Mid-Atlantic Health Law TOPICS

In U.S. v. Skrmetti, the U.S. Supreme Court upheld Tennessee’s law banning certain gender-affirming medical treatments for minors. The decision grants states significant discretion to regulate such treatments regardless of a medical provider’s determination that such a course of action is medically appropriate.

SB1

In 2023, Tennessee passed SB1, which prohibits the use of puberty blockers or hormone therapy for transgender teens. Supporters of the legislation argued that the law protected children from “irreversible medical procedures.” 

Several transgender teenagers, their families, and a medical provider filed a lawsuit, alleging that the law constituted sex-based discrimination and violated the U.S. Constitution’s 14th Amendment right to equal protection. Originally, these parties were joined by the Biden Administration, though the Trump Administration reversed course saying that it did not believe the law needed to be challenged.

Level of Scrutiny

At issue before the Supreme Court was the appropriate level of scrutiny to apply when considering the legality of SB1. The majority of the U.S. Supreme Court concluded that a more relaxed standard of review should be applied. This relaxed standard is known as the rational basis test, and means that Tennessee merely needed to demonstrate that there is a plausible reason for the law to uphold it.

The alternative, higher standard typically applies when a law seeks to treat people differently based on sex. In that case, states may only draw classifications if such categories serve “important governmental objectives” and the classification is “substantially related to the achievement of those objectives.”

The Supreme Court’s majority believed that no such classification occurred in SB1 because the ban applied to all minors who might receive care, regardless of their sex, an inter- pretation the liberal minority vehemently 
argued ignored the explicit language of the law referencing a state interest in encouraging minors “to appreciate their sex, particularly as they undergo puberty.”

Impact

While future legal battles remain, the decision has broad ramifications for the treatment of transgender patients across the country. Over half the states now have laws limiting gender affirming care for minors, and many of these laws include penalties for providers who defy the ban. 
Locally, Maryland does not ban gender affirming care for minors, and Maryland’s Trans Shield Act protects both patients and providers from out-of-state prosecution and investigation. As a result, Maryland providers may see an influx of patients traveling to Maryland for care from states with restrictive laws such as Tennessee’s SB1.
 

Alexandria K. Montanio
410-576-4278 • amontanio@gfrlaw.com