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United States v. Skrmetti

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Supreme Court of the United States
United States v. Skrmetti
Term: 2024
Important Dates
Argued: December 4, 2024
Decided: June 18, 2025
Outcome
affirmed
Vote
6-3
Majority
Chief Justice John Roberts • Clarence Thomas • Samuel Alito (Parts I and II–B) • Neil Gorsuch • Brett Kavanaugh • Amy Coney Barrett
Concurring
Clarence Thomas • Amy Coney Barrett • Samuel Alito
Dissenting
Sonia Sotomayor • Elena Kagan • Ketanji Brown Jackson

United States v. Skrmetti is a case that was decided by the Supreme Court of the United States on June 18, 2025, during the court's October 2024-2025 term. The case was argued on December 4, 2024.

In a 6-3 vote, the Court affirmed the decision of the United States Court of Appeals for the Sixth Circuit, holding that "Tennessee’s law prohibiting certain medical treatments for transgender minors is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment and satisfies rational basis review."[1] Chief Justice John Roberts delivered the majority opinion of the court. Justices Clarence Thomas and Amy Coney Barrett filed concurring opinions. Justice Samuel Alito filed an opinion concurring in part and concurring in the judgment. Justice Sonia Sotomayor wrote a dissenting opinion, joined in full by Justice Ketanji Brown Jackson, and in part by Justice Elena Kagan. Justice Kagan also authored a dissenting opinion.[1] Click here for more information about the ruling.

HIGHLIGHTS
  • The issue: The case concerned whether Tennessee Senate Bill 1 violates the Fourteenth Amendment. Click here to learn more about the case's background.
  • The questions presented: "Whether Tennessee Senate Bill 1 (SBl), 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," Tenn. Code Ann. § 68-33-103(a)(1), violates the Equal Protection Clause of the Fourteenth Amendment."[2]
  • The outcome: The U.S. Supreme Court affirmed the decision of the United States Court of Appeals for the Sixth Circuit, which upheld Tennessee's Senate Bill 1. The Court stated the law was not subject to a heightened scrutiny standard, but rather a rational basis review standard.


    • The case came on a writ of certiorari to the United States Court of Appeals for the Sixth Circuit. To review the lower court's opinion, click here.

    Background

    Case summary

    The following are the parties to this case:[3]

    The following summary of the case was published by SCOTUSblog:[5]

    “

    Tennessee’s law forbids medical treatments that are 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.” Kentucky’s law prohibits medical treatments “for the purpose of attempting to alter the appearance of, or to validate a minor’s perception of, [a] minor’s sex.” Both provisions outlaw a range of treatments, including gender-reassignment surgery. But the challenges before the court specifically concern two nonsurgical treatments: the administration of puberty blockers to stop physical changes brought on by puberty; and hormone therapy, which seeks to produce physiological changes to conform physical appearance with gender identity.[6]

    		”

    To learn more about this case, see the following:

    Timeline

    The following timeline details key events in this case:

    Questions presented

    The petitioner presented the following questions to the court:[2]

    Questions presented:
    “ Whether Tennessee Senate Bill 1 (SBl), 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," Tenn. Code Ann. § 68-33-103(a)(1), violates the Equal Protection Clause of the Fourteenth Amendment.[6] ”

    Oral argument

    Audio

    Audio of oral argument:[7]




    Transcript

    Transcript of oral argument:[8]

    Outcome

    The U.S. Supreme Court affirmed the U.S. Court of Appeals for the Sixth Circuit's ruling that allowed Tennessee’s Senate Bill 1 to take effect by reversing a lower court’s preliminary injunction. The Court held that the constitutionality of the law was not subject to a heightened scrutiny standard, but rather a rational basis judicial review standard and that it satisfies the rational basis review, meaning that the law did not violate the Equal Protection Clause of the Fourteenth Amendment.[1]

    According to SCOTUSblog:[5]

    “ Tennessee’s law prohibiting certain medical treatments for transgender minors is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment and satisfies rational basis review.[6] ”

    Opinion

    Chief Justice John Roberts delivered the majority opinion of the Court. In his opinion, Chief Justice Roberts wrote:[1]

    “ 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. The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best. Our role is not “to judge the wisdom, fairness, or logic” of the law before us, Beach Communications, 508 U. S., at 313, but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment. Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process.

    The judgment of the United States Court of Appeals for the Sixth Circuit is affirmed.[6]

    		”
    —Chief Justice John Roberts

    Concurring opinions

    Justice Thomas

    Justice Clarence Thomas wrote a concurring opinion:[1]

    “ This case carries a simple lesson: In politically contentious debates over matters shrouded in scientific uncertainty, courts should not assume that self-described experts are correct.

