On June 18, 2025, the U.S. Supreme Court issued a 6–3 decision in United States v. Skrmetti, ruling that Tennessee’s ban on gender-affirming care for minors does not violate the 14th Amendment’s equal-protection clause. Chief Justice Roberts emphasized that legality doesn’t hinge on medical opinions, leaving such policy questions to state legislatures. The ruling affirms restrictions in Tennessee and Missouri and potentially shields 26 other states with similar bans from legal challenge.
Impact on Trans Youth and Their Families
Approximately 100,000–300,000 trans youth reside in states affected by these bans; nearly 40% of transgender minors are now denied access to essential medical care. Medical professionals and LGBTQ advocates warn that removing access to puberty blockers and hormone therapy “violates bodily autonomy” and could trigger mental health crises. Justice Sotomayor’s dissent underscored how this ruling “authorizes untold harm to transgender children,” pointing directly to the disproportionate mental health risks, including heightened suicide rates.
Families, already grappling with this issue, confront stark choices. Uprooting lives to states with protective laws, resorting to telehealth or out-of-state care, and leaning heavily on mental health and community support systems. Though David calls these coping strategies “traumatic,” advocates say vigilance in state legislatures still offers a possible path to reversal—while acknowledging that this ruling sets a high barrier for future legal challenges.
Ripple Effects from Minors to Adults
Today’s decision isn’t just about youth; it sets a precedent for expanding gender-affirming care (GAC) restrictions to adult trans populations. Federal-level moves are already underway: under the early-2025 executive order, Medicaid funding for gender-affirming treatment has been removed for all ages. Further, conservative states have targeted adult GAC through executive actions and proposed legislation. Rights advocates are warning that institutional momentum could soon deprive trans adults of hormone therapy and surgery options through both state bans and federal funding restrictions.
What’s Next: Courtroom Battles and Political Battlegrounds
Despite this setback, the decision doesn’t end the fight. Litigation will shift toward federal courts and appellate challenges, with opponents aiming to reframe GAC as a protected right or demand a higher judicial review standard. Meanwhile, trans supporters are focusing on bolstering state-level protections, working toward “shield laws” that safeguard healthcare without federal dependence.
The Bottom Line
Today, trans youth and their families must brace for intensified legal and political battles. For allies: mobilize, donate, lobby, and run for office. Now more than ever, state policies will shape trans lives. Collective advocacy and community strength are our best defenses in this critical moment.
Stay tuned; this is far from over. Solidarity, advocacy, and resilience remain essential.
