Tennessee Attorney General Jonathan Skrmetti told podcaster Buck Sexton he has” “fought so hard” and taken “so much fire” for the case. “People care a lot about this issue and it is really vindicating to come out with a win,” Skrmetti added.
Skrmetti’s legal position regarding SB1, the Tennessee law enacted in 2023, was that gender-affirming care for minors, including the use of puberty blockers, could have irreversible effects (such as sterility), and therefore, the state has the right to intervene in such matters to protect youth. The state also argued that the use of puberty blockers can lead minors down a path of irreversible treatments such as hormone therapy or sex-change surgeries. Puberty blockers may also lead to psychological and emotional harm because they hasten the process of medical transition without a full understanding of the long-term effects, according to arguments from the state of Tennessee.
Sotomayor criticized the majority ruling for what she believes to be “denying a well-established medical treatment,” including puberty blockers to transgender youth. Sotomayor also argued that puberty blockers are reversible and only pause the progression of puberty, providing time for minors to make informed decisions about further treatment. Sotomayor justified her stance on puberty blockers citing the opinions of medical organizations such as the American Medical Association(AMA) and the American Academy of Pediatrics (AAP) who support the use of hormone treatments.
Importantly, SCOTUS ruled that SB1 does not violate the 14th Amendment’s Equal Protection Clause and agreed with Skrmetti that this is a matter of “protecting kids from the consequences of decisions that they cannot fully understand.” Skrmetti also emphasized that the medical community has not reached a consensus on the long-term impact of puberty blockers.
SCOTUS’s landmark decision, however, leaves room for states to enact such bans without federal courts stepping in, granting broad discretion to state legislatures. The majority ruled that states have the right to regulate medical treatments, especially when science or social consensus is still evolving. Notably, the American Professional Society on the Abuse of Children (APSAC) has warned that states would craft legislation “to ban or restrict ‘gender-affirming healthcare‘ for transgender and gender-diverse youth.”
In March 2023, Tennessee enacted SB 1 (Public Chapter No. 1), banning puberty blockers, hormone therapy, and certain surgeries for minors diagnosed with gender dysphoria—though permitting these treatments for medical conditions such as precocious puberty. A legal challenge to block the state’s ban on “medically necessary gender-affirming care” was filed in April 2023 by ACLU, ACLU-Tennessee, Lambda Legal, and Akin Gump Strauss Hauer & Feld LLP. They sued on behalf of Samantha and Brian Williams of Nashville and their 15-year old transgender daughter with two other anonymous plaintiff families and Memphis physician Dr. Susan Lacy.
Tennessee’s SB1 bans medical transition treatments for youth up to age 18 and ceased treatments for children who were currently receiving surgeries, puberty blockers and other life-altering therapies within nine months of the law’s effective date of July 1, 2023 or by March 31, 2024. The law also established a private right of action against medical providers providing these interventions to children with gender dysphoria.
Proponents of the bill believe evidence shows “medical procedures that alter a minor’s hormonal balance, remove a minor’s sex organs, or otherwise change a minor’s appearance are harmful to a minor when these procedures are performed for the purpose of enabling a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex or treating purported discomfort or distress from a discordance between the minor’s sex and asserted identity,” according to the text of the bill.
Leading Tennessee’s legislative action were child advocate Landon Starbuck and her husband Robby, political commentator Matt Walsh, TN State Rep William Lamberth and TN State Senator Jack Johnson. In 2023, SB1 made it illegal in Tennessee to mutilate children who struggle with their gender identity and was the basis for the SCOTUS ruling. In response to a request for a statement about the SCOTUS ruling, Ms. Starbuck responded with the following on June 19, 2025,
“Over 6,000 girls had their healthy breasts cut off at the hands of surgeons, thousands of children had their growth stunted. Many children were left chemically castrated and permanently sterilized. Their childhoods weren’t just stolen but much of their futures as well. We can’t go back in time to save those kids but with this Supreme Court ruling, we know countless children will be saved going forward.”
In an April 2023 interview, Starbuck stated her support of the ban was based in part on the negative experiences of transitioned adults like activist Chole Cole who has experienced firsthand the harmful consequences of decisions she made as a child. Starbuck stated,
“I gave testimony on SB1 in support of stopping the genital mutilation of children, sex changes, and puberty blockers and hormones being used off label, and that is what my testimony was about,” said Starbuck, “and echoed the same sentiments of the transitioned adults that were transition as children who are experiencing lifelong side effects and complications as a result of that medical malpractice,” says Starbuck.
Cole started puberty blockers at age 13 and underwent a double mastectomy at age 15. She began the process of detransitioning at age 17. Profoundly traumatized by her experiences, she continues to testify against medical transitioning and denounces gender-affirming care for minors.
Notably, in September 2022, Starbuck obtained a document from the Vanderbilt’s Pediatric Transgender Clinic “proving that Dr. Cassandra Brady [was treating] patients as young as 6 with ‘gender affirming care,’ and was advocating for mastectomies on children to ‘alleviate stress.'” Starbuck’s efforts were integral to the shuttering of clinic operations in June 2023.
As mentioned above, previous activity in the case include a lower court battle involving a federal district court which granted a preliminary injunction and recognized transgender individuals as a quasi-suspect class. The Sixth Circuit later allowed enforcement, and the DOJ entered the case, first supporting the plaintiffs but later under the Trump administration, (Feb. 7, 2025) switching to support Tennessee.
SCOTUS’s ruling upholds similar bans on gender affirming care in 25 or more states. Some states have also moved to restrict access for this type of care for adults. The decision marks a signficant moment in constitutional law and trans rights. There will likely be counter legislation from states that are supportive of gender-affirming care.
Freedom Forever’s investigative team wrote an exhaustive report on the mothers of trans kids and the “social contagion of transitioning children.” Their investigation found mothers pushing medical transition treatments in online forums. The report documents many perhaps well-meaning mothers who are pushing their children to transition because they are “caught up in a social contagion which offers them a quasi-religious community full of purpose, affirmation, praise and fellowship.” Alarmingly the mothers seem to be “fast-tracking transitions for their kids…vulnerable kids who are struggling with mental health issues.” The report describes the mothers’ actions as a “modern day munchausen by proxy.” The discussions among the mothers are both alarming and painful to read.
Freedom Forever is an all-volunteer organization that focuses its energy and time on preserving the innocence and safety of children. Freedom Forever now offers crisis support for survivors and families. Please call the Crisis Resource Line at 615.307.0152 or email our resource specialist at Starr@FreedomForever.us.
