In a landmark case, the Supreme Court considers the treatments for transgender youth.

On Wednesday, the Supreme Court heard oral arguments in a significant case concerning whether states can prohibit minors from receiving gender transition medical care under the Equal Protection Clause of the 14th Amendment. This closely monitored case may have far-reaching consequences for the care and treatment of young people in approximately half of U.S. states.

The case, United States v. Skrmetti, focuses on a Tennessee law that prohibits gender-transition treatments for adolescents in the state. Enacted in March 2023, the law targets healthcare providers in Tennessee who continue to offer gender-transition treatments to transgender minors, exposing them to fines, lawsuits, and other legal liabilities.

The main concern in the case is whether Tennessee's Senate Bill 1, which prohibits any medical treatments that enable a minor to identify with or live as a gender identity different from their assigned sex, or to alleviate any discomfort or distress resulting from a mismatch between their sex and declared gender identity, violates the Equal Protection Clause of the Fourteenth Amendment.

The Supreme Court considered restrictions on medical treatments and procedures for transgender adolescents for the first time on Wednesday, as many other states have moved to ban or restrict such treatments. The case and oral arguments received significant attention, with observers closely watching the back-and-forth for clues as to how the court might rule.

The Biden administration and the ACLU represented petitioners in a lawsuit to challenge a Tennessee law, which sought to overturn the law on behalf of the parents of three transgender adolescents and a Memphis-based doctor.

The constitutionality of state bans on transgender medical treatment for minors, such as SB1, was the main topic of discussion during Wednesday's oral arguments. The question at hand was whether these laws should be subject to a higher level of scrutiny under the Equal Protection Clause of the Constitution due to their potential discrimination against a "quasi-suspect class" or on the basis of sex.

The debate over the level of scrutiny that the court should apply in reviewing laws involving transgender care for minors, including SB1, persisted on both sides.

The court should apply the heightened scrutiny test, which demands that states specify a significant goal that the law achieves, while Tennessee maintained that the rational basis test, which is the least stringent standard used by the 6th Circuit Court in evaluating SB1, is sufficient.

The U.S. Solicitor General Elizabeth Prelogar, representing petitioners, contended that SB1 violates the Equal Protection Clause by discriminating against individuals based on their sex. According to the petitioners, SB1 prohibits treatment only when it aligns with the patient's birth sex.

In Tennessee, it was argued that the sex-based classification of SB1 applies to individuals based on their sex.

Elizabeth Prelogar, the U.S. Solicitor General, cited an unnamed petitioner in the case, referred to as John Doe, who wants to take puberty blockers to undergo a typical male puberty. However, SB1 states that because John's sex at birth was female, he cannot have access to those medications. Prelogar argued that if John's sex is changed, the restriction under SB1 will lift, and the result will be different.

In addition to addressing the justices' concerns about states' ability to pass legislation protecting minors, petitioners aimed to satisfy the stricter scrutiny standard.

In response to Justice Kavanaugh's inquiry about the impact of the ruling on other states, Prelogar stated that the court could write a narrow opinion that only requires heightened scrutiny when a law prohibits conduct that is inconsistent with sex. However, she noted that the court has made it clear that this is an intermediate standard. If the state can demonstrate an important interest and substantiate that it needed to draw sex baselines to serve that interest, it would still be permitted.

On Wednesday, opponents of SB1 in Tennessee claimed that the bill aimed to safeguard minors from unproven and potentially dangerous medical treatments.

Tennessee Solicitor General Matthew Rice contended that SB1 does not satisfy the requirement for heightened scrutiny because it draws a "purpose-based line" rather than a "sex-based line."

According to Rice, the law is based solely on medical purposes and not a patient's sex. The only way petitioners can argue for a sex-based line is by equating fundamentally different medical treatments.

Rice stated that administering testosterone to a boy with a deficiency is not the same as giving it to a girl with psychological distress related to her body.

The justices posed challenging inquiries to respondents regarding the categorization and implementation of SB1.

Justice Kentaji Brown Jackson referenced the race-based case of Loving v. Virginia, which overturned Virginia's law prohibiting marriage between individuals of different racial backgrounds, specifically a White man and a Black woman, when discussing issues of classification.

Rice asked, "So how are they different?" She pointed out that under SB1, an individual can receive puberty blockers or hormone treatments if it aligns with their sex, but not if it contradicts it.

Justice Elena Kagan questioned Rice regarding the implementation of SB1, specifically referring to the bill's text and one of its stated objectives, which is to "promote among minors a positive attitude towards their gender identity and prohibit treatments that may lead to a negative perception of their gender identity."

"Kagan advised Rice that while they had discussed the classification extensively, it was important to consider what led to the classification in order to better understand its purpose."

The state of Tennessee maintains that its law remains constitutional under heightened scrutiny, asserting in its court brief that it has a compelling interest in safeguarding the health and safety of minors and preserving the integrity and ethics of the medical profession.

The controversial case arises during a period in Washington when the Republicans are poised to seize control of the White House, retain the House, and reclaim the Senate, thereby enhancing their power to shape the federal judiciary.

The court is expected to rule on U.S. v. Skrmetti before July 2025.