on transgender status”.
Yet its logic, once released, is hard to contain. If Tennessee can bar hormones from one purpose, many other laws might try the same trick. Already, states like Alabama, Arkansas, and others may lean on Skrmetti to maintain or expand their bans. Perhaps future litigants will try to distinguish SB1 by focusing on its particular facts. Maybe Congress or state courts will step in. For now, though, Skrmetti stands as the law of the land on this question.
Uprooted Lives
Legal nuance aside, families are already feeling the impact. When state law denies a minority care, ordinary people are confronted with impossible life choices. Consider the story reported by ABC News of Misty Stamm and her daughter in Tennessee. Nine months after birth, Tennessee’s SB1 (HB 1558 in 2021) became effective for puberty blockers; just as her daughter hit adolescence, Misty found herself driving over five hours to Ohio so her child could start puberty blockers that Tennessee would no longer allow.
When Ohio’s courts blocked a new ban there, the Stamms even turned to telehealth in Virginia, each appointment now requiring a 2 hour drive each way simply to comply with the law. Misty’s words to ABC are chilling: “If we didn’t have the care, I don’t think she’d be alive.” For Misty Stamm and her daughter, gender-affirming care was literally lifesaving, and she is determined to get it at any cost.
This is not an isolated incident. The Southern Equality report cited in that story found many families driving more than eight hours one way to reach a clinic. Other reports, from Southern Equality Research Center and others, note that families in Texas, Florida, Missouri and beyond already face “logistical and financial chaos,” scrambling for hotels and flights just to see a doctor. For some, moving across the border to a neighboring blue state is the only option—and that, too, is often unaffordable for low-income parents.
The costs are punishing. The Southern report bluntly quantifies it: “Gas, airfare, lodging…could cost thousands of dollars.” In one family’s case in Louisiana, a plan to go see an endocrinologist was derailed. They had to line up friends, rent a car and book a hotel—only to have doctors cancel appointments due to the shifting legal climate. Many states ban telehealth services for these treatments, so even virtual visits require physically crossing a border. Imagine living in Tennessee and being forced to drive 5 hours round-trip, every month, just to pick up hormone prescriptions. And that’s on top of already strained family routines, work and school.
The toll on the children is immense. When Stamm’s daughter finally got puberty blockers, “the mental health issues stopped completely,” Misty tells us. They had struggled for years with suicidal thoughts and depression; within months of treatment, clinicians said her daughter was doing so well, she was released from weekly therapy and only seen occasionally.
Put another way: her mental well-being hinged on medical care. Cut off that care, and the statistics tell us the risk of suicide skyrockets. That’s reality. For many trans youth and doctors, these hormones are as urgently needed as insulin for a diabetic child.
It’s easy for opponents of gender-affirming care to obscure these facts with slogans about “waiting until they’re adults.” In reality, pediatric endocrinologists do not give permanent treatments or surgeries to prepubescent kids, they prescribe reversible, age-appropriate interventions, under careful guidelines.
Most trans guidelines recommend pubertal blockers only at the onset of puberty, exactly the time these bans target. That timing is critical: it is literally the window to prevent the most harmful effects of developing unwanted sexual characteristics (like facial hair in a trans girl or a deep voice in a trans boy).
The American Academy of Pediatrics and World Professional Association for Transgender Health (WPATH) agree that puberty blockers for a teen with gender dysphoria are both safe and reversible, and that they greatly improve mental health. The majority opinion skims past all that expertise, treating transition “procedures” as a catch-all worry.
For families, the fallout is heartbreaking. One Kansas clinic reports that dozens of pending appointments were canceled the week the court issued its ruling. In states where bans just took effect, pediatricians lament long waiting lists as everyone from Arkansas to Idaho now sends their teens packing. Social media is filled with goodbye-party photos: kids and parents celebrating a move to Colorado or Illinois to escape the ban.
Meanwhile back home, classmates of these teens may be falling through the cracks, losing hope in medical care they once had. It’s not hyperbole to say lives are at stake. The attorneys in Skrmetti described gender-affirming care as “often life-saving,” and many doctors agree. To quote Lambda Legal: “gender-affirming care is often life-saving care.” The majority’s refusal to take this seriously will be felt in human suffering for years.
The Constitution, Bent to Ideology
The Skrmetti decision is less about doctors and hormones than about principle: will the Constitution protect those outside the mainstream, or will it be used to justify majoritarianism? Today’s opinion leans heavily toward the latter.
The Court acknowledges that a majority of Americans (through their legislatures) want these bans. The majority is essentially saying, “Fine, that’s your democratic choice, and the Constitution doesn’t stop you.” But the Equal Protection Clause was designed precisely to stop bad democratic choices that violate fundamental fairness. Voting demographics alone don’t immunize a law from challenge. If SB1 had targeted a religious or ethnic group, we instinctively expect courts to step in; what has changed when the target is a sex-based trait like being transgender?
Chief Justice Roberts’s argument is that gender identity legislation falls into a sort of no-man’s land between categories. “Sex” in Bostock terms (and Title VII) means something precise: it’s about treating someone worse because of being male or female. The Court says SB1 isn’t that. And “transgender status” the majority says is not a protected class (unlike, say, race or gender identity under Title VII as in Bostock).
So away we go with rational basis. The majority even closed the door on extending Bostock from the workplace into constitutional law, remarking that “changing a minor’s sex or transgender status does not alter the application of SB1”. In other words, even if one child legally changed gender on paper, SB1 would still ban treatment for dysphoria. They want to treat gender as epiphenomenal.
