All eyes are on the Supreme Court after oral arguments ended yesterday in a case requiring the justices to consider whether Tennessee’s ban on gender-affirming care for transgender minors violates the equal protection clause in the 14th Amendment of the Constitution.

The case of US v Skrmetti was first brought to the Supreme Court by three trans youths and their parents one year ago. The Biden administration filed a petition as well, and it was the government’s petition – not the request submitted by the parents – that the High Court accepted for review. The case is therefore styled as U.S. v. Skrmetti. Jonathan Skrmetti is the Tennessee Attorney General charged with the duty of defending the ban in court.

Tennessee’s contentious law was passed by the state’s legislature on March 22, 2023. The new law blocks healthcare providers from providing treatment for gender-affirming care to minors, including hormone therapy and puberty blockers, regardless of parental consent.

On December 4, 2024, in the highest court of the land, the nine U.S. Supreme Court Justices heard oral arguments for both sides regarding the law. The Supreme Court is currently situated with three liberal and six conservative Justices across the political spectrum. The six conservative Justices seemed to be against overturning the Tennessee law, though it will likely be several months before a formal opinion is released.

U.S. Solicitor General Elizabeth Prelogar represented the Biden administration while the families protesting the ban were represented by ACLU lawyer Chase Strangio, who is the first openly transgender attorney to argue before the Supreme Court. Tennessee state Solicitor General J. Matthew Rice represented the state and defended the ban.

Mr. Rice, in oral arguments, insisted that Tennessee is not violating the 14th Amendment, but instead, just targeting the “purpose” of the treatment for minors. The Equal Protection clause of the 14th Amendment to the U.S. Constitution prohibits any state from denying “to any person within its jurisdiction the equal protection of the laws.” This clause provides the constitutional basis for striking down laws that treat people differently based on certain immutable, protected characteristics, such as race and sex.

“Our fundamental point is there is no sex-based line here,” Rice said.

He added that the ban means that children can still receive puberty blockers, as long as the purpose is to treat their early-onset puberty. However, he said, these treatments are not allowed under the law as a treatment for gender dysphoria.

Ms. Prelogar disagreed strongly.

“The law restricts medical care only when provided to induce physical effects inconsistent with birth sex,” Prelogar said Wednesday. “Someone assigned female at birth can’t receive medication to live as a male, but someone assigned male can. If you change the individual sex, it changes the result. That’s a facial sex classification – full stop – and a law like that can’t stand on bare rationality.”

However, Chief Justice John Roberts said this particular Tennessee case is different from other cases related to sex discrimination because of the medical component.

“It seems to me that the medical issues are much more heavily involved than in many of the cases that you look to,” Justice Roberts told Ms. Prelogar. “And if that’s true, doesn’t that make a stronger case for us to leave those determinations to the legislative bodies rather than try to determine them for ourselves?”

Ms. Prelogar told the Justices that Tennessee’s arguments in favor of the new ban could support a major nationwide reaction to restrict transgender healthcare rights for minors.

The nonprofit Human Rights Campaign reports that 26 states have passed bans on gender-affirming care “affecting 39.4% of trans youth, or 118,300 trans minors between the ages of 13 and 17 across the US.”

During oral arguments, Justice Amy Coney Barrett asked Mr. Rice about the “possible impact” of the laws in regard to restricting women and girls from women’s and girls’ sports competitions and how the law’s impact would keep transgender people out of the bathrooms for women and girls in public buildings and schools.

During oral arguments on Wednesday, Justice Sonia Sotomayor spoke about the serious repercussions facing transgender children if the Tennessee law remains standing since it denies all transgender children access to gender-affirming care.

Justice Sotomayor cited an example of one of the petitioner families, where the child vomited every day and stopped speaking because of their not being able to speak in the voice that matched their identity.

“These are difficult decisions,” Ms. Prelogar noted. “Obviously, anytime you’re thinking about a medical intervention, you need to weigh risks and benefits. But the state has come in here, and in a sharp departure from how it normally addresses this issue, it has completely decided to override the views of the parents, the patients, the doctors who are grappling with these decisions.”

Justice Roberts said to Ms. Prelogar that “The Constitution leaves that question to the people’s representatives, rather than to 9 people, none of whom is a doctor.”

Though the Supreme Court is stacked 6-3 with conservatives versus liberals, a recent precedent goes against the concept of the court supporting Tennessee’s law.

In Bostock v Clayton County (2020), conservative Justice Neil Gorsuch penned a 6-3 opinion, joined by fellow conservative Justice Roberts and the Court’s liberal wing, in which the Court held that Title VII of the Civil Rights Act “bars employers from discriminating based on sexual orientation or gender identity.”

In that majority opinion, Justice Gorsuch wrote: “An individual’s homosexuality or transgender status is not relevant to employment decisions. That’s because it is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex.” It will be interesting how this Court squares its decision in the Tennessee case with its very recent precedent in Bostock.

The ACLU, in its amicus brief supporting the challenge to the Tennessee law, said that the American Psychological Association (APA) endorsed “unobstructed access to healthcare and evidence-based inclusive, clinical care for transgender, gender diverse, and nonbinary individuals.”

“The health care community’s understanding of what it means to be transgender has advanced greatly over the past century,” the APA wrote. “It is now understood and widely accepted within the medical and mental health communities that an incongruence between one’s sex and gender in and of itself implies no impairment in a person’s judgment, mental health, or general social or vocational capabilities.”

The decision is expected to be announced in June.