Court upholds ban on transgender care for minors

In a 6-3 decision June 18, the U.S. Supreme Court upheld Tennessee’s ban on puberty blockers and hormone therapy for the purpose of gender transition for minor children.

Chief Justice John Roberts wrote the majority’s opinion—the Tennessee law banning puberty blockers and hormone treatments for transexual minors doesn’t violate the Constitution’s Equal Protection Clause.

The decision’s impact is far-reaching, as 26 other states—including Texas—have similar laws.

Tennessee passed Senate Bill 1 in 2023, “restricting sex transition treatments for minors by enacting the Prohibition on Medical Procedures Performed on Minors Related to Sexual Identity” bill, the opinion syllabus explains.

The legislation does not prevent hormonal therapy or puberty blockers in minors for reasons other than gender identity.

Regarded by many as a setback for transgender rights, many Baptists view the decision favorably.

Texas Baptists’ Christian Life Commission noted on Facebook: “We celebrate the 6-3 decision in U.S. v. Skrmetti as being in line with Christ’s teaching for his followers to care for the vulnerable among us.”

The case was argued not on the basis of science, but on the basis of scrutiny.

Understanding Standards of Review

John Litzler, CLC director of public policy, explained in equal rights cases, there are standards of review—or levels of scrutiny—that must be applied to determine the constitutionality of a law—strict, intermediate and rational basis.

The lowest level, rational basis, applies to most laws. Where rational basis applies, the government only must demonstrate the law is rationally related to a legitimate government interest.

Intermediate scrutiny is used for laws that discriminate based on gender. In these cases, the government must show that a law in question serves an important government objective and substantially relates to achieving that objective.

Strict scrutiny, the highest level, applies to laws affecting fundamental rights or suspect classifications, such as race or national origin. When strict scrutiny applies, the government must prove the law is narrowly tailored to achieve and serve a compelling state interest, he explained.

The case brought against the Tennessee ban, by three transgender minors and a doctor, challenged the law under the Equal Protection Clause.

The district court partially enjoined the law, identifying transexual as a “quasi-suspect class,” holding SB1 discriminates on the basis of sex and transgender status and that it was not likely to survive intermediate scrutiny, the opinion syllabus explains.

But, the Sixth Circuit Court of Appeals reversed the finding of the lower court, holding the law did not trigger increased scrutiny or fail rational basis review.

So, the opinion syllabus explains, the Supreme Court heard the case to consider whether Tennessee’s SB1 violates the Equal Protection Clause of the Fourteenth Amendment.

Plaintiffs argued SB1 warranted heightened scrutiny because it relies on sex-based classifications, but the court determined transgender does not qualify as a quasi-suspect group and the age and medical use classifications of the bill do not merit strict scrutiny.

Siding with the Sixth Circuit ruling, the Supreme Court found only rational basis review was required for the law before them, since the law applies to opposite sex minors equally and allows for hormonal medical treatments for purposes other than gender identity.

“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,” Roberts wrote.

“The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best,” he continued.

The court’s role is limited to deciding constitutionality of the law not its “wisdom, fairness or logic,” Roberts concluded. “We leave questions regarding its policy to the people, their elected representatives, and the democratic process.”

The dissenting opinion

Justice Sonia Sotomayor wrote the dissenting opinion.

She wrote: “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.”

She asserted: “By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims,” noting, “In sadness, I dissent.”

Prior to the ruling, the Texas Baptists CLC team met Tennessee Attorney General Jonathan Skrmetti, defendant in the case, at the SBC annual meeting, where they were able to “hear his heart about why he believes this law protects children,” their Facebook page said.

Background from ERLC panel

Skrmetti participated in a panel discussion at the annual meeting last week, moderated by Ethics and Religious Liberty President Brent Leatherwood.

In the discussion, Skrmetti explained the importance of Christian voices weighing in on judicial proceedings by way of amici, or “friend of the court” briefs.

He noted the state is limited in the kinds of arguments it can make and must be extremely selective in what it includes in court filing documents due to length restrictions.

However, amici serve as important additions to the state’s arguments, because they allow faith-based, religious arguments about a law to be considered alongside the government’s arguments.

Skrmetti noted the reality of gender dysphoria and urged Christians not to minimize the difficulty of facing gender dysphoria for those who face it.

“We should be compassionate,” he said, and gender dysphoria “should not be made light of.”

Yet, he asserted, overwhelming evidence shows the majority of children who experience gender confusion outgrow it.

He also cited a growing number of European countries embraced these medical treatments but now are reckoning with the permanent effects they have on the adults who underwent the treatments as children.

Children cannot give informed consent, he asserted.

When asked how the bill came to pass, Skrmetti explained, “The legislature thought, ‘this is a really important issue where we have to protect kids from this unchecked momentum from an unproven approach.’”

Though he was not involved in the bill becoming a law, Skrmetti said he was proud to defend Tennessee’s law before the Supreme Court.

While the CLC was not involved directly in this case, they signed onto an amicus brief in Texas case Free Speech Coalition, Inc. v. Paxton, also being argued on the basis of level of scrutiny.

The Paxton case relates to a law requiring age verification to access online pornographic material.

The outcome in the Skrmetti case has implications for the Free Speech Coalition, Inc. v. Paxton case, on which the Supreme Court’s decision is expected soon.