Breaking Down the Supreme Court's Ruling in Skrmetti v. United States

On June 18, 2025, the U.S. Supreme Court issued a deeply concerning decision in a case called Skrmetti v. United States. At the center of the case was a Tennessee law (Senate Bill 1 or SB1) that bans gender-affirming medical care, like puberty blockers and hormone therapy, for transgender people under 18.

The Court ruled in favor of Tennessee, allowing the law to stay in place. The vote was 6-3. Justices Sotomayor, Jackson, and Kagan strongly disagreed, saying the law clearly targets transgender youth and violates their constitutional rights. But the majority of the Court didn’t see it that way—and their decision opens the door for more states to follow suit.

Let’s break down what happened and why it matters.

What the Court Said—and What They Didn’t

This ruling was not about whether gender-affirming care is safe or effective. Major medical associations, including the American Medical Association and the American Academy of Pediatrics, agree that gender-affirming care is medically necessary and endorse access to this evidence-based care for transgender youth. However, the Court didn’t weigh in on that.

Instead, the Court focused narrowly on whether Tennessee’s law violates the Equal Protection Clause of the 14th Amendment, which protects people from being treated unfairly by the government based on things like race, sex, or identity.

Tennessee’s argument? The law doesn’t discriminate, because it bans certain treatments for all minors, no matter their gender. The state says it’s simply not allowing puberty blockers or hormones to be used for specific diagnoses such as gender identity disorder, gender dysphoria, and gender incongruence. Those treatments are still allowed for other medical reasons, like early puberty or hormone deficiencies.

The Supreme Court agreed with Tennessee. They said the law doesn’t single out trans youth, but bans treatment for specific conditions. And since not every transgender person seeks medical care, the Court said the law isn’t targeting transgender people as a group.

The Legal Logic Used in the Decision

To get there, the Court heavily leaned on the 1974 case Geduldig v. Aiello, directly applying this previous legal argument that has been highly scrutinized. In that case, the Court ruled that it wasn’t sex discrimination for an insurance plan to exclude pregnancy-related disabilities from coverage. 

In both Geduldig v. Aiello and Skrmetti v. United States, the Court divides care recipients into two groups. One group is those seeking care to treat a diagnosis defined as excluded, which is often specific to one identity group like pregnant women or transgender youth. The other is anyone seeking the same care or treatments to treat a diagnosis that has not been excluded.

And because of that the Supreme Court was able to argue that sex and gender identity, respectively, were not the sole reason for care being denied, but rather it was based on specific medical diagnoses. 

“Thus, although only transgender individuals seek treatment for gender dysphoria, gender identity disorder, and gender incongruence—just as only biological women can become pregnant—there is a “lack of identity” between transgender status and the excluded diagnoses. Absent a showing that SB1’s prohibitions are pretexts designed to effect invidious discrimination against transgender individuals, the law does not classify on the basis of transgender status.” (U.S. Supreme Court Ruling on Skrmetti v. United States)

In simple terms, the Supreme Court said that banning care for certain medical conditions, like gender dysphoria, is not the same as banning care for transgender people. Why? Because not every transgender person seeks treatment for those conditions. And because of that, they claim it’s not illegal discrimination under the Constitution, even though the people most affected by the law are transgender youth.

But critics, including the dissenting justices, argue this is a flawed and dangerous way of thinking. Just like pregnancy exclusions in the past disproportionately harmed women, laws like SB1 disproportionately harm trans youth—even if the law doesn't say so outright.

What This Means Going Forward

This ruling sets a dangerous precedent. It gives states a green light to pass similar laws banning gender-affirming care for trans youth, and it makes it harder to challenge these bans in court.

But here are some important points about the Court’s ruling:

• This ruling does not change Colorado law. In Colorado, gender-affirming care is still legal and protected. Providers can continue offering medically necessary care to trans youth.

• This ruling was not on whether or not gender-affirming care is safe. It only ruled on a narrow legal question, not on the science or standards of care.

• This decision raises the stakes in the fight for transgender rights. It’s now more important than ever to protect and expand access to gender-affirming care at the state level, support trans youth and their families, and push for long-term federal protections.

At Rocky Mountain Equality, we believe every young person deserves to grow up safe, supported, and with access to the care they need. We’ll keep fighting for trans youth, no matter what the Supreme Court says.