U.S. Supreme Court
Legal expert maps out how gender-affirming care bans may be challenged post-Skrmetti
Ruling leaves door open to state constitution claims
In a devastating loss for transgender youth and their families, the U.S. Supreme Court’s conservative supermajority on June 18 voted to uphold Tennessee’s law banning access to gender-affirming health care for minors in a 6-3 ruling that effectively shields similar restrictions in more than 20 other states.
Chase Strangio, a lead attorney for the plaintiffs in U.S. v. Skrmetti and the first trans lawyer to argue before the nation’s highest court, acknowledged the “setback” during a press call with reporters while stressing the need to “continue onward in the fight” because the avenues open to challenge laws like Tennessee’s Senate Bill 1 had not been fully extinguished.
Speaking with the Washington Blade on Monday, Professor Holning Lau of the University of North Carolina School of Law outlined the ramifications of the justices’ majority opinion and mapped out three ways in which cases aimed at striking down healthcare bans or other anti-trans policies and practices could play out in its wake.
An internationally recognized expert on equality rights, particularly in the contexts of sexuality, gender, and family life, Lau previously served as president of the ACLU of North Carolina’s board of directors and as a teaching fellow at UCLA’s Williams Institute on Sexual Orientation and Gender Identity Law and Public Policy.
He is also the co-author of a recent paper that examines the exceptions to laws prohibiting medical interventions for gender transitions in minors that permit “so-called gender-normalizing surgeries, which are performed on intersex infants to conform their bodies to socially constructed expectations about the male/female binary.”
These carveouts, Lau and his colleague UNC Law School Associate Professor Barbara Fedders argue, cut against the reasoning cited by the lawmakers behind legislative restrictions targeting healthcare for trans youth like SB 1 and by the lawyers defending them in court.
Specifically, Lau told the Blade courts could interpret such “intersex exceptions” as evidence that gender affirming care bans were written with or are undergirded by sex stereotypes, unwarranted fears, and disgust — possible grounds to argue they should be struck down under the animus doctrine, which holds that government action motivated by hostility or prejudice towards a particular group is unconstitutional.
While there was some discussion of animus in the context of U.S. v. Skrmetti, notably in the concurring opinion by conservative Justice Amy Coney Barrett, the plaintiffs’ case focused primarily on “the sex discrimination argument because of Bostock v. Clayton County,” Lau said, referring to the 2020 Supreme Court case that determined sex-based discrimination in the context of employment, as defined by federal civil rights law, includes discriminatory conduct that is motivated by the victim’s sexual orientation or gender identity.
‘A huge, huge setback’
Five years after LGBTQ rights advocates were toasting their victory in the landmark case, which saw three of the conservatives on the High Court joining their liberal counterparts in a majority opinion written by Justice Neil Gorsuch, “a lot of folks may have reasonably thought that the logic of Bostock points towards this very straightforward sex discrimination argument,” Lau said, adding that liberal Justice Sonia Sotomayor “adopts that avenue of reasoning in her dissent” in Skrmetti.
“The way that the majority rejects the sex discrimination arguments in in the majority opinion of Skrmetti is not persuasive in my view,” he said. “I struggle for words to capture the reasoning of the majority opinion.”
Echoing Strangio’s remarks, Lau noted that Skrmetti “doesn’t completely close the door” to legal challenges but is nevertheless “a huge, huge setback.”
On the one hand, he said “lower courts might say that this was very much about the context of medical treatment and minors,” which means “there may still be cases that prevail having to do with transgender discrimination in other contexts, like the military ban or the restrictions on passports.”
At the same time, however, Lau cautioned that “you could also read this case as signaling more obstacles ahead, especially if a case gets back to the Supreme Court” since “three of the justices have already signaled in Skrmetti that they do not view gender identity discrimination as warranting heightened scrutiny.”
Litigation aside, young people and their families who will suffer the most direct and harmful consequences, namely the loss of access to medically necessary gender-affirming care, will have to navigate “a patchwork of state laws,” he said, which in many cases will mean relocating or traveling out of state for treatments that have been criminalized in the places where they live.
The Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, which overturned the nationwide right to abortion, led to many of these same outcomes, he said. In an email following Monday’s phone interview, Lau further explained that “Dobbs unleashed conflicts between states, and there are signs that similar conflicts will arise with respect to gender-affirming care for trans youth.”