    Deference to legislatures, not experts, is particularly critical here. Many prominent medical professionals have declared a consensus around the efficacy of treating children’s gender dysphoria with puberty blockers, cross-sex hormones, and surgical interventions, despite mounting evidence to the contrary. They have dismissed grave problems undercutting the assumption that young children can consent to irreversible treatments that may deprive them of their ability to eventually produce children of their own. They have built their medical determinations on concededly weak evidence. And, they have surreptitiously compromised their medical recommendations to achieve political ends.

    The Court today reserves “to the people, their elected representatives, and the democratic process” the power to decide how best to address an area of medical uncertainty and extraordinary importance. Ante, at 24. That sovereign prerogative does not bow to “major medical organizations.” Post, at 5, n. 5 (opinion of SOTOMAYOR, J.). “[E]xperts and elites have been wrong before—and they may prove to be wrong again.” Students for Fair Admissions, Inc., 600 U. S., at 268 (THOMAS, J., concurring).[6]

    		”
    —Justice Clarence Thomas


    Justice Alito

    Justice Samuel Alito wrote an opinion, concurring in part and concurring in the judgment. In his concurrence, Justice Alito wrote:[1]

    “ I concur in the judgment and join Parts I and II–B of the opinion of the Court. I agree with much of the discussion in Part II–A–1, which holds that Tennessee’s Senate Bill 1 (SB1) does not classify on the basis of “sex,” but I set out my own analysis of this issue in Part I of this opinion. I do not join Part II–A–2 of the opinion of the Court, which concludes that SB1 does not classify on the basis of “transgender status.” There is a strong argument that SB1 does classify on that ground, but I find it unnecessary to decide that question. I would assume for the sake of argument that the law classifies based on transgender status, but I would nevertheless sustain the law because such a classification does not warrant heightened scrutiny. I also do not join Part II–A–3 of the Court’s opinion because I do not believe that the reasoning employed in Bostock v. Clayton County, 590 U. S. 644 (2020), is applicable when determining whether a law classifies based on sex for Equal Protection Clause purposes.

    ... Because transgender status is not a suspect or “quasi-suspect” class, even if Tennessee’s SB1 classifies on that ground, it must be sustained so long as it “bears some fair relationship to a legitimate public purpose.” Plyler, 457 U. S., at 216. As the Court notes, SB1 easily satisfies that standard. Ante, at 21–24.

    I therefore agree with the Court that the judgment of the United States Court of Appeals for the Sixth Circuit should be affirmed.[6]

    		”
    —Justice Samuel Alito

    Justice Barrett

    Justice Amy Coney Barrett wrote a concurring opinion, joined by Justice Thomas. In her concurrence, Justice Barrett wrote:[1]

    “ Because the Court concludes that Tennessee’s Senate Bill 1 does not classify on the basis of transgender status, it does not resolve whether transgender status constitutes a suspect class. Ante, at 16–18; see Geduldig v. Aiello, 417 U. S. 484, 496 (1974). I write separately to explain why, in my view, it does not.

    ... The Equal Protection Clause does not demand heightened judicial scrutiny of laws that classify based on transgender status. Rational-basis review applies, which means that courts must give legislatures flexibility to make policy in this area.[6]

    		”
    —Justice Amy Coney Barrett

    Dissenting opinions

    Justice Sotomayor

    Justice Sonia Sotomayor wrote a dissent, joined in part by Justice Elena Kagan and in full by Justice Ketanji Brown Jackson. In her dissent, Justice Sotomayor wrote:[1]

    “ To give meaning to our Constitution’s bedrock equal protection guarantee, this Court has long subjected to heightened judicial scrutiny any law that treats people differently based on sex. See United States v. Virginia, 518 U. S. 515,533 (1996). If a State seeks to differentiate on that basis, it must show that the sex classification “serves important governmental objectives and that the discriminatory means employed are substantially related to the achievement of those objectives.” Ibid. (internal quotation marks omitted). Such review (known as intermediate scrutiny) allows courts to ascertain whether the State has a sound, evidence-based reason to distinguish on the basis of sex or whether it does so in reliance on impermissible stereotypes about the sexes.

    Today, the Court considers a Tennessee law that categorically prohibits doctors from prescribing certain medications to adolescents if (and only if) they will help a patient “identify with, or live as, a purported identity inconsistent with the minor’s sex.” Tenn. Code Ann. §68–33–103(a)(1)(A) (2023). In addition to discriminating against transgender adolescents, who by definition “identify with” an identity “inconsistent” with their sex, that law conditions the availability of medications on a patient’s sex. Male (but not female) adolescents can receive medicines that help them look like boys, and female (but not male) adolescents can receive medicines that help them look like girls.

