Supreme Court debates Tennessee’s Law on Hormone Treatments for Gender Dysphoria

Outside the U.S. Supreme Court building Wednesday afternoon, lawyers supporting state bans on hormonal treatments for young people with gender dysphoria spoke more bluntly than they did during oral arguments before the justices.
Inside the courtroom, they argued that Tennessee’s law banning puberty blockers and hormonal treatments for people under 18 was about “protecting children.” They cited the need to prevent minors from suffering irreversible changes to their bodies—such as loss of fertility, increased risk of heart troubles, bone loss, and other issues.
Outside the courtroom, however, their arguments echoed the culture wars of 40 to 50 years ago, when Anita Bryant’s “Protect the Children” campaign was prominent. It also recalled the debates over state bans on same-sex marriage a decade ago, which opponents similarly framed as efforts to “protect children.”

“The evidence shows that a large majority of [minors with gender dysphoria] will grow out of it unless they are put on these medications,” said J. Matthew Rice, Tennessee’s solicitor general, who defended the state’s SB 1 law before the Supreme Court.

Alabama Attorney General Steve Marshall, who joined Rice at an impromptu post-argument media gathering, said litigation to maintain access to medical treatment for minors with gender dysphoria was simply an effort “to push a transgender agenda.” South Carolina Attorney General Alan Wilson added that the laws enacted by his state and 24 others in the past three years aimed to “prevent a 12-year-old from using chemical castration.”

“We can tell parents when they have to keep their kids in the backseat of a car, and we can restrict kids from buying cigarettes,” said Wilson, comparing these new laws to existing child protection measures.

The court heard arguments for well over the one hour it had initially allotted to the case, U.S. v. Skrmetti (Jonathan Skrmetti is Tennessee’s attorney general). As often occurs in LGBTQ-related cases, the nine justices appeared divided into two camps:

• The three progressive justices posed questions challenging the controversial law.
• The six conservative justices focused on defending it.

U.S. Solicitor General Elizabeth Prelogar, representing the Biden administration’s opposition to Tennessee’s law, argued that the ban violates the U.S. Constitution by discriminating based on sex, thus infringing the Equal Protection Clause. She contended the law should be scrutinized under heightened judicial review—greater than the lenient “rational basis” standard. Prelogar urged the Court to remand the case to the Sixth Circuit Court of Appeals with instructions to apply this heightened scrutiny.

ACLU attorney Chase Strangio, the first openly transgender person to advocate before the Supreme Court (addressed by Chief Justice John Roberts as “Mr. Strangio”), argued that Tennessee’s SB 1 had “taken away the only medicine that has provided relief for patients.”

“And do you maintain that these medicines reduce the risk of suicide?” asked Justice Samuel Alito, known for his hostility toward LGBTQ issues.

“I do,” Strangio replied.

Alito countered, stating he had not seen evidence that treatments for gender dysphoria reduced the risk of suicide.

Interestingly, at a press conference on Monday, Rick Colby—a longtime Republican lobbyist and father of a transgender son—said his child had been “near suicide” before receiving hormonal treatment.

“It’s a real thing,” Colby stated. “Today, my son is thriving.”

The case before the Court originated from a lawsuit filed by one transgender girl, two transgender boys, and their parents after Tennessee’s legislature banned medical treatment for minors diagnosed with gender dysphoria. The medical community defines gender dysphoria as significant distress stemming from a mismatch between one’s gender identity and sex assigned at birth. A Memphis doctor, Susan Lacy, joined the lawsuit, which initially succeeded at the district court level. The federal judge ruled the bans constituted “disparate treatment on the basis of sex.” However, the Sixth Circuit U.S. Court of Appeals reversed the decision. Both the transgender youth and the U.S. government appealed the Sixth Circuit’s ruling to the Supreme Court, with at least four justices agreeing to hear the U.S.’s petition.

The Question:

The Department of Justice’s (DOJ) petition asked whether Tennessee’s law violated the Equal Protection Clause. The petition from the ACLU and Lambda Legal added two further questions:

1. Should the state law be subject to heightened scrutiny due to sex-based discrimination?
2. Does the law violate parents’ fundamental right to make decisions about their children’s medical care under the Fourteenth Amendment’s Due Process Clause?

The Court agreed to hear only the DOJ’s petition and framed the question in a way that some have called prejudicial:

“Whether Tennessee Senate Bill 1 (SB 1), which prohibits all medical treatments intended to allow ‘a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex’ or to treat ‘purported discomfort or distress from a discordance between the minor’s sex and asserted identity,’ violates the Constitution.”

According to Tennessee’s briefs, SB 1 aims to “protect children” from medications that block puberty or administer “cross-sex hormones” to develop traits of a different sex. The state contends these treatments risk infertility, bone loss, sexual dysfunction, and “unknown effects on brain development” during critical developmental years.

The brief acknowledged that while the U.S. Food and Drug Administration (FDA) approves puberty blockers for hormonal imbalances caused by precocious puberty, it has not approved them for gender dysphoria.

Although some state lawmakers claim the diagnosis of gender dysphoria is easily obtained, the official psychiatric diagnostic manual requires patients to exhibit “clinically significant distress or impairment in social, occupational, or other important areas of functioning” to qualify. Diagnoses must also include “a marked incongruence between [their] experienced/expressed gender and assigned gender, lasting at least six months,” as well as six additional criteria, such as a “strong desire” to be another sex or an “insistence” on being the other gender.

Constitutional Arguments:

Plaintiffs and the U.S. government rely on the Fourteenth Amendment’s Equal Protection Clause, which states:

“No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”

In response, Tennessee argued that Equal Protection does not “prohibit states from enacting laws protecting children from sex-transition medical interventions with risks of lifelong harm.” Tennessee also questioned whether the Due Process Clause grants parents the right to demand such medical treatments for their children when the state deems them unproven and excessively risky.

A decision in the case is expected by June.

Additional Context:

• The plaintiffs’ brief noted there are approximately 1.5 million Americans who identify as transgender.
• Chase Strangio, 42, came out as transgender during law school at Northeastern University in Boston. He has worked on several high-profile LGBTQ cases, including Obergefell v. Hodges and Bostock v. Clayton County.
• J. Matthew Rice, 35, Tennessee’s solicitor general and a former clerk to Justice Clarence Thomas, argued for Tennessee.
• Dr. Susan Lacy, a Memphis physician involved in the lawsuit, said she has treated more than 800 children and adults. She emphasized that treatments for minors already require parental consent.
• At a press conference on December 2, two fathers of transgender youth spoke: Brian Williams, father of lead plaintiff L.W., and Rick Colby, who credited treatment with saving his son from suicide.

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