The Equal Protection Clause and Transgender Rights: The Implications of United States v. Skrmetti

By Camilla Guzman '27

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The Fourteenth Amendment, passed after the Civil War, enforcing equal rights for African Americans, stands as one of the most foundational and contentious parts of the Constitution. The Equal Protection Clause is a core part of the amendment that ensures that governments do not enact discriminatory laws without a justified reason. (1)

Recently, the application of the Equal Protection Clause for transgender Americans was tested during the hearing of US v. Skrmetti. The case raised questions about how the Fourteenth Amendment applies to transgender people in the United States. However, the US v. Skrmetti decision did little to answer that question. (2) Rather, the decision complicates how lower courts respond to equal protection claims involving transgender individuals during a time in which over 500 bills involving the question of transgender rights are being debated across the country. The outcome of US v. Skrmetti puts a major obstacle in the fight for transgender rights due to the majority’s flawed interpretation of the Equal Protection Clause of the Fourteenth Amendment and disregard of widespread medical consensus on gender-affirming care for minors. 

United States v. Skrmetti 

2023 saw the passing of SB 1, or the Prohibition on Medical Procedures Performed on Minors Related to Sexual Identity, in Tennessee. SB 1 prevents healthcare providers from administering drugs such as puberty blockers or hormones to minors for gender transition. (3) However, SB 1 does not prevent the administration of hormones or puberty blockers for issues unrelated to gender transition, such as a congenital defect. (4) In response to the passing of SB 1, a group of parents and their doctor used the Equal Protection Clause to challenge the law. The District Court ruled that SB1 discriminates against individuals based on their sex and the fact that they are transgender. However, the Sixth Circuit Court reversed the decision. In 2025, the case reached the Supreme Court, and the justices ruled 6-3 that SB 1 did not violate the Equal Protection Clause of the Fourteenth Amendment. (5)

A Question of Classification 

To understand the reasoning behind the Supreme Court’s decision in US v. Skrmetti, one must understand the justices' scrutiny and different types of classifications under the Fourteenth Amendment. There are three levels of scrutiny justices apply to decide whether a government law or action is discriminatory: (6)

• Strict scrutiny: Courts use this standard to judge whether a law discriminates based on suspect classifications such as race or nationality. In these cases, governments must prove that their action is narrowly tailored to accomplish a compelling government interest. (7)

• Intermediate scrutiny: This standard applies to government actions that concern potential discrimination based on quasi-suspect classifications such as sex. A government must prove that an action is substantially related to an important government interest. (8)

• Rational basis review: The easiest standard to pass, rational basis review is applied to other classifications, such as age or disability, that are not judged under strict scrutiny. For these cases, justices must determine whether a government is rationally related to a government interest. (9)

The core question of US v. Skrmetti was whether SB I discriminates on the basis of sex. In 2025, the US Supreme Court upheld the Sixth Circuit Court’s conclusion that SB 1 did not discriminate on the basis of sex and therefore did not warrant heightened scrutiny. SB 1 denies a minor access to gender-affirming drugs regardless of the sex of the individual. Rather, the Court held that the law only targeted individuals based on two separate classifications: their age and medical use (the reason behind the prescription of puberty blockers). Classifications such as age and medical use are inspected under rational basis review. Based on this standard, the court found that Tennessee had a rational basis to place restrictions on hormones and puberty blockers due to what the state found were medical risks associated with treatments. (10) 

Why SB 1 warrants heightened scrutiny 

While the majority opinion firmly holds that SB 1 does not discriminate on the basis of sex, the American Civil Liberties Union, the civil rights organization representing the plaintiff in this case, argued that the Tennessee law does discriminate on the basis of sex. They held that SB 1 only prohibits treatments like hormones or puberty blockers for minors only if the treatment they are seeking is not aligned with the sex they were assigned at birth (12). 

For example, if teenager A, who was assigned male at birth, wanted to take the hormone testosterone to induce male puberty in response to growth delays, that would be perfectly permissible under the law. Teenager A and his parents seek hormone treatment for the teenager to develop in alignment with his sex assigned at birth. However, if Teenager B were assigned female at birth and seeking a testosterone prescription to induce male puberty, this would be expressly prohibited under Tennessee SB 1. Teenager B and his parents are seeking hormone treatment for the teenager to develop in a way that does not align with his sex assigned at birth. The key difference between the two teenagers is their sex assigned at birth. 

