In United States v. Skrmetti (2025), the Supreme Court ruled that transgender people are not a constitutionally recognized protected class under the Equal Protection Clause, and therefore laws affecting them do not require heightened scrutiny. The case centered around Tennessee’s SB1, which bans gender-affirming medical care—such as puberty blockers and hormone therapy—for minors when used to treat gender dysphoria, but allows those same treatments for other conditions like precocious puberty. The law was challenged by the U.S. Department of Justice on grounds that it discriminated based on sex and transgender status.

The key legal issue was what level of judicial scrutiny should apply when a law singles out transgender people. Under Fourteenth Amendment jurisprudence, laws that classify people based on suspect or quasi-suspect traits—such as race, national origin, or sex—must meet a higher standard of justification. These include strict scrutiny and intermediate scrutiny. Strict scrutiny requires that the law be narrowly tailored to serve a compelling governmental interest. Intermediate scrutiny demands that the law be substantially related to an important government interest. All other classifications are reviewed under the deferential rational basis test, where the law only needs to be rationally related to a legitimate government interest.

In this ruling, the Court applied rational basis review. The majority held that the law distinguished based on age and medical purpose—not sex or gender identity—and therefore did not implicate a suspect class. The opinion, authored by Chief Justice Roberts, emphasized that Tennessee’s law applies equally to all minors, regardless of their sex assigned at birth. The Court rejected the argument that targeting gender dysphoria-related treatments was inherently a form of sex discrimination. The majority also declined to elevate transgender status to a quasi-suspect or suspect class, which would have triggered intermediate or strict scrutiny. This marks a significant departure from lower court decisions that had begun to apply intermediate scrutiny in transgender-related equal protection cases.

Notably, the Court stopped short of defining a categorical rule for all transgender discrimination claims, but the reasoning leaves little ambiguity: transgender people are not, in the Court’s view, a protected class that warrants higher judicial protection—at least not under current doctrine. The decision signals a narrower interpretation of the Equal Protection Clause when it comes to gender identity, placing legislative judgment above judicial intervention in areas of contested medical and cultural debate.

The dissent, authored by Justice Sotomayor and joined by Justices Kagan and Jackson, argued that the law discriminates on the basis of sex in practice, since it denies treatments based solely on whether a patient’s gender identity aligns with their sex assigned at birth. She accused the majority of allowing legislatures to disguise discrimination through superficially neutral criteria, warning that the ruling sets a dangerous precedent by refusing to scrutinize laws that effectively target a marginalized group under the guise of medical regulation.

While this case did not overturn prior transgender rights decisions—like Bostock v. Clayton County (which applied Title VII protections to transgender workers)—it does limit constitutional protections in the context of medical treatment. By declining to treat transgender status as a protected class, the Court has left such individuals more vulnerable to state-level legislative restrictions, and it shifts the battleground firmly into the political arena rather than the judicial one.

IF YOU NEED A LAWYER CONTACT US