In recent years, more than half of U.S. states have enacted laws banning medical treatments such as puberty blockers and hormones for transgender minors. It’s sparked some fierce national debate over the rights and health of transgender youth. Tennessee’s law, known as SB1, became a focal point in this legal battle, culminating in a challenge that reached the U.S. Supreme Court. On June 18, the Court upheld Tennessee’s ban — and by extension, similar laws nationwide — marking a pivotal moment in the ongoing struggle over transgender healthcare for minors in America.
This article provides a deeper dive into the statute at the center of the SCOTUS ruling.
Tennessee’s Trans Care Ban
Two years ago, the Tennessee legislature enacted Senate Bill 1. SB1 bans puberty blockers or hormones to minors that allow them to present as the gender they identify with. The exact text of the statute prohibits a healthcare provider from “prescribing, administering, or dispensing any puberty blocker or hormone” for the purpose of
- “enabling a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex,” or
- “treating purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”
The statute also addresses surgeries that are trans-affirming. It prohibits doctors from “surgically removing, modifying, altering, or entering into tissues, cavities, or organs of a human being” for the purposes above.
Other medical uses of hormones and puberty blockers, even for minors, are explicitly permitted by the statute. These include treatments for congenital defects, early puberty, disease, or physical injuries.
Enforcement mechanisms include civil penalties of $25,000 per violation, potential disciplinary action by state regulatory authorities against providers, and a private right of action enabling injured minors or their nonconsenting parents to sue providers. The stated purpose of SB1 is to protect minors from physical and emotional harm by encouraging them to appreciate their biological sex and by preventing what the legislature views as experimental and potentially harmful medical interventions whose full effects are not yet known.
Practical Effects of the Ban
While some were celebrating SB1’s passing, others were deeply concerned. After all, the American Academy of Pediatrics (AAP) even recommends that adolescents and young adults who identify as transgender or non-binary should have access to gender-affirming care. AAP highlights the potential benefits of gender-affirming care, which include improved mental health, self-esteem, development, and overall well-being for transgender and non-binary youth. Conversely, they point out that lack of access to such care can negatively impact mental health and increase the risk of depression, anxiety, and suicide
But per Tennessee’s (and other states’) law, this is illegal. Since the text of the statute can be confusing, it might be useful to consider some concrete examples of what kinds of treatments are illegal under the statute.
SB1 would prohibit a doctor from prescribing estrogen to a 16-year-old who was assigned male at birth but identifies as female, to develop more feminine physical features and help the minor present as a girl. Similarly, a doctor would be prohibited from prescribing testosterone to a 17-year-old assigned female at birth, who identifies as male, to induce male secondary sex characteristics (such as facial hair or deeper voice) for purposes of gender transition.
On top of that, under the law, a doctor is prohibited from prescribing puberty blockers to a youth who was assigned female at birth but identifies as male, for the purpose of delaying the development of female secondary sex characteristics (like breasts or menstruation) in order to alleviate gender dysphoria or help them live as a boy. Nor can a healthcare provider give puberty blockers to a 13-year-old experiencing distress because their gender identity does not match their biological sex, with the goal of giving them more time to explore their gender identity without developing further sex characteristics.
All this very much leaves conditions like “gender incongruence,” “gender identity disorder,” or “gender dysphoria” untreated at a vulnerable age.
Increasing Skepticism on Trans-Affirming Care
Over the three years prior to Tennessee’s enactment of SB1 (i.e., 2020–2023), more than 20 states had enacted laws banning the provision of sex transition treatments to minors, and two states had enacted near-total bans. The legislative history of SB1 reflects growing debate in both the U.S. (and abroad) about the risks and benefits of medical interventions for transgender youth.
Earlier clinical guidelines from organizations like the World Professional Association for Transgender Health (WPATH) permitted puberty blockers and hormones for minors in rare circumstances. But as more recent years saw a sharp increase in the number of minors seeking these treatments, there was a corresponding intensification of scientific and policy debates.
The Tennessee legislature cited concerns that such treatments can lead to irreversible sterility, increased risk of disease and illness, adverse psychological consequences, and that minors may lack the maturity to fully understand or appreciate these risks. The legislature also noted that guidelines regarding these treatments had changed substantially in recent years and referenced restrictive moves by European health authorities as evidence of ongoing uncertainty.
Some Notes on the Science
We should note for the record that puberty blockers are not hormones, and their use is reversible and temporary. Puberty blockers should not be confused with gender-affirming hormones (like estrogen or testosterone). They prevent the development of natal puberty but do not introduce new sex characteristics. If taking puberty blockers is stopped, the body's natural production of puberty hormones typically resumes, and puberty continues from where it left off. Thus, puberty blockers are not a permanent solution but rather a way to gain time.
While the hormones, blockers, and surgical methods that are used for gender-affirming care carry certain risks just like any other medication or procedure, they are generally considered safe when taken under medical supervision. The medications are only prescribed under strict medical guidelines, typically by a multidisciplinary team that includes endocrinologists, mental health professionals, and often social workers. The decision to use them is highly individualized, based on thorough assessment of the adolescent's gender dysphoria, mental health, and overall well-being. In the United States, most states require parental or legal guardian consent for minors to receive medical treatments, especially those with long-term effects like gender-affirming hormones
Trans Bans Get Green Light
Despite the benefits of trans-affirming care, and despite the precautions taken in the medical community, 26 states have already passed some kind of ban on gender-affirming care. About 40% of trans youth aged 13-17 (at least 118,300 people) live in those states. Some of these states have considered increasing the ban to apply to youth up to 26 years old. Many of these states also ban using public funds to pay for gender-affirming care (for both minors and adults). This means that if someone is on Medicaid, works in the government sector, or is in jail, they cannot use their insurance to offset the cost of transgender health care.
And now, after SCOTUS’s decision Skrmetti, more states can feel confident in issuing similar bans. As the ruling makes clear, the legality of gender-affirming care for minors is now largely a question for state legislatures, not the courts. The ruling leaves in place Tennessee’s SB1 and similar laws across the country, emphasizing that debates over transgender youth healthcare will continue to play out in the political arena. For transgender minors and their families, this means access to care—and its risks and benefits—will depend more than ever on where they live and who represents them in state government.
Related Resources:
- Sixth Circuit Upholds State Bans on Gender-Affirming Care for Minors (FindLaw's Federal Courts)
- Supreme Court Upholds State Bans on Gender-Affirming Care for Minors (FindLaw's Federal Courts)
- Laws on Gender-Affirming Care for Minors (FindLaw's Learn About the Law)
