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The case, U.S. v. Skrmetti, will have far-reaching implications for gender-affirming care and other issues of bodily autonomy.
LGBTQ+ rights groups and allies are preparing for a landmark case at the U.S. Supreme Court Wednesday — the high court’s first case on gender-affirming care.
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The case is U.S. v. Skrmetti, formerly L.W. v. Skrmetti, and deals with a Tennessee law that bans gender-affirming care for transgender minors. Senate Bill 1, signed into law by Republican Gov. Bill Lee in March 2023, bans surgery, puberty blockers, and hormone treatment for the purpose of gender transition for people under 18.
The following month, three families with transgender children and one doctor filed a suit challenging the law in U.S. District Court for the Middle District of Tennessee. L.W. is the trans daughter of Samantha and Brian Williams, and Skrmetti is Jonathan Skrmetti, the attorney general of Tennessee, who is named as a defendant along with other state officials. The case became U.S. v. Skrmetti when President Joe Biden's administration joined the suit on the side of the families and the doctor.
The suit argues that the law violates the U.S. Constitution’s guarantees of equal protection and due process as well as the Affordable Care Act’s Section 1557, which bans sex discrimination in health care. The plaintiffs are represented by Lambda Legal, the American Civil Liberties Union and its Tennessee affiliate, and the law firm of Akin Gump Strauss Hauer & Feld LLP.
U.S. District Judge Eli Richardson granted a preliminary injunction in June 2023, blocking the law from being enforced. However, a three-judge panel of the U.S. Court of Appeals for the Sixth Circuit lifted that in September 2023. So the plaintiffs are asking the court to review the Sixth Circuit’s decision. Chase Strangio of the ACLU will argue the case on behalf of the Tennessee families and doctor; he will be the first out trans person to argue a Supreme Court case. U.S. Solicitor General Elizabeth Prelogar will argue on behalf of the Biden administration.
LGBTQ+ and other civil rights groups will be watching the case closely. “At its heart, this case is about human dignity,” Kelley Robinson, president of the Human Rights Campaign, said in an HRC explainer on the case. “Transgender youth are not political pawns — they are children who deserve compassion, medical care and the same opportunities to thrive as all youth, and their parents deserve the same rights to support their needs as all other parents. No politician should ever be able to interfere in the decisions best made by families and doctors — but that’s exactly what these discriminatory bans allow.”
Twenty-six states have adopted a law or policy banning most or all gender-affirming care for minors making a gender transition, while allowing such procedures for cisgender minors with conditions such as early-onset puberty or an anomaly of sexual development.
Bans on the care for trans minors are “are based on serious misconceptions about transgender people,” Tekla Taylor and Shayna Medley wrote in an online article for Advocates for Trans Equality.
“Trans healthcare, or gender-affirming care, has been studied for decades,” they explained. “The medications that many trans people need, including hormone therapy and puberty pausing medications, have been safely prescribed since the 1980s.”
But those backing such bans often claim the care is experimental or unproven and act as if young people receive it without parental knowledge or consent, and none of that is true. During his presidential campaign, Donald Trump made the wild and false assertion that children were transitioning genders at school. Also, being trans isn’t a “stage” that people outgrow, as some opponents of gender-affirming care contend.
“Every child deserves access to healthcare that supports their well-being,” Robinson said. “Nearly every major medical organization agrees: gender affirming care isn’t a political statement; it’s healthcare that can prevent depression, reduce suicide risk, and help children thrive. This is about healthcare, plain and simple.”
Recent studies have found that receiving puberty blockers can dramatically reduce risk of suicidality — in some cases by over 70 percent — among transgender youth, HRC noted. A Stanford University School of Medicine study indicated that people who underwent gender-affirming hormone treatment as teens had a higher rate of positive mental health outcomes than those who had it as adults. A study by several health care professionals, published in The New England Journal of Medicine,found that trans youth who had this treatment saw improvements in life satisfaction and positive affect, with lower levels of gender dysphoria, depression, and anxiety.
“Sadly, while the positions of the anti-trans side are thoroughly misleading — if not outright false — the harm that these bans do is very real,” Taylor and Medley reported. A Trevor Project study found that 90 percent of LGBTQ+ young people were negatively affected by anti-LGBTQ+ political rhetoric, and 45 percent of trans and nonbinary youth said they or their families have considered moving to a different state because of anti-trans laws.
Advocates for Trans Equality has filed a friend-of-the-court brief with the Supreme Court in the Tennessee case. Such briefs are filed by people and organizations not directly involved in a case but wishing to offer an opinion. It’s signed by more than 60 people who have benefited from gender-affirming care, including prominent actors Elliot Page and Nicole Maines and Stonewall veteran Miss Major.
"The people who contributed to this brief, like the diverse community of trans people they represent, have found joy and meaning in their lives, regardless of age, race, faith, or origin,” said a statement from Sydney Duncan, senior counsel at Advocates for Trans Equality. “No matter their differences, each of their stories credits gender affirming healthcare as the key that unlocked their ability to become happy, successful, and engaged with the world around them. We are living proof that gender-affirming healthcare matters, that it is good, and that it is right. Transgender youth, their families, their doctors — and certainly not politicians — should be the ones making these medical decisions. We ask the Supreme Court to strike down this cruel and discriminatory law.”
HRC has laid out the effects of potential rulings. They depend on the level of scrutiny the court applies to the case. Possibilities include finding Tennessee's law unconstitutional, and therefore similar state laws are unconstitutional; sending the case back to the Sixth Circuit, which, depending on the level of scrutiny applied, could send a strong message that the Tennessee law and others like it are rarely permissible or result in such laws remaining in place or even being strengthened; or affirming the Sixth Circuit ruling, which would mean all such laws would stay in place.
"Bans on transgender health care are part of a larger attack on sex discrimination protections that will harm bodily autonomy by restricting reproductive rights and access to medical care — all of which are a part of the far right’s attempts to redefine sex and gender," Haley Norris, policy analyst for the LGBTQI+ policy team at the Center for American Progress, wrote on the center's website. "The fallout of this decision, which likely won’t be released until the summer of 2025, is something that everyone concerned about bodily autonomy should be worried about."
Families and advocates will gather outside the court Wednesday for a rally titled “Freedom to Be: A Celebration of Transgender Youth and Families.”
