In June 2025, the Supreme Court, controlled by a conservative supermajority, delivered yet another 6-3 decision that is deeply hostile to LGBTQ+ people. The decision in U.S. v. Skrmetti marks a significant and devastating departure from the constitutional principle of equal protection, upholding SB1. This Tennessee law restricts transgender adolescents from receiving essential gender-affirming medical care. To quote Justice Sonia Sotomayor’s dissent, the conservative majority’s opinion “contorts logic and precedent.” It also deploys toxic rhetoric to introduce hurtful ideology-driven claims, while masquerading them as law. In these ways, Skrmetti composes a tale according to which bans targeting only transgender youth—enacted by 27 States in which at least 120,400 of them reside—somehow do not violate the U.S. Constitution’s Equal Protection Clause. To reach this result, the majority refuses to recognize that these bans are grounded in any suspect classification based on either transgender status or sex. Instead, it asserts that the bans permissively classify treatments based on patients’ age and medical diagnosis. Relying on this sleight of hand, the majority then subjects SB1 to the most deferential level of scrutiny, a rational basis review, which the state easily satisfied. Voilà!

Yet, SB1 so explicitly engages in suspect classifications and so clearly uses them to discriminate against transgender minors that this charade not only defeats conventional legal analysis but also defies truth. First, only transgender people can suffer gender dysphoria, so there is simply no way a prohibition limited to this medical diagnosis does not turn on the patients’ here For comparison, long ago, the Court decided that because not all women get pregnant, pregnancy is not a sufficient proxy for being a woman and cannot make classification relying on it facially discriminatory based on sex. However, proxies are still part of conventional Equal Protection analysis, and gender dysphoria is the closest proxy possible for transgender identity, making its use analogous to targeting people wearing yarmulkas, which is undisputably a facially discriminatory act. Second, SB1 allows treating other (cisgender) minors with the same medications for different diagnoses, such as congenital disabilities or precocious puberty. Thus, the theory that the ban relies on age-based classification equally fails. Critically, the mislabeling of the classifications to evade heightened scrutiny does more than deny access to puberty blockers and hormone therapies: It disavows the living experience of transgender minors and their families.

Deviating from its routine adherence to a textualist approach, the conservative majority refused to account for SB1’s wording. The statutory language, however, is infused with ideological intent to discriminate against transgender minors, wielding rhetoric that distrusts and degrades them. For example, the text persistently reflects doubts about the existence and authenticity of gender identity by describing it not as an actual identity but only as a “purported” or “asserted” one. Worse, the language devalues even the problem of gender dysphoria itself. While the diagnosis’s scientific definition underscores “clinically significant distress,” SB1 reduces it to a mere “discomfort.”

Remarkably, the majority not only abandoned its equal protection jurisprudence and loyalty to textualism but also used its shadow docket to avoid reviewing SB1’s infringement on the rights of parents supporting transgender minors in the same term in which it dramatically expanded the rights of religious parents. At the same time, the Court actively joined the broader anti-trans project unleashed by the conservative movement. In the dozens of pages they wrote, none of the conservative justices agreed to call the medicinal treatment of gender dysphoria by its most common name, gender-affirming care. Instead, they carefully removed the idea of gender, the need for affirmation, and the necessity of care, replacing them all with the irregular phrase “sex transition treatments.”

Worse, the majority decision bolsters the second Trump administration’s assaults on transgender people. For example, the majority reiterated conservative talking points regarding high rates of regret among transgender adolescents, raising the allegation despite refuting evidence on the record to suggest that withholding treatment might be rational. Likewise, against a record showing a consensus in the American medical community, the majority looked to other countries to assert that treating minors with gender dysphoria is controversial.

Several conservative members of the Court went even further and used the litigation in Skrmetti as an opportunity to question transgender equality beyond the boundaries of the dispute before them. In doing so, they more than gestured at additional contexts in which they might be willing to undo LGBTQ+ constitutional rights. For instance, although the Court found no suspect classifications, Justices Clarence Thomas and Samuel Alito unnecessarily echoed the conservative efforts to undo Bostock v. Clayton County—the precedent holding that it is impossible to discriminate against transgender (and homosexual) individuals without impermissibly discriminating based on sex. Similarly, Justice Amy Coney Barrett used Skrmetti to suggest that, because trans people fall outside of the Equal Protection Clause in the medical context, they also likely have no claims against regulations limiting their ability to use adequate bathrooms or participate in sports.

Most troubling, while presenting all these theories, the conservative majority callously ignored one thing: The grave and immediate danger of leaving distressed minors without any medical care, forcing them to struggle at least until they turn 18, all while their bodies grow further away from how they experience themselves.

Ultimately, Skrmetti betrays transgender adolescents and distorts the Equal Protection Clause by allowing, legitimizing, and incentivizing blunt ideological sex-based discrimination. It also demonstrates how, instead of protecting a vulnerable minority group as their constitutional duty demands, the Court’s conservatives side with Republican legislators while presenting their approach as judicial restraint. In reality, Skrmetti reveals the opposite of restraint: A willingness to abandon the constitutional order of equality before the law to enhance a brutal anti-trans campaign.