For example, he said “A growing number of states might seek to penalize interstate travel for gender-affirming care — targeting families who travel across state lines and/or medical providers who provide care to such families.”
“There is ongoing litigation concerning the constitutionality of interstate bans and shield laws in the abortion context, and those cases will bear significance on interstate bans and shield laws regarding gender-affirming care,” Lau said.
Counsel for the plaintiffs in Skrmetti probably turned to Bostock because the case was “the most recent victory, and the most on point when it comes to gender identity,” Lau said.
The animus doctrine was an important element of cases that expanded equal rights and protections for LGBTQ people, he said, pointing to U.S. v. Windsor (2013), which struck down portions of the Defense of Marriage Act, a law that prohibited the federal government from recognizing same-sex marriages, and Romer v. Evans (1996) which struck down a Colorado constitutional amendment prohibiting the state from enacting any LGBTQ inclusive nondiscrimination rules.
Lau said those cases are examples of where the Supreme Court has found indirect evidence of impermissible animus in the laws under consideration by the way they were designed or structured, as opposed to more direct evidence like overt expressions of sex stereotypes, fear, and disgust toward a particular group that might arise during the legislative process.
These cases and the animus doctrine, Lau added, are closely associated with the late former Justice Anthony Kennedy, an appointee of President Ronald Reagan who was the “swing vote” responsible for ultimately deciding many of cases considered by the Roberts court where the justices were split 5-4.
Following his retirement in 2018 and the emergence of a 6-3 conservative majority, there is less certainty about how the justices might evaluate animus related arguments in the context of disputes over issues of gay or transgender rights, Lau said, especially relative to how they were expected to look at the reasoning central to the Bostock decision just five years ago.
“I would have liked to see more” engagement with animus in the Skrmetti opinions, Lau said. Barrett in her concurrence did address the question, writing that there was a rational basis for Tennessee legislators’ SB 1, in contrast with the court’s findings in Romer, where the “sheer breadth” of law was “so discontinuous with the reasons offered for it that the [law] seem[ed] inexplicable by anything but animus toward the class it affect[ed]”.)
“To be sure, an individual law ‘inexplicable by anything but animus’ is unconstitutional,” Barrett said. “But legislatures have many valid reasons to make policy in these areas, and so long as a statute is a rational means of pursuing a legitimate end, the Equal Protection Clause is satisfied.”
Lau said that notwithstanding her position on Skrmetti, the fact that Barrett “did make reference to the animus jurisprudence suggests that there is potentially a future for animus doctrine, even in the post-Kennedy Supreme Court.”
Rather than the animus doctrine or Bostock’s reasoning that gender identity discrimination constitutes sex based discrimination, the court relied on Geduldig v. Aiello (1974), Lau said, which found that pregnancy discrimination “is not a type of sex discrimination” and remains a case that “strikes so many people as being incorrectly decided.”
“Whenever I teach Geduldig v. Aiello, my students are shocked by the court’s reasoning,” he said, “and it’s so formalistic in its reasoning that it’s so divorced from people’s lived experiences.”
The same can be said for the majority opinion and concurrences in Skrmetti, Lau said, where the justices said “that even if transgender kids are the only ones seeking treatment for gender dysphoria, not all transgender kids are seeking this treatment, and kids can still get the treatment if they have a different type of diagnosis” such as any of the conditions delineated in the exceptions that were written into SB 1 and similar laws in other states.
“One day, I imagine teaching [Skrmetti] and my students will be, likewise, shocked at the Court’s exceedingly formalistic reasoning,” he added.
Legal challenges to anti-trans healthcare bans in a post-Skrmetti world
After Skrmetti, Lau said he expects to see cases challenging bans and restrictions on healthcare for trans youth that are based on state constitutional claims, noting “a case where there was a recent victory in Montana based on Montana’s constitution,” a win that came despite the fact that it was decided in a place that “might not strike you as particularly hospitable to transgender rights.”
“The state constitutional law claims are particularly promising,” he said, “but it’ll be very context specific,” with the cases ultimately turning on the language contained in these different constitutions and “what sort of jurisprudence we have in each particular state.”