Therefore, as argued by the plaintiff representative and expressed in the dissenting opinion, Tennessee SB 1 does expressly discriminate on the basis of sex because it bans treatment only when it is inconsistent with a minor’s sex. While age and medical use are classifications under the law, sex is also a crucial classification (13). 

The dissenting opinion of US v. Skrmetti highlights both the limitations of current legal frameworks in addressing transgender rights and the pervasive misunderstanding of transgender identity in the United States. 

Why Gender Identity Should be a Suspect Class 

Gender identity, as a class separate from sex, is not a suspect or even quasi-suspect classification under the law. As briefly touched upon above, the concurring opinions on US v. Skrmetti argued in favor of this for three reasons: (1) gender does not have the immutable characteristics of race or sex, (2) that the transgender population was too diverse and undefined as a group, and (3) that the transgender population does not have sufficient “political powerlessness.” (14)

Firstly, Justice Barrett argues that since transgender status is not determinable at the moment of birth, the status is not immutable and cannot constitute a suspect class. (15) Frontiero v. Richardson describes an immutable characteristic as a trait one is born with and therefore has no control over. (16) However, in Watkins v. US, a broader definition of immutability was formulated to include traits that are “so central to a person’s identity that it would be abhorrent for the government to penalize a person for refusing to change” these traits. This newer definition includes characteristics like homosexuality or religion that are not determinable at birth. (17). Therefore, under this newer criterion, transgender status falls under an immutable characteristic. 

One might argue, as Justice Barrett did, that the ability for a transgender person to detransition undermines immutability. However, this argument does not take rarity and social stigma into account. Most studies report detransition rates and transition regret at or below 13.1 %. Moreover, over 80% of those who detransition cite social stigma, parental pressure, and difficulty finding employment as the reasons behind their detransition. (18) Simply put, detransition is most often caused by external factors, not due to changing one’s identity. 

Secondly, Justice Barrett argues that transgender is too "amorphous" and cites the APA’s definition of transgender as an umbrella term. She draws comparisons to San Antonio Independent School District v. Rodriguez, in which the court declined to acknowledge the poor as a suspect class. (19) Wealth is relative, depending on certain residential areas and time periods, and therefore does not have a single, unifying characteristic. However, transgender status does have a unifying characteristic. Even though transgender identity can take a variety of forms and expressions, to be transgender is to identify with a gender incongruent with the one a person was assigned at birth. Additionally, the medical classification of transgender as an umbrella term does not mean it is barred from being a suspect class since other suspect classifications, namely race, are considered umbrella terms (20). 

Thirdly and lastly, Justice Barrett argues that transgender individuals are not sufficiently politically powerless for transgender status to be protected to constitute a suspect group in need of constitutional protections. (21) However, political powerlessness does not mean that a group has no political power but only that there is a risk that their “discrimination will not be rectified, sooner rather than later, merely by resort to the democratic process.” (22)

Currently, the United States is overrun with examples of how democratic processes have not rectified discrimination against transgender individuals, and the outcome of US v. Skrmetti only exacerbates the state of transgender rights in this country. 

The Current Landscape of Transgender Rights 

Every leading major US medical organization, such as the American Medical Association, strongly supports the type of gender-affirming care that US vs Skrmetti aided in banning. (23) In fact, a study done by the APA demonstrates that puberty blockers are correlated with decreased suicidal ideation. (24)

As a result, the precedent set by US v. Skrmetti raises concerns for transgender minors across the country. To date, 27 states have partially or completely banned gender-affirming care for minors. (25)

Two prominent examples of legislation concerning transgender minors are Little v. Hecox and West Virginia v. B.P.J, which both assess the constitutionality of laws that ban transgender women from competing in public school sports teams. (26) In both cases, the Court ruled 6-3 in favor of barring transgender women from playing on these teams. (27) The defense in the Little v. Hecox case uses the Skrmetti majority reasoning to argue that the ban should face rational basis review rather than intermediate scrutiny. (28)

By ruling that government bans related to transgender issues are not sex-based discrimination and do not trigger heightened scrutiny, the US v. Skrmetti decision sets an alarming precedent for transgender rights. 

