In a huge loss for the medical-industrial complex and queer activism, the Supreme Court, in United States v. Skrmetti, in a 6–3 decision, upheld Tennessee’s law banning so called “gender-affirming” medical care for minors. In other words, medically-unnecessary and extreme body modification of minors will not resume in my home state. With this decision, the Court upheld the power of states to stop unwarranted medical practices on a vulnerable segment of the population. This is a major blow to the twisted project to manufacture simulated sexual identities—and a major victory for those fighting to set medicine on an objective scientific foundation.
Predictably, major US medical groups—including the American Psychiatric Association and the Endocrine Society—released a joint statement expressing disappointment with the ruling: “Every patient should have access to the medical care they need.” Like lobotomies for impulse dysregulation? That’s the analogy. GAC involves the altering of physiology through drugs and hormones, amputation of healthy breasts, the mutilation of genitalia—none of which treat a disease but instead manufacture (rarely in a convincing fashion) the appearance of a gender the subject can never truly be. These harmful practices affirm a delusion rather than dealing with the delusion itself. In doing so, they create life-long medical patients worth billions of dollars to the medical industry.
This ban will save countless children a lot of misery and pain. But it will also put medical science back on the path to actually doing health care and not extreme body modifications for an ideological agenda. Twenty-five states have now enacted laws that restrict doctors from providing puberty blockers, hormone therapies or surgery to transgender minors. Two more, Arizona and New Hampshire, ban surgeries. With this decision, it is hoped more states will pass laws banning these practices. Even better would be federal law. And not just for minors. No doctor should be allowed to take advantage of the vulnerable.
The majority, led by Chief Justice Roberts, framed the issue not as one of discrimination, but of permissible state regulation of medical practices. The opinion emphasized that the law did not target transgender individuals based on their status or sex, but rather restricted certain medical procedures based on age and the nature of their use. Because of this framing, the Court applied the lowest level of constitutional review—rational basis—and found that Tennessee had legitimate state interests, such as protecting children from what it described as irreversible medical interventions.
Roberts further wrote that the Court’s role is not to judge the morality or wisdom of such legislative decisions, but only their constitutionality. In declining to treat the law as a form of sex discrimination, the majority rejected the application of heightened scrutiny, which would have required the state to show a more compelling justification for the ban. Concurring opinions from Justices Barrett and Thomas underscored skepticism about emerging medical consensus around “transgender care” and reiterated their views that courts should defer to legislatures, particularly in fast-evolving medical fields.
In her dissent, Justice Sotomayor, joined by Justices Jackson and Kagan, argued that the Tennessee law was plainly discriminatory and violated the Equal Protection Clause. Sotomayor pointed out that the law allows certain medical treatments for minors while denying them to minors who wrongly believe they are the other gender, making the discrimination both clear and sex-based. “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,” she wrote. Of course. Why would it be any other way?
Micropenis is a medical condition characterized by an abnormally small penis—typically defined as a stretched penile length more than 2.5 standard deviations below the average for age and sex. It is typically caused by insufficient testosterone exposure during fetal development or early childhood. Early medical intervention, especially during infancy or early childhood, can stimulate penile growth. This involves short courses of testosterone therapy, either through injections or topical application, which can significantly increase penile length if administered at the appropriate developmental stage. In some cases, additional treatments during puberty or adulthood may be considered, but the response is generally best when treatment is initiated early. Thus proper diagnosis and timely hormone therapy are crucial for both physical development and the psychological well-being of affected individuals.
A mother who chooses not to intervene in treating her son’s micropenis during childhood, perhaps believing the decision should be left to the child when he’s older, is ultimately doing him a disservice. While the intention to respect bodily autonomy may seem thoughtful to her (or perhaps virtuous if driven by gender ideology), it ignores the medical reality that effective treatment can only stimulate meaningful penile growth if begun in early childhood. Delaying care until the child is old enough to decide means missing the narrow window when intervention can make a real difference. In this case, the well-meaning but misguided idea of letting the child choose later removes that choice altogether. Proper parental care sometimes requires making difficult, time-sensitive decisions in the child’s best interest—especially when inaction leads to permanent consequences.
But administering testosterone to a girl? For what purpose? If giving testosterone to a boy with a micropenis is justified because it aligns with his biological development, then administering the same hormone to a girl—whose body is not deficient in testosterone and for whom such an intervention will fundamentally alter her natural development—stands on entirely different ground. That terrain is ideological, and preys on the false belief that girls can become boys. In this case, it’s not a corrective treatment but a deliberate disruption of healthy female development in pursuit of a gender identity that, like the choice deferred in the micropenis example, evolves over time.
Putting aside the impossibility of children changing genders, the logic that children should be left to decide later seems conveniently abandoned here—replaced by irreversible interventions made on the basis of subjective feelings rather than objective medical need. If bodily autonomy matters, it should matter in both directions. But unlike the boy with micropenis, the girl given testosterone loses not just a developmental window, but her unaltered path into adulthood—without ever having the chance to truly choose it. The same thing holds with puberty blockers—unless these are used to stop precocious puberty (an actual medical condition).
Sotomayor criticized the majority for failing to apply even intermediate scrutiny—typically used in cases involving sex discrimination—and for minimizing the harm done to transgender youth and their families. Her opinion warned that the ruling would open the door for further erosion of protections for LGBTQ+ individuals and that it sends a dangerous message that states can target vulnerable populations under the guise of neutral regulation. It’s rather embarrassing for a Supreme Court justice to make an argument this absurd.
Eithan Haim of Dallas, the whistleblower who exposed atrocities performed on underage patients at Texas Children’s Hospital in Houston, makes this analogy: “It would be like saying a patient without cancer but ‘identifies as having cancer’ is being discriminated against because a doctor is refusing to give them chemotherapy.” In effect, Sotomayor is arguing that upholding the Tennessee ban on administering chemotherapy to a person without cancer is denying that person “lifesaving medical treatment.”
What the Court upheld was not discrimination, but discernment—the ability of a society to distinguish between treating a medical condition and indulging a psychological fiction with irreversible drugs and surgeries. The Tennessee law does not deny health care; it affirms that medical care must be grounded in biological reality and genuine pathology, not ideological fantasies. Children deserve protection from experimental interventions that yield lifelong consequences based on feelings that may change with time. Just as a parent is expected to act swiftly and wisely to correct a physical disorder like micropenis during a narrow developmental window, the same obligation should apply in preventing healthy children from being irreversibly harmed by ideologically driven procedures masquerading as medicine.
The Court’s decision validates a simple truth: that medicine must serve the body, not remake it in the image of delusional thinking and political belief.
freedom and reason 