The Supreme Court agreed on Monday to consider a Tennessee law that bans certain medical treatments for transgender minors, the first time the justices will decide on the constitutionality of such statewide bans.
The move could have broad ramifications for about 25 states that have enacted similar measures. Republican-led state legislatures have pushed to curtail transgender rights in recent years, with laws that target gender-transition care and that regulate other parts of life, including which bathrooms students and others can use and which sports teams they can play on.
The case, United States v. Skrmetti, will be heard in the court’s next term, which typically begins on the first Monday in October, though no date has been set yet for oral argument. The justices had considered whether to hear two challenges to transition care, including the Tennessee appeal and one centered on a Kentucky law, at their private conference each week. But they had repeatedly postponed making a decision, suggesting there might have been debate over whether to do so.
The court’s decision to take up the case signals a willingness by at least some of the justices to delve into yet another polarizing social issue, even as they have yet to rule on some of the biggest cases for this term, involving emergency abortion care, disinformation on social media and the scope of presidential power.
The Biden administration and a number of legal advocacy groups representing transgender youths had asked the court to intervene after a federal appeals court upheld the ban. In Tennessee, the law prohibits three types of transgender medical care for minors — puberty blockers, cross-sex hormones and gender-transition surgeries.
The administration has argued that the law violates the equal protection clause of the 14th Amendment because it “frames that prohibition in explicitly sex-based terms.” Solicitor General Elizabeth B. Prelogar, in the government’s petition to the court, identified what she viewed as a disparity in the state’s approach, saying that even as Tennessee bans transgender medical care, it “leaves the same treatments entirely unrestricted if they are prescribed for any other purpose.”
In his brief, the attorney general for Tennessee, Jonathan Skrmetti, argued that the number of minors receiving diagnoses and medical treatment for gender dysphoria had risen sharply in recent years, prompting Tennessee and other states to respond. The laws, he said, were enacted “to ensure that potentially irreversible sex-transition interventions of uncertain benefit are not performed on minors who may not be able to fully grasp their lifelong consequences and risks.”
Such treatments, he warned, “carry serious and potentially irreversible side effects, including infertility, diminished bone density, sexual dysfunction, cardiovascular disease and cancer.”
The Biden administration strongly resisted that notion, saying such treatment is rare and citing guidelines that medical interventions for transgender adolescents occur only in “appropriate cases” and after undergoing a thorough assessment to determine that it is warranted.
The number of teenagers who identify as transgender has rapidly risen over recent years, but data suggests that only a small number receive puberty blockers or hormones. Surgeries in adolescents are exceedingly rare. About 100,000 transgender minors live in the states that have passed laws restricting gender-affirming care, according to the Williams Institute at UCLA.
Many American medical groups have endorsed youth gender treatments as evidence-based and necessary.
Lambda Legal, one of the groups challenging the Tennessee ban, voiced cautious optimism that the court would hear the case.
“This court has historically rejected efforts to uphold discriminatory laws, and without similar action here, these punitive, categorical bans on the provision of gender-affirming care will continue to wreak havoc on the lives of transgender youth and their families,” said Tara Borelli, senior counsel for the group.
Mr. Skrmetti, who is defending the ban, said in a statement that he looked forward to arguing before the court.
The case, he added, will “bring much-needed clarity to whether the Constitution contains special protections for gender identity.”
Until Monday, the current court had mostly refrained from wading into transgender rights.
This spring, the justices temporarily allowed Idaho to enforce a state ban that limited medical treatment for transgender youth. The law, passed by the state’s Republican-controlled Legislature, makes it a felony for doctors to provide transgender medical care for minors, including hormone treatment.
The justices did not decide on the substance of the case, but the decision, issued in response to an emergency application, split largely along ideological lines, with the court’s liberals dissenting.
In 2023, the justices upheld a federal appeals court, ruling that a 11-year-old transgender girl in West Virginia, Becky Pepper-Jackson, could compete on her middle school’s girls’ cross-country and track teams while an appeal in her case moved forward.
In June 2020, the court ruled that a landmark civil rights law protected transgender workers from discrimination, handing an unexpected victory to the movement for L.G.B.T.Q. equality. But the court has shifted rightward since then, with the appointment of Justice Amy Coney Barrett to succeed Justice Ruth Bader Ginsburg after her death in September 2020.
Transgender young people, their families and doctors have said that the medical care can relieve gender distress, known as dysphoria, which many transgender minors experience. Several European countries have recently restricted hormone treatments for children, but none have imposed outright bans.
Federal courts have splintered over such laws aimed at blocking transition care, allowing the measures in some states and banning them in others, intensifying pressure on the Supreme Court to intervene.
The Tennessee case traces back to November 2022, when a group of legislators introduced a bill outlawing transgender care for minors. Members of the Legislature’s Republican supermajority had rallied around it, calling it S.B. 1 to underscore its importance to their agenda.
The bill included language that Tennessee had a “compelling interest in encouraging minors to appreciate their sex, particularly as they undergo puberty,” and in prohibiting procedures “that might encourage minors to become disdainful of their sex.”
Violations of the law are punishable by a fine of $25,000 for each prohibited prescription or treatment, professional discipline and potential civil liability.
A group of legal advocacy organizations, including the American Civil Liberties Union, the A.C.L.U. of Tennessee and Lambda Legal, sued the state of Tennessee, seeking to block the new law.
The groups brought the suit on behalf of Samantha and Brian Williams, a Nashville couple, and their adolescent child, who is transgender, along with two other families and a Memphis-based doctor, Susan N. Lacy.
The child, L.W., is a 15-year-old transgender girl whose dysphoria made her feel that she was “trapped in the wrong body” and “drowning,” according to the government’s brief. The lawyers wrote that in 2021, “after extensive assessments and consideration of risks and benefits,” L.W. began treatment at Vanderbilt University Medical Center, first with puberty blockers and later with estrogen.
L.W. said she was “terrified” of the permanent changes that would happen to her if that “care was taken away,” according to the government’s brief.
Another plaintiff, identified in the brief as Ryan Roe, a 15-year-old transgender boy, said in court filings that he entered hormone therapy at Vanderbilt after two years of psychotherapy and extensive counseling and that “gender-affirming health care saved my life and the idea of losing it terrifies me.”
The third, identified as John Doe, is a 12-year-old transgender boy who in 2021, after years of psychotherapy and endocrine monitoring, began taking puberty-delaying medication.
After a federal district judge temporarily blocked the ban, a divided three-judge panel of the U.S. Court of Appeals for the Sixth Circuit in Cincinnati quickly overturned the lower-court decision, reinstating the ban in early July 2023. It was the first time a federal court had allowed such a law banning transition care to fully take hold in the country.
In November 2023, the federal government filed a petition asking the Supreme Court to review the case.
Amy Harmon contributed reporting.