Today, the U.S. Supreme Court in United States v. Skrmetti upheld Tennessee’s law protecting children from harmful puberty blockers, hormones, and irreversible mutilating surgeries. The majority of the High Court rejected a legal challenge from three gender-confused teens, their parents, and a doctor who argued the law violated their equal protection rights and discriminated based on sex. However, the majority ruled that Tennessee’s law “clearly” did not turn on sex but rather restricts “questionable” medical treatments equally for all minors regardless of their sex. 

Liberty Counsel filed a brief in support of the Tennessee law.

The decision will provide a solid foundation to keep in effect similar laws protecting children in 26 other states.

In writing for the majority, Chief Justice John Roberts wrote that Tennessee’s “Save Adolescents from Experimentation (SAFE) Act,” or SB1, “does not prohibit conduct for one sex that it permits for the other.” Rather, the law is a medical and age regulation that blocks puberty blockers, hormones, and mutilating surgeries from being used on any minor to treat several medical diagnoses—gender dysphoria, gender identity disorder, and gender incongruence—due to their “harmful” and “sometimes irreversible” risks. The opinion noted those risks include “irreversible sterility, increased risk of disease and illness, and adverse psychological consequences.”

“SB1 divides minors into two groups: those who might seek puberty blockers or hormones to treat the excluded diagnoses, and those who might seek puberty blockers or hormones to treat other conditions,” wrote Chief Justice Roberts. “Although only [gender-confused] individuals seek treatment for gender dysphoria, gender identity disorder, and gender incongruence—just as only biological women can become pregnant—there is a ‘lack of identity’ between [gender-confused] status and the excluded medical diagnoses.” Under these circumstances, Chief Justice Roberts wrote, the Court did not find any sex-based discrimination in SB1’s medical prohibitions. 

The decision affirms a ruling from the Sixth Circuit Court of Appeals, which upheld the law using a “rational basis” review, a less stringent standard of review that determines whether the law is rationally related to a legitimate government interest. 

Chief Justice Roberts stated that the less stringent review was appropriate since Tennessee’s law proclaimed a “legitimate, substantial, and compelling interest in protecting minors from physical and emotional harm.” Both he and Justice Samuel Alito, who wrote a concurring opinion, noted that the Tennessee legislature only targeted “experimental medical procedures” that are found to be “unsupported and dangerous” by a growing number of international medical experts. SCOTUS cited the Cass Review, a four-year study out of the United Kingdom, that concluded there is a “lack of reliable evidence” for any long-term positive outcomes from these gender interventions.

“We afford states ‘wide discretion to pass legislation in areas where there is medical and scientific uncertainty,” wrote Chief Justice Roberts. “SB1’s ban on such treatments responds directly to that uncertainty.”

In his concurring opinion, Justice Clarence Thomas wrote that children “are being rushed toward medical treatment,” and that states can “legitimately question” whether these “experimental” procedures on children are “ethical.”

“[T]he rising number of detransitioners that clinicians report seeing . . . indicates that this approach can backfire,” wrote Justice Thomas. “States have an interest in ensuring that minor patients have the time and capacity to fully understand the irreversible treatments they may undergo. And, despite the supposed expert consensus that young children can consent to irreversible sex-transition treatments, states have good reasons to disagree; as ‘any parent knows,’ children’s comprehension is limited, and the growing number of detransitioners illustrates the risks of assuming otherwise.”

The High Court indicated that children “benefit from additional time to ‘appreciate their sex’ before embarking on body-altering paths” and states can ban procedures that “encourage them to become disdainful of their sex.” 

“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. The voices in these debates raise sincere concerns; the implications for all are profound,” wrote Chief Justice Roberts. “Having concluded [the law does not violate the Fourteenth Amendment], we leave questions regarding its policy to the people, their elected representatives, and the democratic process.”

Under this broad ruling, states with similar laws facing legal challenges may now see these laws go into effect or be upheld, including Arkansas, Florida, Kentucky, Montana, and Missouri. 

In February 2025, the Trump administration had notified the U.S. Supreme Court that it considered Tennessee’s law banning child medical mutilation constitutional reversing the federal government’s previous position on the issue under Joe Biden. The Trump administration urged the High Court, which had already heard oral arguments in the case, to still decide it on its merits as the decision would affect many other legal cases. The notification followed President Trump’s executive order declaring these medical procedures as “barbaric” and stopping federal funding to organizations that support these irreversible mutilating surgeries for minors under the age of 19.

Liberty Counsel Founder and Chairman Mat Staver said, “The U.S. Supreme Court decision United States v. Skrmetti sets a precedent that there is no right to subject children to medical mutilating surgeries. States have broad discretion to protect children from these dangerous drugs and irreversible, experimental surgeries. Every state needs to follow suit and ban child medical mutilation.”