Published June 18, 2025
Here’s my summary of the Chief’s opinion in United States v. Skrmetti. (I quote extensively from the opinion but have not undertaken to include all of the quotations marks.)
1. The Tennessee law does not classify on any bases that warrant heightened review under the Equal Protection Clause. It classifies on two bases. First, age. Second, medical use: “Healthcare providers may administer puberty blockers or hormones to minors to treat certain conditions but not to treat gender dysphoria, gender identity disorder, or gender incongruence.”
a. Neither classification turns on sex. The law prohibits healthcare providers from administering puberty blockers and hormones to minors for certain medical uses, regardless of a minor’s sex. The plaintiffs and the dissent contend that an adolescent whose biological sex is female cannot receive puberty blockers or testosterone to live and present as a male, but an adolescent whose biological sex is male can. But when properly understood from the perspective of the indications that puberty blockers and hormones treat, the law clearly does not classify on the basis of sex. A healthcare provider may not administer puberty blockers or hormones to any minor to treat gender dysphoria, gender identity disorder, or gender incongruence.
We reject the argument that the law enforces a government preference that people conform to expectations about their sex. The statutory findings that plaintiffs object to do not evince sex-based stereotyping. Tennessee’s stated interests in “encouraging minors to appreciate their sex” and in prohibiting medical care “that might encourage minors to become disdainful of their sex” simply reflect the State’s concerns regarding the use of puberty blockers and hormones to treat gender dysphoria, gender identity disorder, and gender incongruence. (Chief quotes with approval Tennessee’s brief stating that minors who become disdainful of their sex are “at risk for serious psychiatric conditions.”)
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Edward Whelan is a Distinguished Senior Fellow of the Ethics and Public Policy Center and holds EPPC’s Antonin Scalia Chair in Constitutional Studies. He is the longest-serving President in EPPC’s history, having held that position from March 2004 through January 2021.
