Throwback: United States v. Skrmetti | Rational Basis or Heightened Scrutiny?: The Constitutional Test for Transgender Rights

This week, we'll air throwback episodes. Each episode will relate to the current cases.

Today's case is United States v. Skrmetti. I chose this case to segue into the 2026 Supreme Court calendar. In January, the Supreme Court hears two transgender cases that in some ways offshoot from Skrmetti. Here are a few details on these cases. We'll be sure to preview these cases soon. Also, check out our July 7th Roundup episode for more details.

Transgender Sports Cases

Little v. Hecox (Idaho) | Case No. 24-38 | Docket Link: Here

1. Background: Idaho's "Fairness in Women's Sports Act" banning transgender women from women's sports teams
2. Key Player: Lindsay Hecox, transgender student at Boise State University
3. Ninth Circuit Reasoning: Applied heightened scrutiny; found likely Equal Protection violations
4. Post-Skrmetti Impact: How the medical treatment precedent affects sports participation

West Virginia v. B.P.J. | Case No. 24-43 | Docket Link: Here

1. Background: West Virginia's H.B. 3293 categorical sports ban
2. Key Player: B.P.J., 14-year-old transgender student with amended birth certificate
3. Unique Factors: Puberty blockers, competitive performance, individual circumstances
4. Fourth Circuit's Approach: Case-by-case analysis vs. categorical rules
5. Strategic Litigation: Why B.P.J. argued for waiting on Skrmetti decision

Here's the background on United States v. Skrmetti.

Tennessee enacted Senate Bill 1 (SB1) in 2023, prohibiting healthcare providers from prescribing puberty blockers or hormones to minors for treating gender dysphoria or helping them transition, while still allowing these treatments for other medical conditions like congenital defects or precocious puberty. Three transgender minors, their parents, and a doctor sued under the Equal Protection Clause, with a district court initially blocking the law after finding transgender individuals deserve heightened constitutional protection. The Sixth Circuit reversed, ruling the law only needed to meet the lowest constitutional standard (rational basis review), prompting the Supreme Court to take the case.

The Supreme Court ruled 6-3 that Tennessee's ban on gender-affirming medical treatments for transgender minors does not violate the Equal Protection Clause because the law classifies based on age and medical use rather than sex or transgender status, requiring only rational basis review which the law satisfies.

Analysis (3 sentences): The Court rejected arguments that the law discriminates based on sex, finding that it applies equally to all minors regardless of biological sex and merely removes certain diagnoses from treatable conditions—similar to how pregnancy-related exclusions don't automatically constitute sex discrimination under precedent like Geduldig v. Aiello. The majority applied the lowest level of constitutional scrutiny (rational basis review), deferring to Tennessee's legislative judgment about protecting minors from potentially harmful medical treatments in an area of scientific uncertainty. The dissenters argued the law clearly discriminates against transgender individuals and should face heightened constitutional scrutiny, warning that the majority's approach undermines equal protection for vulnerable minorities and ignores the real-world impact of denying medically necessary care.