Per Lambda Legal, “On Dec. 11, 2024, the Montana Supreme Court upheld a preliminary injunction that (Senate Bill) 99 was likely unconstitutional under the Montana state constitution’s privacy clause, which prohibits government intrusion on private medical decisions. The ruling rested entirely on state constitutional grounds, insulating transgender adolescents, their families and health care providers from any potential negative outcome at the U.S. Supreme Court.”
Lau said the remaining two primary avenues for challenging anti-trans healthcare restrictions are likely to be animus based claims and cases grounded in arguments about parental rights, a phrase that often crops up in the context of efforts to undermine rather than strengthen freedoms and protections for LGBTQ people.
The reasoning was cited in a 2023 decision by a federal judge in Idaho who temporarily struck down the state’s ban on gender affirming care for kids, writing: “Transgender children should receive equal treatment under the law … Parents should have the right to make the most fundamental decisions about how to care for their children.”
Asked whether he believes jurists will consider parental rights or animus the more persuasive argument, Lau demurred, telling the Blade “I would be hesitant to say which one is more promising,” noting that animus claims often turn on very specific evidence that might show for example that the lawmakers behind a ban or restriction on transgender medicine were driven by sex stereotypes, irrational fear, or disgust toward a particular group.
Animus and the intersex exceptions
Asked whether anti-trans legislators are being counseled to avoid overt expressions of anti-trans sentiment or prejudice for fear that they might provide grounds for a successful legal challenge against their gender affirming care bans, he said “I think that’s very possible,” adding that “legislators are savvier now in terms of concealing their motives and their biases.”
“Philosopher Martha Nussbaum was monumental and unpacking disgust as an element of animus,” Lau said. “And so in my article, I try to unpack it to help readers connect the dots that there is this visceral disgust towards both intersex children and transgender minors, and that that can be connected to the doctrine of animus.”
In their paper, Lau and Fedders focused on the potential for courts to find inferred animus in laws like Tennessee’s SB 1 based on how they are structured, with sweeping restrictions on the one hand coupled with exceptions on the other that would allow families to pursue medical interventions for their children only when they have certain conditions or diagnoses.
“If we couple that with evidence from the legislative record” pointing to animus “there may be a case to be made,” Lau said.
Both the opinions in Skrmetti and the language of the SB 1 statute address how the law allows otherwise prohibited treatments or interventions to be administered to minors when they are indicated for diagnoses other than gender dysphoria or used for purposes other than gender transitions.
“They don’t call them intersex exceptions,” Lau said, but rather “exceptions for congenital defects,” defined as “including DSDs, disorders in sexual development — or what many intersex advocates would now refer to as ‘differences’ in sexual development.”
Interact, an intersex rights organization, “filed an amicus brief in Skrmetti that dovetailed with my article in that they argued the intersex exceptions support the idea that there are sex stereotypes that undergird the gender affirming care bans,” he said.
“I would like to see more discussion of the interplay between transgender rights and intersex rights,” Lau added, noting how questions about intersex vis-a-vis trans identities are relevant beyond the context of healthcare restrictions. For instance, he pointed to the Trump-Vance administration’s directive for the State Department to not allow passport holders to have the gender markers on their documents changed to align with their gender identity, also removing the option to select ‘X’ rather than the male/female binary category.
“The restrictions on passports not only affect transgender folks, but also non-binary and intersex folks as well,” Lau said. “And with respect to the bans on gender affirming care, not only do they restrict transgender youth’s access to gender affirming care, but they reflect and reinforce this understanding of intersex conditions that is very harmful and damaging to intersex youth.”
U.S. Supreme Court
Nine trans activists arrested outside Supreme Court
Gender Liberation Movement organized demonstration against Skrmetti ruling
On Friday afternoon, nine transgender organizers and allies were arrested on the steps of the U.S. Supreme Court for blocking the street and protesting the recent U.S. v. Skrmetti ruling.
The ruling, decided 6-3 by the conservative majority on Wednesday, upheld Tennessee’s ban on gender-affirming care for minors. The decision will allow states to pass laws restricting gender-affirming care for minors and further minimizes bodily autonomy.
