WASHINGTON, DC— Today, the U.S. Supreme Court issued a devastating ruling in US v. Skrmetti, upholding Tennessee’s ban on affirming healthcare treatments for transgender youth (Senate Bill 1). Further, by deciding that SB1 is constitutional, the Supreme Court has made it more difficult to challenge similar laws in the 27 other states where such laws are currently in effect. This decision enables the removal of access to best-practice, medically necessary healthcare for thousands of transgender youth, inflicting harm on families who want to get their children the care they need to be healthy and thrive. The enormity of the harm that these laws do is sweeping, and so too are the violations of people’s rights. Challenges to bans on healthcare for transgender youth on different bases will continue - and it is important to note that this care remains available in many states.   

Human Rights Campaign President Kelley Robinson released the following statement:  

“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.”

In the Court’s dissent, Justice Sonia Sotomayor writes, “the majority subjects a law that plainly discriminates on the basis of sex to mere rational-basis review. By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent."

The Court applied rational basis scrutiny in its analysis of Senate Bill 1, which the law survived—devastating access to transgender medical care for youth and widening already significant gaps in healthcare equality. This the first time the US Supreme Court has ruled on a case about transgender healthcare. 

The History of the Case: 

Senate Bill 1, Tennessee legislation that bans affirming care for transgender youth regardless of parental consent and medical recommendation, was signed into law in March 2023. In April 2023, the American Civil Liberties Union, the ACLU of Tennessee, Lambda Legal, and Akin Gump Strauss Hauer & Feld LLP sued the State of Tennessee on behalf of families and transgender youth to block the state’s ban. The United States then joined the case in opposition to the state ban. A district court judge later determined that the plaintiffs were likely to succeed on their constitutional claims and issued a preliminary injunction, blocking the law from going into effect. 

The district court decision was later appealed up to the Sixth Circuit, where a divided panel reversed the lower court’s decision. The plaintiffs filed petitions for a Writ of Certiorari asking the U.S. Supreme Court to review the 6th Circuit’s reversal. In June 2024, the Supreme Court agreed to take up the United States’ petition. Oral arguments were heard on December 4, 2025. 

Benefits of Transgender Medical Care for Youth:

Transgender medical care for youth is supported by every major medical association in the country. According to analysis by HRC, previous studies have found that transgender and non-binary youth who are able to receive hormonal treatments report positive psychosocial impacts, including increased well-being and decreased depression. 

• Other recent studies have found that receipt of puberty blockers can dramatically reduce risk of suicidality — in some cases by over 70% — among transgender youth, compared to those who were unable to access desired treatment.

A study by Stanford University School of Medicine found that positive mental health outcomes were higher for transgender people who accessed gender affirming hormone treatment as teenagers versus those who accessed it as adults. A third study, published in the New England Journal of Medicine, found that, two years after initiating gender affirming hormone treatment, transgender youth reported higher levels of life satisfaction and positive affect, and lower levels of gender dysphoria, depression and anxiety.

State Legislative State of Play:

See HRC Map on Current State Attacks on Transgender Healthcare 

As of today, 27 states have passed laws banning some type of gender-affirming care for minors. Twenty-five states, including Tennessee, banned puberty blockers and/or hormone therapy treatments, removing access to best practice, medically necessary care for transgender youth. [In two states, Arizona and New Hampshire, the bans only apply to some extremely rare types of care for minors.]

• 23 bans on access to hormone treatment are in effect, with bans in Arkansas and Montana currently blocked. Some of these laws threaten investigation and even imprisonment for parents and/or medical professionals who help children access the healthcare they need.

The Human Rights Campaign (HRC) is the nation’s largest LGBTQ+ civil rights organization working to achieve equality for lesbian, gay, bisexual, transgender and queer (LGBTQ+) people, with 3.6 million members and supporters. The HRC Foundation (a 501(c)(3)) works to ensure LGBTQ+ people are safe, seen and supported where it matters most: at school, at work and in every community across the country. From the courtroom to the classroom, from Congress to corporate America, HRC and the HRC Foundation build power through partnerships, storytelling, and action—working to create a future rooted in equity, freedom and belonging for all LGBTQ+ people.