With the arrival of June comes the first true glimmers of a patently American summer: vibrant Pride parades, weekend barbecues, festivals galore — and the looming release of the Supreme Court's most contentious rulings. Among this year's slate is a landmark case on gender-affirming care for minors that will have sprawling implications for transgender youth and adults, alongside the potential to upend decades of anti-discrimination law.

U.S. v. Skrmetti concerns Tennessee's 2023 gender-affirming care ban, which prohibits physicians from providing medical treatments like hormone therapy or puberty blockers to minors seeking to transition. During oral argument in December 2024, the Biden administration argued that a patient's birth-assigned sex determines what treatment the law prohibits or allows; for example, providing someone assigned female at birth with estrogen therapy is not prohibited under the law, while providing that treatment to a child assigned male at birth is.

The state, on the other hand, argued that the law doesn't determine what treatments are allowed based on sex or transgender status but instead on the reason why someone seeks the treatment; a child could seek puberty blockers to treat precocious puberty but not to delay puberty while they make sense of their gender identity.  

Though the Trump administration has since notified the Supreme Court that it thinks the ban does not violate the Equal Protection clause, it has nevertheless urged the justices to decide the case. The Supreme Court will determine whether transgender Americans have a constitutional protection from discrimination and, if so, whether it's on the basis of sex or under a new protected classification of transgender identity. 

A decision is expected by the close of the judicial session at the end of the month. 

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No matter how the justices decide, the case will be far-reaching, impacting access to health care for trans youth, trans Americans' protections against discrimination and, potentially, the foundation of equal protection doctrine. If December's oral argument was any indication of its thinking (legal experts say it isn't always), the highest court's ruling stands a good chance of unleashing greater harm onto a community of less than two million people already facing broad legislative attacks at the state level and targeted executive actions at the federal. 

But Rutgers University law professor Katie Eyer, who specializes in anti-discrimination law, takes a slightly more optimistic view. The leading scholar in LGBTQ employment rights, social movements and constitutional change told Salon that, while four of the conservative justices seemed likely to vote against the plaintiffs, Justice Amy Coney Barrett's thoughtful questioning — and Justice Neil Gorsuch's opinion expanding Title VII anti-discrimination protections based on sexaulity and gender identity in Bostock v. Clayton County — indicate it's still possible the plaintiffs could prevail.

Even if the Supreme Court ultimately rules in favor of Tennessee, she added, the LGBTQ community has survived these attacks before — and reversed them. 

This conversation has been edited for length and clarity.

I understood the state ... to be arguing that they're basing the denial of care on the purpose or the use of said medical care like to alter a child's gender presentation or to help the child transition, versus slowing precocious puberty. Is that an accurate read? Can you kind of break down in plain terms, what all that means? 

You're absolutely right. Their full argument is that this law does not distinguish based on sex or transgender status, but instead the distinction is based on medical use. The problem with that argument is that is just not what the statute does. The statute — it doesn't specify that you even need a medical use for these types of treatments. So to give an example, outside of the context of a trans youth receiving hormone therapy, hormone therapy could be used for no medical purpose in the state of Tennessee. The most concrete example of that is a cisgender child in Tennessee can still get a breast enhancement for no medical purpose. The law does not address that. It does not prohibit it. So although they frame the argument in that term, that's not actually what the law says. And........

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