The nine arrested were part of a larger group of more than 30 protesters wearing colors of the trans Pride flag— pink, blue, and white, — standing outside of the nation’s highest court. Organizers unfurled large cloths in pink, blue, and white, shared personal testimonies about how their gender-affirming care was a matter of life and death, released pink and blue smoke, and saw nine trans participants take their hormone replacement therapy.
The protest was led by the Gender Liberation Movement, an organization that “builds direct action, media, and policy interventions centering bodily autonomy, self-determination, the pursuit of fulfillment, and collectivism in the face of gender-based sociopolitical threats.” Among the nine arrested was GLM co-founder Raquel Willis.
Before being arrested, Willis spoke to multiple media outlets, explaining that this decision was an overreach of power by the Supreme Court.
“Gender-affirming care is sacred, powerful, and transformative. With this ruling in U.S. v. Skrmetti, we see just how ignorant the Supreme Court is of the experiences of trans youth and their affirming families,” said Willis. “Everyone deserves the right to holistic healthcare, and trans youth are no different. We will continue to fight for their bodily autonomy, dignity, and self-determination just like previous generations. No court, no law, no government gave us our power, and none can take it away.”
GLM co-founder Eliel Cruz also spoke to media outlets about the Skrmetti ruling, calling it “a historical moment of fascist attacks,” and encouraged the LGBTQ community to “organize and fight back.”
“As a cisgender man, I stand in solidarity with the trans community during these escalating attacks on their safety, well-being, right to exist in this world, and ability to live a future free of violence,” Cruz said. “I’m enraged at the Supreme Court’s decision to uphold a ban on gender-affirming care for youth. My heart hurts for the families and young people who this will negatively impact and harm.”
The Washington Blade reached out to Capitol Police for comment.
A spokesperson said the nine activists were arrested for violating D.C. Code §22-1307 — “Crowding, Obstructing, or Incommoding” — on First Street, N.E., after receiving three warnings.
U.S. Supreme Court
Lawyers who fought gender affirming care ban at the Supreme Court remain optimistic
Wednesday’s decision, while disappointing, leaves room for more legal challenges
Following the U.S. Supreme Court’s ruling on Wednesday upholding Tennessee’s ban on medical care for transgender minors, several of the plaintiffs’ attorneys expressed disappointment with the outcome but stressed that the fight was not over.
While the decision in U.S. v. Skrmetti will shield Tennessee and more than 20 other states from litigation challenging their anti-trans healthcare restrictions, the majority decision was not so broadly written that opportunities to fight for expanded rights and protections — or to push back against the Trump-Vance administration’s discriminatory policies — were extinguished, they said.
Addressing reporters during a press call hours after the decision was released were Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Project, Karen Loewy, director of constitutional law practice at Lambda Legal, and Lucas Cameron-Vaughn, senior staff attorney at the ACLU of Tennessee.
On the one hand, the lawyers were adamant that the conservative justices in the 6-3 majority opinion “got this completely wrong,” as Cameron-Vaughn said, because Tennessee’s law is “clearly a sex based classification and transgender based classification” on its face.
At the same time, he said “the fact that it’s a narrow ruling means that we will continue to fight and stand with trans people and their families in Tennessee with all the tools at our disposal to continue to stand against the assault from the government.”
Explained Strangio, “The court did not rule on whether or not transgender status independently warrants the type of heightened scrutiny that sex based classifications also trigger,” meaning that “lower court decisions — for example, in the 9th and the 4th Circuit that have already recognized that transgender status triggers this type of heightened scrutiny — will remain good law, and that government discrimination targeting transgender people, either through facial classifications or invidious discrimination, are both contexts in which the [Supreme] Court has today explicitly left open for heightened scrutiny.”
“The most immediate effect is on our clients and other young, young transgender people in Tennessee and across the country who need medical care that the government has stepped in to ban,” added Strangio, who is the first transgender attorney to argue before the Supreme Court. “And for them, we are devastated, and we know that we will continue fighting so that government discrimination against transgender people will end.”
“This is a setback in many ways,” he said, “but we continue onward in the fight and we can, you know, hold simultaneously, both the pain of this decision and all of the possibilities of the future we’re building.”
Responding to a question from the Washington Blade about whether the justices considered the potential harms of cutting off access to treatments for young people who have begun to medically transition, Strangio said he and his co-counsel stressed the issue in briefs and during oral argument.
