The Supreme Court Just Threw Trans Kids Under The Bus—Here's What Their Ruling Means

SCOTUS lands devastating blow against trans youth and their families

Transgender rights supporters and opponents rally outside of the U.S. Supreme Court. Photo by Kevin Dietsch/Getty Images.

U.S. v Skrmetti

Yesterday, the Supreme Court issued a 6-3 ruling in U.S. v Skrmetti, with the right-wing justices ruling to uphold Tennessee’s ban on gender-affirming care for transgender youth. This ruling will have devastating impacts on trans kids not just in Tennessee, but in the 25 other states that have passed similar bans as well — making it nearly impossible for hundreds of thousands of kids across the country to get the care they need and deserve.

The ruling in Skrmetti is the culmination of a years-long attempt from the far-right and transphobic activists to whip up a moral panic about trans youth and their care. Despite the fearmongering and lies about the trans community, the reality is just this: parents of trans kids want to be able to make healthcare decisions for their kids with their doctors and without interference from anti-science state legislators more interested in waging a culture war for personal gain than they are about kids’ safety.

Let’s get into the weeds a bit on this case. For 50 years, the Supreme Court has held that the Equal Protection Clause of the 14th Amendment requires that laws that treat people differently based on sex should be analyzed using what they call “intermediate scrutiny.” This means that if the government passes a law that negatively impacts a certain class of people based on their sex, the Court theoretically should hold it to a much higher standard in order to find the law constitutional. Yet, in Skrmetti, Chief Justice John Roberts and the right-wing majority somehow managed to determine that the Tennessee ban does not discriminate on the basis of sex, and so this heightened standard did not apply. They ruled that the law was constitutional under a much lower standard of review, and is not discriminatory on the basis of sex.

To arrive at this conclusion, the majority engages in a series of highly questionable mental acrobatics. Just look at what the law says: It bans the use of hormone therapy and puberty blockers for trans kids experiencing gender dysphoria, but allows the use of those same medications for cisgender kids who need access to them for a range of other conditions. So, if you had a child assigned male at birth whose puberty was delayed, he could be prescribed testosterone to address his development. If you had a son who was trans, however, who wanted his gender presentation to match his gender identity, he is prohibited from taking medication for this purpose solely because he was assigned female at birth. In other words, healthcare would be denied to your son based on his sex.

But Chief Justice Roberts can’t be bothered with the fact that Tennessee’s ban is plainly discriminatory on the basis of sex. In his majority opinion, he waves away reality without much fanfare, writing:

[The Tennessee ban] does not exclude any individual from medical treatments on the basis of transgender status but rather removes one set of diagnoses—gender dysphoria, gender identity disorder, and gender incongruence—from the range of treatable conditions.”

Except that, again, the law only excludes trans kids from medical treatments for gender dysphoria or gender incongruence, and does so based on the sex they were assigned at birth. By contrast, cisgender kids can still receive treatment to assist with conditions that might cause gender incongruence, contrary to what Chief Justice writes here.

For example, boys experiencing gynecomastia—the growth of breast tissues in males—would still have access to testosterone treatments to address the issue. Girls experiencing hirsutism can still access estrogen to address unwanted body hair. But trans kids cannot. The only difference between these hypothetical children is their sex — the treatments are the same.

This decision has the potential to be catastrophic for trans youth. Being denied treatment for gender dysphoria is, frankly, a life-and-death issue. As Justice Sonia Sotomayor wrote in her dissent,

Tragically, studies suggest that as many as one-third of transgender high school students attempt suicide in any given year. When provided in appropriate cases, gender-affirming medical care can meaningfully improve the health and wellbeing of transgender adolescents, reducing anxiety, depression, suicidal ideation, and (for some patients) the need for more invasive surgical treatments later in life. That is why the American Academy of Pediatrics, American Medical Association, American Psychiatric Association, American Psychological Association, and American Academy of Child Adolescent Psychiatry all agree that hormones and puberty blockers are ‘appropriate and medically necessary’ to treat gender dysphoria when clinically indicated.

But John Roberts and the MAGA majority on the Court don’t care about that. Roberts concludes his ruling with a wholesale adoption of the anti-trans activists’ argument:

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.

