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United States v. Skrmetti

Supreme Court of the United States · 2025 · Constitutional Law

Constitutional LawEqual ProtectionSex classificationsTransgender minorsRational basis reviewEqual Protection ClauseFourteenth Amendmentrational basis review

Facts

Tennessee enacted SB1 in 2023 to prohibit healthcare providers from prescribing puberty blockers or hormones to minors for the purpose of enabling a minor to identify with, or live as, an identity inconsistent with the minor's sex, or to treat distress from discordance between sex and asserted identity. The law does not restrict those treatments for adults, and it permits their use for minors to treat congenital defects, precocious puberty, disease, or physical injury. The Tennessee legislature found that using these treatments for gender dysphoria in minors carried potentially irreversible risks, that minors may lack maturity to appreciate those risks, and that the evidence and medical guidance in this area remained uncertain and evolving. Plaintiffs argued that the law violated equal protection because it discriminated on the basis of sex and transgender status.

Issue

Whether Tennessee's SB1, which prohibits puberty blockers and hormones for minors when used to treat gender dysphoria, gender identity disorder, or gender incongruence, violates the Equal Protection Clause of the Fourteenth Amendment. More specifically, the question was whether SB1 triggers heightened scrutiny as a sex-based or transgender-status classification, or instead is subject only to rational basis review.

Rule

If a law neither burdens a fundamental right nor targets a suspect class, it is upheld under the Equal Protection Clause so long as it bears a rational relation to a legitimate governmental objective. A statute that classifies by age and by medical use does not trigger heightened scrutiny merely because it references sex or regulates treatments sought by transgender minors, so long as its application does not turn on sex and it does not classify on the basis of transgender status.

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One of 10 multiple-choice questions for this case. Pick an answer to see why.

Ohio enacts a statute providing that physicians may prescribe puberty-delaying drugs to minors for precocious puberty, congenital endocrine disorders, or physical injury, but not to treat gender dysphoria. Adults may receive the same drugs for any lawful indication. Several families sue, arguing the law should receive heightened scrutiny because it concerns treatment sought in relation to sex identity.

What level of scrutiny should a court apply under the Equal Protection Clause, according to the controlling doctrine?

Explanation. The majority held that a law of this kind is reviewed under rational basis review when it classifies by age and by medical use—permitting certain drugs for some indications and forbidding them for other indications in minors—without making treatment turn on sex. Mere reference to sex-related concepts or the fact that transgender minors are the ones who seek the excluded treatment does not itself trigger heightened scrutiny. (Derived from United States v. Skrmetti (n.d.).)