He continued, “I think one of the frustrating things about the type of deference that this court found would apply here” as opposed to a more heightened level of scrutiny “is that they don’t really look at the underlying evidence, and so they can just sort of defer broadly and uncritically to state legislatures or legislatures more more generally.”
Strangio noted that while the dissenting opinions from the liberal justices, particularly Sonia Sotomayor’s, addressed harms related to the sudden loss of access to treatments for transgender youth, “that did not figure in in the majority opinions, in the ways that we all wished that it would have.”
“And we know how devastating it is for people to lose access to medically necessary care,” he said.
Responding to the same question, Loewy said “I would just lift up Justice Sotomayor’s dissent in as much as her questioning of Tennessee’s attorneys during argument was a recognition of the real harms to our actual clients. And her dissent really talks about what it meant before our clients had access to the gender affirming medical care that they needed, and the real harm of that now being unavailable to them.”
“So, there was definitely some recognition during the discussion, during argument, of what this really means for trans young people,” Loewy said. “And you know, it was clearly not part of the calculus that the majority was willing to really consider.”
U.S. Supreme Court
Supreme Court upholds ban on transgender care for minors
Skrmetti decision among this term’s most highly anticipated rulings
The U.S. Supreme Court on Wednesday upheld a ban on medical interventions for transgender minors in Tennessee, with the three liberal justices dissenting in a ruling that will shield similar laws that block or restrict access to care in more than 20 other states.
Conservative Chief Justice John Roberts, writing for the majority, said questions about the “safety, efficacy, and propriety of medical treatments” should be resolved democratically.
Liberal Justice Sonia Sotomayor argued, in her opinion, that the decision “authorizes, without second thought, untold harm to transgender children and the parents and families who love them,” adding that “Because there is no constitutional justification for that result, I dissent.”
Plaintiffs who challenged Tennessee’s ban were a doctor and three families argued that the policy violated the Equal Protection Clause of the 14th Amendment.
They also emphasized that the care prohibited for minors in the state — puberty delaying medication, hormone therapy, and surgeries — is made available to patients younger than 18 if they are sought for reasons other than gender transitions.
The case, U.S. v. Skrmetti, was among the most anticipated of the court’s June term.
President Donald Trump in February formally reversed course from the Biden-Harris administration’s support for the plaintiffs challenging the Tennessee law, urging the Supreme Court to uphold the ban.
Attorneys, Democratic lawmakers, and medical groups object to the ruling
Representing the plaintiffs in the litigation challenging the ban were the Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Project, Lucas Cameron-Vaughn, senior staff attorney at the ACLU of Tennessee, Karen Loewy, director of constitutional law practice at Lambda Legal, Jennifer Levi, senior director of transgender and queer rights at GLAD Law, Shannon Minter, legal director of the National Center for Lesbian Rights, Sasha Buchert, counsel and director of the Nonbinary and Transgender Rights Project at Lambda Legal, and attorneys with the firm Akin Gump.
“Today’s ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution,” said Strangio, who is the first trans lawyer to argue before the Supreme Court. “Though this is a painful setback, it does not mean that transgender people and our allies are left with no options to defend our freedom, our health care, or our lives.”
“The Court left undisturbed Supreme Court and lower court precedent that other examples of discrimination against transgender people are unlawful,” Strangio said. “We are as determined as ever to fight for the dignity and equality of every transgender person and we will continue to do so with defiant strength, a restless resolve, and a lasting commitment to our families, our communities, and the freedom we all deserve.”
“This is a heartbreaking ruling, making it more difficult for transgender youth to escape the danger and trauma of being denied their ability to live and thrive,” said Buchert. “But we will continue to fight fiercely to protect them. Make no mistake, gender-affirming care is often life-saving care, and all major medical associations have determined it to be safe, appropriate, and effective. This is a sad day, and the implications will reverberate for years and across the country, but it does not shake our resolve to continue fighting.”
“The Court today failed to do its job,” said Levi. “When the political system breaks down and legislatures bow to popular hostility, the judiciary must be the Constitution’s backbone. Instead, it chose to look away, abandoning both vulnerable children and the parents who love them. No parent should be forced to watch their child suffer while proven medical care sits beyond their reach because of politics.”
