Published June 19, 2025
In a much-anticipated decision, United States v. Skrmetti, the Supreme Court handed a win to states seeking to protect children from sex-rejecting hormonal and surgical procedures. The 6–3 decision, with Chief Justice Roberts writing for the majority, dealt a significant blow to the transgender juggernaut, curtailing the strategy of using courts to thwart legislative or executive action that protects children from the harms of “transition” procedures. But the Justices shied away from addressing more fundamental definitions of the human person, meaning we’ll likely see the transgender issue in court again before long.
The key question in Skrmetti was whether Tennessee’s 2023 law prohibiting sex “transition” treatments for minors—including puberty suppression, cross-sex hormones, and surgical interventions—is a sex-based classification requiring “heightened scrutiny” under the Equal Protection Clause. The majority held that the Tennessee law did not involve a sex-based classification but instead “prohibits healthcare providers from administering puberty blockers and hormones to minors for certain medical uses, regardless of a minor’s sex.” Classifications that “turn on age or medical use” (not sex) are subject to “rational basis review.” In this case, the Court found that the state has a “legitimate, substantial, and compelling interest in protecting minors from physical and emotional harm.” Policy questions, such as those raised by Tennessee’s law, are best left “to the people, their elected representatives, and the democratic process.”
A win for common sense, the Skrmetti decision will have a broad impact.
First, Skrmetti sends a message that the twenty-five states with similar laws are standing on solid ground, absent state law or other challenges, protecting thousands of children from serious harm. That’s a win.
Second, Skrmetti will likely spur additional legislative and policy action on a national scale, as well as in additional states. Tennessee’s law provides a blueprint for crafting laws and policies that prohibit pediatric medical “transition” and withstand Equal Protection challenges. Although the majority declined to decide whether “transgender status” is a protected class, the separate concurrences by Justice Barrett (joined by Justice Thomas) and Justice Alito offer differing analyses of “transgender status,” ultimately rejecting claims that it is a protected class. (Unlike race, for example, transgender identification is not innate, immutable, or immediately apparent.) These concurrences may help guide future litigation and shape public arguments, countering claims that “being transgender” merits special treatment under the law.
Third, the appalling brutality of pediatric medical “transition” is laid bare for all to see. Justice Thomas’s concurrence includes four pages detailing the nature of those interventions and their attendant risks, particularly the “irreversible” consequences of genital surgery, such as permanent infertility. Thomas also calls out the dissents’ “sanitized description” of these interventions as “gender-affirming care.”
Fourth, the Court recognized that pediatric “transition” interventions are experimental, based on weak evidence, and under serious global scrutiny, thus giving weight to the concerns of parents who view these interventions with distrust and even outrage. The Court’s opinion also seems likely to change how clinicians, hospitals, and their insurers assess the legal and financial risks of performing “transition” procedures on minors.
Fifth, Justice Thomas dismisses the claim that “courts should defer to so-called expert consensus.” In fact, Thomas excoriates expert culture, writing that “experts” are often ideologically or politically motivated, and noting how expert culture in the past led to eugenics, forced sterilization, and other abuses. Thomas recounts the history of “gender” guidelines and exposes the deceptive practices of the World Professional Association for Transgender Health (WPATH), the self-styled world authority in “gender-affirming care.” He criticizes the “exceptionally broad” claim that these interventions (such as “castration” for self-identified “eunuchs”) are “medically necessary” and cites evidence that WPATH knew they were eliciting “consent” from children who are incapable of giving it. Consequently, Thomas says the states “may legitimately question” not only whether these “transition” procedures are “effective,” but whether they are “ethical.”
Despite resolving some key questions, the Skrmetti case leaves others unresolved. The Court fails to tackle the underlying anthropological issue presented by “transgender” claims, and it capitulates to gender ideology in its use of language. The majority opinion, for example, contrasts a “transgender boy (whose biological sex is female)” with “a boy whose biological sex is male.” Does a majority of the Court really believe that there are two kinds of “boys”—those who are biologically male and those who are biologically female? The Court also uses the pronouns “he” and “his” over a dozen times to refer to the “boy” who is biologically female. Nearly all the Justices also fall into the trap of using language (“transgender minor,” “transgender adolescent,” “transgender individual”) that accepts the premise that some people “are” “transgender persons,” neither male nor female but a new kind of person: a “trans” person.
Such language is not just factually incorrect. It signals acceptance of the transgender premise that feelings and beliefs determine reality. At heart, gender ideology makes an ontological claim: that certain people are transgender, and that human beings are no longer male or female, but cisgender or transgender. Until the courts recognize that this language stakes an ideological claim—rejecting science and objective truth—gender ideology will continue to present a clear danger to vulnerable individuals, while threatening cultural stability and legal coherence.
Because the case involves minors, the Skrmetti opinion only covers pediatric medical transition. Unfortunately, once a struggling and confused teen turns eighteen, he or she can still elect to undergo these harmful procedures. As long as our culture supports adult transition, men who identify as transgender will still seek to enter women’s bathrooms and displace women in sports and other areas. This too reflects an erroneous anthropology, for it accepts the argument that some people “are trans.” As such, these individuals demand that others affirm their chosen gender identity.
Finally, the majority opinion tiptoed around the 2020 Bostock decision, which prohibits workplace discrimination based on sexual orientation or “transgender status,” declaring that it didn’t apply and need not be considered. Justices Alito and Thomas candidly declared that they believe Bostock to be wrongly decided. Until Bostock is overturned, individuals who identify as transgender will continue to demand that others validate their “transgender” identity, and some lower courts will continue to twist language and law to comply with Bostock.
The Skrmetti decision is a great first step, a win for common sense. It should embolden parents to hold politicians accountable for ending pediatric medical transition, especially in red states. It also helps the Trump administration’s efforts to ban pediatric medical transition, despite ongoing opposition. However, the continued widespread use of the lexicon of gender ideology, even among Supreme Court Justices, shows how entrenched gender ideology has become, and why defense of an anthropology rooted in truth is crucial.
Theresa Farnan, Ph.D., is a fellow at the Ethics and Public Policy Center focusing on the challenges of gender ideology as part of EPPC’s Person and Identity Project.