Next Steps 

In the wake of US v. Skrmetti and the recent Little v. Hecox and West v. B.P.J rulings, focusing on securing the protection of trans rights in other areas of the law and monitoring state and local actions is crucial for legal advocates. Each of these Supreme Court rulings allows states to address legislation banning healthcare and inclusion in sports for trans minors on their own terms. Therefore, directing efforts towards state legislation still debating these measures may prevent these bans from taking effect in more parts of the US. 

Endnotes

1. U.S. Const. amend. XIV‌

2. United States v. Skrmetti, 605 U.S. 4 (2025).

3. Tennessee, Public Chapter No.1 (2023), codified at Tenn. Code Ann §§ 68-33-101-113.

4. Ibid.

5. Skrmetti, 605 U.S. 2 (2025).

6. Legal Information Institute, “Equal Protection,” Wex, Cornell Law School, last reviewed July 2025, https://www.law.cornell.edu/wex/equal_protection

7. Legal Information Institute, “Strict Scrutiny,” Wex, Cornell Law, last reviewed September 2-24, https://www.law.cornell.edu/wex/strict_scrutiny

8. Legal Information Institute, “Intermediate Scrutiny,” Wex, Cornell Law School. Last reviewed June 2023. https://www.law.cornell.edu/wex/intermediate_scrutiny

9. Legal Information Institute, “Rational Basis Test,” Wex, Cornell Law School, last reviewed March 2024, https://www.law.cornell.edu/wex/rational_basis_test

10. Skrmetti, 605 U.S. 1 (2025).  

11. Ibid.

12. Transcript of Oral Argument, United States v Skrmetti, No. 23 - 477, (U.S. Dec 4, 2024), https://www.supremecourt.gov/oral_arguments/argument_transcripts/2024/23-477_hgdj.pdf.

13. Ibid. 

14. Skrmetti, 605 U.S. 9 (2025). 

15. Ibid.

16. Frontiero v. Richardson, 411 U.S. 677 (1973).

17. Watkins v. United States, 354 U.S. 178 (1957). 

18. Pablo Expósito-Campos et al., “Gender Detransition: A Critical Review of the Literature,” Int. J. Environ. Res. Public Health 20, no.9 (2023): 5787, https://pmc.ncbi.nlm.nih.gov/articles/PMC10803846/.

19. Skrmetti, 605 U.S. 3 (2025).

20. Mohammed Khalilzadeh, “Deconstructing the Immutability and Political Powerlessness Standards in Justice Barrett’s Skrmetti Concurrence on Transgender,” University of Illinois Law Review Online (June 3, 2026), https://illinoislawreview.org/online/deconstructing-the-immutability-and-political-powerlessness-standards-in-justice-barretts-skrmetti-concurrence-on-transgender-rights/

21. Skrmetti, 605 U.S. 7 (2025). 

22. Kerrigan, 289 Conn. at 197.

23. American Medical Association, “Advocating for the LGBTQ Community,” AMA, https://www.ama-assn.org/public-health/population-health/advocating-lgbtq-community.

24. Michael Biggs, “Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria,” Archives of Sexual Behavior 49, no.7 (2020): 2227-2229, https://pmc.ncbi.nlm.nih.gov/articles/PMC8169497/

25. Lindsey Dawson and Jennifer Kates, “Policy Tracker: Youth Access to Gender-Affirming Care and State Policy Restrictions,” KFF (Kaiser Family Foundation), last updated November 24, 2025, https://www.kff.org/lgbtq/gender-affirming-care-policy-tracker/

26. Little v. Hecox, 24-38 (U.S. argued Jan. 13, 2026); West Virginia v. B.P.J., No. 24-43 (U.S., argued Jan. 13, 2026

27. West Virginia et al. v. B.P.J., 609 U. S. 2 (2026).

28. Little v. Hecox, 24-38 (U.S. argued Jan. 13, 2026).