“The Court’s ruling abandons transgender youth and their families to political attacks. It ignored clear discrimination and disregarded its own legal precedent by letting lawmakers target young people for being transgender,” said Minter. “Healthcare decisions belong with families, not politicians. This decision will cause real harm.”
In a press conference on Capitol Hill, Senate Democratic Leader Chuck Schumer (N.Y.) told reporters, “This Supreme Court seems to have forgotten that one of their jobs is to protect individual rights and protect individuals from being discriminated against. It’s an awful decision.”
“On the floor, we had a bill, that the Republicans wanted to take away these rights,” Schumer said. “And we got, I believe, every Democrat voting against it. So it failed because it needed 60 votes. So we’re going to explore every solution.”
U.S. Rep. Pramila Jayapal (D-Wash.) also hosted a press conference, arguing that the court’s decision — and conservative-led efforts to restrict the rights and freedoms of transgender people more broadly — is of a piece with the Republican Party’s broader policy agenda, particularly in Trump’s second term.
In 2019, the congresswoman shared that her daughter, then 22, was trans. When asked on Wednesday whether her staunch opposition to the ruling was both professional and personal, Jayapal said, “I’m not speaking about my personal situation these days” but her family aside, “it’s also personal to me as a member of Congress that represents families who are experiencing the same kinds of issues and the same kind of fear that I hear from people across the country.”
She added, “And so I think what’s important is to recognize that trans people are a tiny percentage of the country and are doing no harm to anyone else. And despite the disinformation, the lies that are being circulated about trans people, I think that we are powerful when we come together, when we realize that these attacks are coordinated and are really about the same thing, which is exerting power over us and taking away our rights in a democracy that should be about allowing everyone to contribute their full selves.”
U.S. Sen. Ed Markey (D-Mass.) said: “Today, hate won. The far-right justices of the Supreme Court endorsed hate and discrimination by delivering a win for Republicans who have relentlessly and cruelly attacked transgender Americans for years. With 25 states already having laws in place that ban gender-affirming care for trans youth, the Supreme Court has cleared the way for families in half of the country to no longer access the medically necessary and life-saving care they need for their children.”
The senator continued, “But here is what no Court nor politician can ever change: trans people will continue to exist. Their health care is lifesaving and essential, and trans rights are human rights. We have a fight ahead of us, but discrimination and hate cannot and must not win.”
U.S. Sen. Jeff Merkley (D-Ore.) said: “Access to medically-necessary care for trans youth saves lives, and the U.S. Supreme Court’s callous decision puts trans youth and their families at risk.
“MAGA extremists across the nation will not stop at banning medically-necessary gender-affirming care for trans youth. The Court’s life-altering decision lays out the playbook for extremist politicians to continue their crusade against trans people and further exclude them from daily life. And this is just the beginning—this decision opens the floodgates for MAGA extremists in state legislatures and Congress to ban medically-necessary care, from gender-affirming care to abortion access.
“This is just wrong—everyone should have access to the care they need, when they need it. No exceptions.
“Let’s get politicians out of the exam room. We will continue to fight these divisive policies in communities nationwide to fully realize the vision of America as a land of freedom and equality for all, and I won’t rest until my Equality Act is signed into law to deliver on this fundamental promise.”
“Today’s decision by the Supreme Court is devastating for young transgender Americans and their families who live in states that decide to put divisive and dehumanizing politics over people,” said U.S. Rep. Mark Takano (D-Wis.), chair of the Congressional Equality Caucus.
“The Court’s ruling upholding Tennessee’s cruel and politically-motivated ban on medically-necessary care for young trans people undermines the ability of transgender patients, their families, and doctors to make medical decisions about accessing evidence-based care without politicians’ interference,” he said.
The congressman added, “The law the Court upheld is an attack on some of the most vulnerable in our community—but we still have other tools to challenge anti-trans laws in courts across the country. As Chair of the Equality Caucus, I am committed to continuing to lead elected officials from across the country in the fight for full equality for transgender people under the law here in Congress.”
