Sixth Circuit Reinstates Tennessee's Gender-Affirming Care Ban for Minors

Sixth Circuit Reinstates Tennessee's Gender-Affirming Care Ban for Minors

A divided federal appeals court has revived a Tennessee law barring gender-affirming medical care for transgender minors, handing states a major win in a legal fight that is almost certainly bound for the Supreme Court.

The U.S. Court of Appeals for the Sixth Circuit on November 1 lifted a district court's preliminary injunction that had blocked enforcement of Tennessee's Senate Bill 1 since last year. The law, which the legislature passed in early 2023, prohibits health care providers from administering puberty blockers, hormone therapy, or surgery to minors for the purpose of treating gender dysphoria. Writing for the majority, Chief Judge Jeffrey Sutton concluded that the plaintiffs had not shown a likelihood of success on their equal protection and due process claims, reasoning that the Constitution does not compel states to permit a particular medical treatment.

"The Constitution does not require Tennessee to permit a medical procedure that its legislature has deemed harmful to minors," Sutton wrote, according to the opinion, which rejected comparisons to cases like United States v. Virginia on sex-based classifications.

Judge Jane Stranch dissented, arguing that the law warrants heightened scrutiny because it draws a sex-based line—permitting the same treatments for cisgender minors while forbidding them for transgender youth. The ruling follows a similar Sixth Circuit decision upholding Kentucky's ban, and it deepens a circuit split with the Eighth Circuit, which has allowed such laws to take effect, while other courts have blocked them. Tennessee Attorney General Jonathan Skrmetti called the decision "a win for the rule of law and for the protection of children," according to a statement from his office.

What to watch: The plaintiffs are expected to seek en banc review or petition the Supreme Court, which has already agreed to hear a related challenge to Tennessee's law in its current term. A ruling there could settle the question nationwide.

Primary sources: Sixth Circuit opinion (L.W. v. Skrmetti)