This should worry us all. These activists essentially created a controversy out of nothing, rejecting science and medical expertise along the way and pretending it had nothing to do with bigotry. Now their “sincere concerns” have been elevated by the Supreme Court of the United States to national relevance, somehow equal in “weight” to the scientific consensus about the efficacy and life-saving value of gender-affirming care. Following this ruling, not only are trans kids at risk, but so is the bodily autonomy of any member of any community who finds themselves in the sights of the hard right. Our freedoms are now up for “fierce debate,” subject to the “sincere concerns” of those who want to do us harm.

It’s further unclear now if we can rely on the Equal Protection Clause to protect us from what will assuredly be a wave of legislation aimed at attacking trans people in general along with other marginalized communities. The Court has not only allowed the states to discriminate against trans kids, they have also contorted our understanding of the Equal Protection Clause, which is supposed to protect us from discrimination.

As Justice Sotomayor put it in her dissent:

The Court … 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. [T]here is no constitutional justification for that result.

Roman Catholic Diocese of Albany v. Harris

Skrmetti wasn’t the only alarming opinion handed down by the Supreme Court this week. On Monday, the Court also issued an order in Roman Catholic Diocese of Albany v. Harris, a case challenging a New York law that requires employer health insurance plans to provide abortion coverage. While the law includes a narrow exemption for religious employers whose primary purpose is to proselytize and which primarily hire those who share their faith, it does not exempt employers that are religiously affiliated but whose work is broader than spreading religious values and who hire people regardless of their religious beliefs. Monday’s ruling gives the religious groups challenging the law another chance in court to have the law overturned on First Amendment grounds.

This case is the latest in a line of cases brought by “religious liberty” groups to further muddy the line between church and state. This particular case got a legal assist from the Becket Fund for Religious Liberty, a deeply right-wing legal non-profit at the forefront of protecting homophobic bakery owners who don’t want to make cakes for gay weddings. Leonard Leo, the archconservative dark money activist who is almost solely responsible for the make-up of our current Supreme Court, serves on Becket’s board.

New York’s law already includes an exemption for religious employers and strikes a balance between respecting religious beliefs with the need for providing comprehensive healthcare coverage for employees. States should have the right to set minimum standards for employers who do business within their borders, including making sure that workers have adequate healthcare coverage. Yet the religious right is nevertheless challenging this law, even though they aren’t religious employers by definition. If the challengers prevail here, it will open the door to even more challenges to neutral laws to allow religious organizations – defined as broadly and loosely as possible – to discriminate against people on supposedly religious grounds. It could end up exempting any employer claiming a religious affiliation from a range of state laws designed to protect employees. It’s not particularly surprising that the Supreme Court gave this case a second life.

Upcoming Cases To Watch

Skrmetti is not the only blockbuster case on the Court’s docket this term. We’re still waiting for big cases like:

FCC v. Consumers’ Research

This case has the potential to further erode the federal government’s ability to issue rules and regulations or to hold corporations accountable. Even worse, the plaintiff in this case, Consumers’ Research, is also affiliated with Leonard Leo, who is a major funder of the group as well as close friends with Justices Clarence Thomas and Samuel Alito, who refused to recuse themselves.

Trump v. CASA

This case centers around Donald Trump’s executive order to strip certain Americans of birthright citizenship. A judge in the 9th Circuit issued a nationwide injunction putting Trump’s order on pause while the courts heard legal arguments in the case. At issue in Trump v. CASA is not (yet) whether the president has the power to deny birthright citizenship via executive order, but whether or not the nationwide injunction was appropriate. If the Supreme Court lifts the injunction, it will no doubt throw people’s lives into chaos. Citizenship of children born here could very well be determined based on a state-by-state or even court-by-court basis until the case is resolved.

Braidwood v. Kennedy

This case is a challenge to the ACA provision that requires coverage of preventive healthcare services, in particular PrEP, which is medication that prevents the spread of HIV. Without access to this medication, there is a real risk of an increase in HIV transmissions and a severe public health crisis.

Medina v. Planned Parenthood South Atlantic

At issue in Medina is a South Carolina law that prevents Medicaid recipients from receiving healthcare from Planned Parenthood clinics in the state – not just abortion care but STI testing, birth control, and cancer screenings as well. A ruling upholding this law would be devastating for patients and lead to worse health outcomes for vulnerable community members.

Meagan Hatcher-Mays is a lawyer, democracy expert and the Senior Advisor for United For Democracy, a coalition of over 140 organizations dedicated to fighting for a better Supreme Court. She writes her own newsletter, Swamp Person, and you can follow her on BlueSky. She lives in Washington, DC.