“Every parent wants to keep their child healthy. Parents and trans young people have the right to make private health care decisions with their doctors. Today’s ruling allowing Tennessee politicians to interfere in private health care decisions is not only draconian, it’s dangerous and hateful,” said U.S. Rep. Becca Balint (D-Vt.). “I want families who are feeling scared today about the consequences of this decision to know that I’m with you. I’m fighting for you in Congress every single day, and I will not back down.”
Jayapal, Markey, Merkley, Takano, and Balint were among the 164 members of Congress who filed an amicus brief urging the court to preserve access to care.
New York Attorney General Letitia James also released a statement: “At a time when LGBTQ+ communities are under relentless attack, this decision is dangerous and a profound disappointment. Gender-affirming care is essential and lifesaving health care, and denying young people access to it will have devastating consequences.
“Let me be clear: gender-affirming care remains legal and protected in New York, including for young people.
“To the transgender community in Tennessee and across the country: We stand proudly with you. We are strongest together, and we will not let this decision weaken our resolve to build a safer, more just, inclusive, and compassionate nation for all.”
Also issuing a statement was a coalition of seven medical associations that had submitted an amicus brief supporting the plaintiffs — American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Psychiatric Association, Endocrine Society, the National Association of Pediatric Nurse Practitioners, and the American Pediatric Society.
The organizations said:
“As experts dedicated to providing patients with compassionate, evidence-based care every day, we are disappointed in the United States vs. Skrmetti decision, which increases the likelihood that other states will limit or eliminate families’ and patients’ ability to access medical care.
“As doctors, nurse practitioners, and nurses, we believe that every patient is different. Decisions about medical care must be based on individualized assessments by qualified professionals in consultation with the patient and their parents or legal guardians and guided by well-designed medical evidence. This Supreme Court decision strips patients and families of the choice to direct their own health care.
“Every patient should have access to the medical care they need. Health care professionals must be able to rely on their training, education, and expertise to provide appropriate care based on the needs and values of each patient and their family, without bans or interference.”
LGBTQ and civil rights advocacy groups object to the ruling
Allison Scott, president of the Campaign for Southern Equality, said ““I am heartbroken today. No one should be forced to leave their home state to access healthcare – and it is outrageous to see the U.S. Supreme Court uphold these bans and continue to allow the government to interfere with the personal medical decisions of families.”
“The Court’s ruling can’t change what we know in our bones: our identities, our families, and our lives are strong, worthy, and not up for debate by extremists,” she said. “The Trans Youth Emergency Project will be here to help families navigate this painful time.”
“Today, the Supreme Court took the place of parents and doctors and stripped away their ability to make private, lifesaving decisions for their children,” said GLAAD President and CEO Sarah Kate Ellis. “This ruling is a chilling step toward unchecked government overreach, intruding on the most personal aspects of our private lives.”
She added, “All families are now less safe and left vulnerable to politicians and a Court that has abandoned its duty to protect personal liberties. Every family deserves the freedom to make the medical decisions that help their children live, thrive, and be well.”
“This is a devastating and deeply dangerous decision that carries irreversible harm to transgender youth and their families. The majority’s opinion politicizes decades of medical consensus, ignores the Constitution’s mandate of equal protection, and turns its back on youth and their families,” said Skye Perryman, president and CEO of Democracy Forward.
“Our team at Democracy Forward will continue to work every day to support transgender people, including young people, their families, and communities, and we will never give up making the Constitution’s guarantee of equal protection under the law a reality for all people,” she said.
National LGBTQ Task Force President Kierra Johnson said: “Gender affirming care can mean the difference between life and death for our transgender youth. Today, the Supreme Court rejected the science and authorization of gender affirming care, upheld harmful bans, and denied the lived experiences of trans youth.
“The Supreme Court has now rolled back critical protections against discrimination on the basis of sex. This is an especially devastating moment for transgender youth, their parents and their doctors across the country. Tennessee’s ban on essential medical care — and other similar state bans — will continue to wreak havoc on the lives of these families.
“What we know is this: transgender youth denied access to appropriate medical care are in danger of worse physical and mental health outcomes.
