United States v. Skrmetti: Key Takeaways for Employers

United States vs. Skrmetti is a case about whether a Tennessee law that bans gender-affirming care for adolescents violates the U.S. Constitution’s Equal Protection Clause by discriminating based on sex. On June 18, 2025, the Supreme Court ruled that the law does not violate the Equal Protection Clause, allowing Tennessee to keep the health care ban in place. Although this case does not directly affect workplace DEI programs, many organizations may be wondering how this case could impact the workplace. This explainer provides a brief overview of the case and offers insight on what organizational leaders should consider in light of the Court’s decision.

What this case was about

In 2023, Tennessee passed a law that prohibits medical professionals from providing certain types of gender-affirming care to minors. Specifically, the law prohibits certain medical care that allows minors to live in accordance with a gender identity different from their sex assigned at birth. It also prohibits treatment intended to address distress that may be experienced by a minor whose gender identity is not aligning with their sex assigned at birth (known as gender dysphoria). The law bans treatments such as hormone therapy, puberty blockers, and surgery. 

Tennessee is one of several states that have passed similar bans against gender-affirming care for minors and many of them are being challenged in courts around the country. In Tennessee, three transgender minors and their families, as well as a licensed medical provider in Tennessee, challenged the law on the following constitutional grounds:

• Violation of the Due Process Clause: Plaintiffs argue that the ban infringes on parents’ fundamental right to make healthcare decisions for their children.

• Violation of the Equal Protection Clause: Plaintiffs assert that the law discriminates based on sex and transgender status. 

To support their case, the plaintiffs argued that there was extensive, credible research demonstrating the effectiveness of gender-affirming care in treating gender dysphoria. They also pointed to the high risk of harm to untreated youth, such as depression. The plaintiffs also argued that the legislature ignored testimony from families and medical professionals directly affected by the ban.

What happened in the case

On April 21, 2023, the plaintiffs asked for a preliminary injunction to stop enforcement of the law while the case was litigated. The district court granted the preliminary injunction, finding that the plaintiffs were likely to succeed on the merits of their constitutional claims. They also found that the plaintiffs would suffer irreparable harm without the preliminary injunction (particularly since the youth in the case would be forced to wean off and ultimately cease receiving the care that was already in progress), and the state’s interest in implementing the ban did not outweigh the harm that would come to plaintiffs and trans youth who were eligible to receive this treatment. 

Tennessee appealed that decision. The Sixth Circuit Court of Appeals, in a 2-1 split, reversed the lower court’s decision. The appellate court found that the plaintiffs were unlikely to succeed on the merits, reasoning that the government could, in certain instances, limit a parent’s right to make medical decisions for their children and this was one such permissible instance. The court also held that the law did not amount to sex discrimination. 

The plaintiffs appealed that decision and the Supreme Court heard oral arguments from both sides in December 2024, specifically on the issue of whether the plaintiffs were likely to succeed on the merits of the Equal Protection Clause claim. The court declined to address the Due Process claim. Now, the Supreme Court has decided that the laws banning gender-affirming care for minors is constitutional and does not violate the Equal Protection Clause. They reason that the law does not treat people differently based on sex or transgender status but instead based on age and medical diagnosis. Because of this, the state just had to show that the law was reasonably related to a legitimate goal, and the Court decided that the state had met that requirement. 

What employers can take away from this case

The outcome of this case does not affect an organization’s ability to implement trans-inclusive workplace practices, even in states with laws like Tennessee’s. Policies such as all-gender bathrooms, practices that allow employees to share pronouns in alignment with their gender identity, gender equity training, and inclusive health benefits for adult employees are not affected by this case. 

However, the decision could nonetheless affect employees and their families in other ways. Some families may consider relocating to states where access to care is protected. Organizations should proactively assess the extent to which internal policies and practices could exacerbate or mitigate the effects of this ban and adopt an approach to how best to move forward. This may include revisiting healthcare coverage, leave policies, relocation and mental health support, or other diversity, equity, and inclusion programming.

By preparing thoughtfully in line with organizational values, organizations can provide meaningful support to affected employees even in a challenging legal landscape.