    Tennessee’s law expressly classifies on the basis of sex and transgender status, so the Constitution and settled precedent require the Court to subject it to intermediate scrutiny. The majority contorts logic and precedent to say otherwise, inexplicably declaring it must uphold Tennessee’s categorical ban on lifesaving medical treatment so long as “ ‘any reasonably conceivable state of facts’ ” might justify it. Ante, at 21. Thus, the majority subjects a law that plainly discriminates on the basis of sex to mere rational-basis review. By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent.

    ... This case presents an easy question: whether SB1’s ban on certain medications, applicable only if used in a manner “inconsistent with . . . sex,” contains a sex classification. Because sex determines access to the covered medications, it clearly does. Yet the majority refuses to call a spade a spade. Instead, it obfuscates a sex classification that is plain on the face of this statute, all to avoid the mere possibility that a different court could strike down SB1, or categorical healthcare bans like it. The Court’s willingness to do so here does irrevocable damage to the Equal Protection Clause and invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight. It also authorizes, without second thought, untold harm to transgender children and the parents and families who love them. Because there is no constitutional justification for that result, I dissent.[6]

    		”
    —Justice Sonia Sotomayor

    Justice Kagan

    Justice Kagan also wrote a dissenting opinion.[1]

    “ For all the reasons JUSTICE SOTOMAYOR gives, Tennessee’s SB1 warrants heightened judicial scrutiny. See ante, at 9–27 (dissenting opinion). That means the law survives if, but only if, its sex-based classifications are “substantially related to the achievement” of “important governmental objectives.” United States v. Virginia, 518 U. S. 515, 533(1996). As JUSTICE SOTOMAYOR notes, the point of applying that test is to smoke out “invidious” or otherwise unfounded discrimination. Ante, at 10; Michael M. v. Superior Court, Sonoma Cty., 450 U. S. 464, 469 (1981) (plurality opinion). More concretely put, heightened scrutiny reveals whether a law is based on “overbroad generalizations,” stereotypes, or prejudices, or is instead based on legitimate state interests, such as the one here asserted in protecting minors’ health. Virginia, 518 U. S., at 533. Because the Court is wrong in not subjecting SB1 to that kind of examination, I join Parts I through IV of JUSTICE SOTOMAYOR’s dissent.

    I take no view on how SB1 would fare under heightened scrutiny, and therefore do not join Part V. The record evidence here is extensive, complex, and disputed, and the Court of Appeals (because it applied only rational-basis review) never addressed the relevant issues. Still more, both the plaintiffs and the Government asked this Court not to itself apply heightened scrutiny, but only to remand that inquiry to the lower courts. So I would both start and stop at the question of what test SB1 must satisfy. As JUSTICE SOTOMAYOR shows, it is heightened scrutiny. I respectfully dissent.[6]

    		”
    —Justice Elena Kagan

    Text of the opinion

    Read the full opinion here.

    October term 2024-2025

    See also: Supreme Court cases, October term 2024-2025

    The Supreme Court began hearing cases for the term on October 7, 2024. The court's yearly term begins on the first Monday in October and lasts until the first Monday in October the following year. The court generally releases the majority of its decisions in mid-June.[9]


    See also

    External links

    Footnotes

    1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Supreme Court of the United States, "UNITED STATES, PETITIONER v. JONATHAN SKRMETTI, ATTORNEY GENERAL AND REPORTER FOR TENNESSEE, ET AL.," June 18, 2025
    2. ↑ 2.0 2.1 "U.S. Supreme Court", "23-477 UNITED STATES V. SKRMETTI" June 24, 2024
    3. ↑ Supreme Court of the United States, "No. 23-477," accessed August 13, 2024
    4. ↑ Note: When this case was argued, counsel was given by former United States Solicitor General Elizabeth Prelogar.
    5. ↑ 5.0 5.1 SCOTUSblog, "Restrictions on gender-affirming medical care – and assault weapons," May 24, 2024
    6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
    7. ↑ Supreme Court of the United States, "Oral Argument - Audio," argued December 4, 2024
    8. ↑ Supreme Court of the United States, "Oral Argument - Transcript," argued December 4, 2024
    9. ↑ SupremeCourt.gov, "The Supreme Court at Work: The Term and Caseload," accessed January 24, 2022
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