Cases & Developments

Opinion Affirming the Judgment of the United States Court of Appeals for the Sixth
Circuit. Plaintiffs, several transgender teenagers, their parents, and a doctor challenged Tennessee Senate Bill 1 (SB1) under the Equal Protection Clause of the Fourteenth Amendment, alleging that the law discriminates
on the basis of sex because it bans certain treatments only when they are used to support gender transition, while permitting the same treatments for other medical purposes. SB1 prohibits all medical treatments
intended to help a minor identify with gender inconsistent with their sex assigned at birth, or, to alleviate distress arising from the discordance. The District Court held in plaintiffs favor, finding that transgender
individuals are a quasi-suspect class, as such the SB1 likely does violate the Equal Protection Clause, and issued a preliminary injunction blocking enforcement of the law. However, the Sixth Circuit reversed the
District Court’s ruling, upholding the law and applying a “rational basis” review. Plaintiffs contend that this was legal error, and because SB1’s classification is based on sex, it should
be subject to strict scrutiny rather than the rational basis review. Plaintiffs relied in part on Bostock v. Clayton County, contending that the law’s discriminatory effects on transgender minors
trigger constitutional protections beyond what rational basis review allows. Upon granting certiorari, the Supreme Court was charged with answering whether SB1 violates the Equal Protection Clause of the Fourteenth
Amendment. In a 6-3 decision, the Court upheld the Sixth Circuit’s holding that SB1 is subject to a rational basis review and does not violate the Equal Protection Clause. While plaintiffs argue that SB1 is based
on “sex-based classifications” and calls for strict scrutiny review, the Court found in the contrary and reasoned that SB1 “prohibits healthcare providers from administering puberty blockers and
hormones to minors for certain medical uses, regardless of a minor’s sex.” The Court maintains that SB1 is incorporated by the classifications of age and medical use, but not sex. The
Court acknowledged that SB1 makes reference to sex, but states that “the Court has never suggested that mere reference to sex is sufficient to trigger heightened scrutiny. And such an approach would be especially
inappropriate in the medical context, where some treatments and procedures are uniquely bound up in sex.” In addressing plaintiffs’ citation to Bostock, the Court stated that it had “not
yet considered whether Bostock’s reasoning reaches beyond the Title VII context, and [it] need not do so here.” The Court additionally rejected plaintiffs’ allegation and the District
Court’s holding that the law discriminates on transgender people as a quasi-suspect class, noting that the Supreme Court has never held that transgender people are a suspect or quasi-suspect class. The Court
further noted that “SB1 does not exclude any individual from medical treatments on the basis of transgender status. Rather, it removes one set of diagnoses—gender dysphoria, gender identity disorder,
and gender incongruence—from the range of treatable conditions.” In response to plaintiffs’ argument that SB1 “enforces a government preference that people conform to expectations about their
sex” the Court said that the verbiage reflects the state’s “legitimate, substantial, and compelling interest in protecting minors from physical and emotional harm” and plaintiffs have failed
to acknowledge “the prohibited medical treatments are experimental, can lead to later regret, and are associated with harmful—and sometimes irreversible—risks.