Justice Sonia Sotomayor slams gender-affirming care ruling as 'state-sanctioned discrimination'

Justice Sonia Sotomayor didn't mince her words when dissenting to the majority in U.S. v. Skrmetti, accusing her conservative colleagues of “abandon[ing] transgender children and their families to political whims.”

The U.S. Supreme Court ruled 6-3 Wednesday that Tennessee's law banning gender-affirming care for transgender youth – while allowing the same treatments for youth who aren't trans – does not constitute sex-based discrimination, and therefore does not violate the Equal Protection Clause of the 14th Amendment.

In a scathing dissent, Sotomayor said the Court's decision will “do irrevocable damage to the Equal Protection Clause and invite legislatures to engage in discrimination by hiding blatant sex classifications in plain sight.”

“By refusing to apply heightened scrutiny, the majority renders transgender Americans doubly vulnerable to state-sanctioned discrimination,” she wrote. "In sadness, I dissent."

Joined by Justices Ketanji Brown Jackson and Elena Kagan (outside of one section), Sotomayor argued that the Tennessee law explicitly discriminates on the basis of both sex and gender, as it “expressly classifies on the basis of sex and transgender status,” since “male (but not female) adolescents can receive medicines that help them look like boys, and female (but not male) adolescents can receive medicines that help them look like girls.”

"This case presents an easy question: whether SB1’s ban on certain medications, applicable only if used in a manner 'inconsistent with . . . sex,' contains a sex classification," she wrote. "Because sex determines access to the covered medications, it clearly does. Yet the majority refuses to call a spade a spade."

Sotomayor also noted that the ruling contradicts one of the court's previous decisions in Bostock v. Clayton, which prevents employment discrimination against trans people under Title VII. In Bostock, the Court ruled “it is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex." In Skrimetti, it said, "We have not yet considered whether Bostock’s reasoning reaches beyond the Title VII context, and we need not do so here."

Sotomayor emphasized that "access to care can be a question of life or death,” citing evidence that gender dysphoria can lead to “severe anxiety, depression, eating disorders, substance abuse, self-harm, and suicidality.” Treatments like puberty blockers and hormone therapy “meaningfully improve the health and wellbeing of transgender adolescents," she wrote, referencing several studies that demonstrated depression and anxiety is alleviated in youth when they receive treatment for gender dysphoria.

The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the World Medical Association, and the World Health Organization all agree that gender-affirming care is evidence-based and medically necessary not just for adults, but minors as well. Out of 55 peer-reviewed studies, not a single one found that gender transition has negative outcomes.

"[The Court] also authorizes, without second thought, untold harm to transgender children and the parents and families who love them," Sotomayor concluded. "Because there is no constitutional justification for that result, I dissent."

This story has been updated with additional details.