“Americans look to the Supreme Court as the highest court of the land, making decisions with long term impact in these critical times; decisions that speak to the value certain communities. Transgender youth are often overlooked, undervalued, and lack the protection that they deserve as both minors and transgender community members. Gender dysphoria impacts more than the physicality of a person and, when left untreated, may result in anxiety and depression. When there is no legal doctrine that speaks to pertinence of gender affirming care, it shows that the law is not on their side, discrediting and disenfranchising a community while obliterating their humanity. ”
Imara Jones, CEO of TransLash Media, said: Today the Supreme Court used the greatest hits of discredited anti-trans, pseudoscientific ideas in order to rule against the equal access of trans kids to healthcare. This is healthcare that is safe, supported by every mainstream medical association, and which is granted with the consent of youth’s parents.
“Moreover, the Court could only issue such a ruling by overlooking the obvious: The denial of equal access to healthcare for trans kids is sex discrimination. Gender-affirming treatments are allowed for some children but not others under the Tennessee law SB1, which explicitly states as one of its goals to encourage minors to ‘appreciate their sex.’
“So what they did here is the equivalent of denying a person’s race, in order to declare that racial discrimination laws don’t apply.
“Now, while the Skirmetti ruling is not as sweeping as it could have been, because it leaves the door open to future cases on sports and bathrooms, it will likely turbocharge attempts to exempt trans people from Constitutional protections. What the court has done is give these efforts the sheen of judicial legitimacy, and a road map for how to do so, by directing them to leave out the explicit targeting of trans people.
“Because as long as the attempts to push trans people outside of the bounds of public life using the law are implicit, then governmental entities have free reign to do so, now.
“The success of manipulating legal, scientific, and media organizations with anti-trans disinformation by Christian Nationalist and authoritarian entities is crystal clear in this decision.”
“LPAC is devastated that the Supreme Court has turned away from experts like the American Academy of Pediatrics and hard data showing that health care for trans youth improves physical and mental health, and instead succumbed to political pressure,” said Janelle Perez, executive director of LPAC. “This cruel decision opens the floodgates for politicians to decide what we and our children need to be healthy. These are decisions that should be made by families and healthcare providers, not politicians.”
Human Rights Campaign President Kelley Robinson said: “Today’s Supreme Court decision is a devastating blow to transgender youth and the families who love them, but it will not break our resolve. Families may now have to make the heartbreaking choice to leave their state or split their families, or take on extensive financial burdens, in order to ensure that their kids can access medically necessary care.
“This Court chose to allow politicians to interfere in medical decisions that should be made by doctors, patients, and families—a cruel betrayal of the children who needed them to stand up for justice when it mattered most.
“As parents, advocates, and community leaders, we know that our fight doesn’t end in courtrooms—it lives in our communities, our hearts, and our unwavering commitment to each other. Still, we will not be deterred. We will support families forced to make impossible choices, fund legal challenges, and build a movement so powerful that no politician can ignore us. Together, we will turn this pain into power and keep fighting until every transgender person in America can live with dignity, safety, and the freedom to be who they are.”
Tennessee AG and Log Cabin Republicans celebrate the ruling
Tennessee Attorney General Jonathan Skrmetti said, “In today’s historic Supreme Court win, the common sense of Tennessee voters prevailed over judicial activism. A bipartisan supermajority of Tennessee’s elected representatives carefully considered the evidence and voted to protect kids from irreversible decisions they cannot yet fully understand.”
The AG continued, “I commend the Tennessee legislature and Governor Lee for their courage in passing this legislation and supporting our litigation despite withering opposition from the Biden administration, LGBT special interest groups, social justice activists, the American Medical Association, the American Bar Association, and even Hollywood.”
Log Cabin Republicans interim executive director Ed Williams released the following statement:
“The U.S. Supreme Court just upheld Tennessee’s law prohibiting trans medical surgeries and treatments for minors. This decision is not ‘anti-trans.’ It is a historic and critical win for children and common-sense. The majority of Americans support equal treatment for trans Americans and protections from discrimination. They also back laws like Tennessee’s, which protect children from receiving life-altering and irreversible medical procedures or treatments often pushed on them by a zealous cabal that views children as pawns in their gender ideology crusade.
“LGBT conservatives have long believed there is a middle-road that upholds respect, inclusion, and protection for trans Americans while curbing the excesses of a radical political movement attempting to push its bizarre agenda in sports, schools, governments, and hospitals. Today’s Supreme Court is a step in the right direction.”
The Washington Blade will update this story.
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