That reasoning flouts reality: nearly everyone agrees transgender identity is deeply tied to sex. If I say “one person was born male but is female in gender,” that statement only makes sense because birth sex is sex. The Court here acts as if transgender identity is a choice or ideology, nothing to do with who you are.
Yet the plaintiffs in this case and many medical studies emphasize the biological and psychological grounding of gender identity. And remember Bostock’s insight: it’s a “but-for” test – would the result be different if someone’s sex were different? Justice Alito, in the Skrmetti dissent, pointed out that if you took a transgender girl and imagined that child as a cisgender girl instead, under SB1 she could get blockers for puberty delays (because she wouldn’t have gender dysphoria on that assumption). But the law forbids it only because of the reality of her identity. The majority says “no, even switching the variable leads to the same ban.” But most observers see through this. It’s one thing to say pregnancy as a condition isn’t about sex. It’s quite another to say a child’s self-conception isn’t about sex.
This rigid formalism also ignores one key equal-protection doctrine: animus. Traditionally, even under rational basis, a law cannot rest solely on prejudice. Remember Cleburne v. Cleburne Living Center (1985), where a zoning law targeting mentally disabled people could not be sustained because it was found to express prejudice? Or Romero v. Evans (1996), which struck down a Colorado Amendment banning protections for homosexuals because it was born of animus?
In each case, the Court, even under rational basis, looked at purpose. In Bray, the Court said it needed to see if opposition to abortion was really animus against women as a class (it wasn’t, or so they found). But in Skrmetti, the majority refused to grapple with motivation at all. It was content to say the legislative findings simply restated fears and “were not in themselves evidence of sex-based stereotyping”. In fact, Tennessee’s sponsor unabashedly called gender transition “child abuse” and promised to keep kids “in God’s design.” But the majority interprets such context as irrelevant fluff. This Court has become markedly less willing to look behind the veil of legislation.
It’s worth quoting the Court’s own syllabus (the staff-written summary of the opinion): “SB1 does not classify on the basis of transgender status.” Those words on paper mean one thing—no suspect class—but in practice, they mean something more dangerous: as long as a state law is written in general terms, the Court will not consider whom it actually hurts.
The Court’s apparent faith in legislative purpose, even when medical groups say the purpose is to inflict harm, is astonishing. The slip of a judicial pen might not seem like much, but that kind of textual formalism is exactly what gets regimes like racial segregation upheld (think of Plessy v. Ferguson, where “whites only” in law hid racial animus). If “the text says minor or adult only,” we are told to drop the problem. That is a big change from one generation to the next.
It is important to note that Skrmetti (like Bostock before it) is narrowly stated to Tennessee’s law. The majority repeatedly emphasizes that this decision is based only on the state’s record and context, and “does not extend to other cases concerning discrimination based on transgender status.”
But real Constitutional law rarely stays so contained. Courts will soon clarify what “context of the Tennessee case” really means. In practice, a Tennessee law is the template for similar laws in 24 states and counting. The majority’s language suggests other challenges (say, to a Kansas ban or a federal rule) might get rational basis too. It also hints (per Kagan’s concurring opinion) that if re-argued under heightened scrutiny, SB1 would likely fail – but that was not the Court’s choice. So the broader message is uncertain, but grim: at least in the near term, any law targeting transgender minors faces the same thumbs-down as SB1.
What Comes Next?
Families and advocates will not give up. Lawsuits are already targeting bans in other states, citing Skrmetti. Some challengers may try new angles: perhaps invoking the First Amendment (free speech or religion for parents), perhaps focusing on due process (parental rights to decide medical care), or perhaps under state constitutions.
Public pressure will continue as well, as families share their stories. We may see a fierce push for Federal protection: for instance, a Congressional statute could bar such bans (though that too would face Supreme Court review under Roberts’s Skrmetti logic). It’s also possible the composition of the Court will change before too long, and Skrmetti might be revisited. But that’s a long shot.
For now, what we know is clear: Skrmetti v. Doe upends fundamental premises of equal protection, doing so precisely when the nation’s transgender youth need the law to stand as a shield. The Tennessee law itself is vile in many eyes, but even if one believes that minors should wait, surely one would prefer an outcome that does not leave an entire class of children apparently unprotected by the Fourteenth Amendment. By bending the doctrine to allow SB1, the Court has scored a victory for states’ rights – at the expense of personal liberty, parental rights, and health.
In the Ocean State, Rhode Island’s Democratic governor responded to Skrmetti by promising to expand protections for transgender youth. He called the Tennessee law “state-sanctioned cruelty.” Other states may do the same to attract families and doctors fleeing bans.
At the Federal level, activists in the past urged President Biden to support legislation like the Equality Act, which would prohibit discrimination on gender identity nationwide. But with the current regime and the makeup of both houses of Congress in 2025, it looks impossible that Congress can get that done in the current political climate.
Skrmetti is very much a product of our polarized time. It reflects how even the Supreme Court has become a political flashpoint. Yet, legitimacy of the current court aside, the decision reads like a profound distortion of Constitutional principles.
Chief Justice Roberts wrote that the ruling leaves other Constitutional protections for transgender people “undisturbed.” Even if that were so, and that’s highly debatable, it is cold comfort. Today’s generation of trans youth have few rights left to claim under current law. The Court has stamped this approach as valid—so, pending change, it will likely stand.