
Law & Principles
U.S. Supreme Court upholds ban on child sex-change surgeries
Ray Carter | June 18, 2025
In a decision with repercussions for the state of Oklahoma, the U.S. Supreme Court has upheld a Tennessee law prohibiting medical officials from performing sex-change surgeries on minors who identify as transgender or providing those children with puberty blockers or cross-sex hormones.
Oklahoma has a similar law that has also been challenged in court.
The U.S. Supreme Court upheld Tennessee’s law in a 6-3 decision in United States v. Skrmetti, breaking along ideological lines, with court conservatives finding the Tennessee law (Senate Bill 1) to be constitutional.
The majority opinion, authored by Chief Justice John Roberts, held that the Tennessee law “is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment and satisfies rational basis review.”
“Tennessee determined that administering puberty blockers or hormones to minors to treat gender dysphoria, gender identity disorder, or gender incongruence carries risks, including irreversible sterility, increased risk of disease and illness, and adverse psychological consequences,” Roberts wrote. “The legislature found that minors lack the maturity to fully understand these consequences, that many individuals have expressed regret for undergoing such treatments as minors, and that the full effects of such treatments may not yet be known. At the same time, the State noted evidence that discordance between sex and gender can be resolved through less invasive approaches. SB1’s age- and diagnosis-based classifications are rationally related to these findings and the State’s objective of protecting minors’ health and welfare.”
The plaintiffs in the Tennessee case—three minors who identify as transgender, their parents, and a doctor—argued the law discriminated based on sex and transgender status, and that individuals who identify as transgender are a protected class.
“In politically contentious debates over matters shrouded in scientific uncertainty, courts should not assume that self-described experts are correct.” —Justice Clarence Thomas
But the court majority held that the Tennessee law is based on only two classifications—one based on age and the other based on medical use.
In a dissent, Justice Sonia Sotomayor disagreed.
Sotomayor wrote that the court’s majority “subjects a law that plainly discriminates on the basis of sex to mere rational-basis review. By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims.”
Sotomayor was joined in her dissent by Justice Ketanji Brown Jackson and Justice Elena Kagan.
The plaintiffs’ and the dissenting justices’ arguments relied heavily on a purported consensus among medical experts that sex-change surgeries, cross-sex hormones, and puberty blockers are appropriate treatments for children with gender dysphoria who identify as members of the opposite sex.
But in a concurring opinion, Justice Clarence Thomas wrote the evidence not only showed that no such consensus exists, but that “there are particularly good reasons to question the expert class here, as recent revelations suggest that leading voices in this area have relied on questionable evidence, and have allowed ideology to influence their medical guidance.”
Thomas stated that “this case serves as a useful reminder that the American people and their representatives are entitled to disagree with those who hold themselves out as experts, and that courts may not ‘sit as a super-legislature to weigh the wisdom of legislation.’”
Thomas said the phrase “gender-affirming care” is a “sanitized description” that “obscures the nature of the medical interventions at issue.”
He noted the use of cross-sex hormones can involve giving a female child (who identifies as a male) dosages of testosterone that are up to 100 times greater than native levels, while the dosage of estrogen given to boys (who identify as girls) can be up to 43 times greater than the normal range.
He noted that puberty blockers, cross-sex hormones, and sex-change surgeries are all associated with lifelong impacts on patients that include significant negative physical and mental health outcomes.
“Setting aside whether sex-transition treatments for children are effective, States may legitimately question whether they are ethical,” Thomas wrote (emphasis in original).
“This ruling is a tremendous victory for Oklahoma’s children, ensuring they will not be subjected to the consequences of these life-altering surgeries.” —Oklahoma Attorney General Gentner Drummond
And he stressed that the voices of individuals who have undergone the procedures championed by the plaintiffs should not be ignored.
“The voices of ‘detransitioners’—individuals who have undergone sex-transition treatments but no longer view themselves as transgender—provide States with an additional reason to question whether children are providing informed consent to the medical interventions described above,” Thomas wrote.
Roberts raised a similar issue in the majority opinion.
“The plaintiffs and the dissent, however, contort the meaning of the term ‘medical treatment,’” Roberts wrote. “Notably absent from their framing is a key aspect of any medical treatment: the underlying medical concern the treatment is intended to address.”
Thomas also noted that “when this Court has nonetheless given exalted status to expert opinion, it has been to our detriment,” noting that supposed expert authority played a role in the U.S. Supreme Court’s 1927 decision upholding Virginia’s forced-sterilization law, which bolstered the cause of the pseudoscientific eugenics movement.
“This case carries a simple lesson: In politically contentious debates over matters shrouded in scientific uncertainty, courts should not assume that self-described experts are correct,” Thomas wrote.
Impact on Oklahoma
More than 20 states, including Oklahoma, have enacted laws banning the performance of sex-transition efforts on minors.
In 2023, Oklahoma state lawmakers passed and Gov. Kevin Stitt signed into law Senate Bill 613, which states, “A health care provider shall not knowingly provide gender transition procedures to any child.”
The Oklahoma law defines “gender transition procedures” to include surgical procedures that alter or remove physical or anatomical characteristics or features that are typical for the individual’s biological sex, or the provision of puberty-blocking drugs and cross-sex hormones. The restrictions apply to patients younger than 18.
The American Civil Liberties Union and like-minded groups sued, seeking to have the law overturned.
The plaintiffs in Peter Poe v. Gentner Drummond included five youth who claim to be transgender, their parents/guardians, and one doctor.
The Oklahoma Council of Public Affairs (OCPA) joined with Do No Harm, a group of medical professionals, to defend SB 613 in an amici curiae brief filed in the case.
“No reliable scientific evidence justifies the use of puberty blockers, cross-sex hormones, and surgeries to treat gender dysphoria in minors. To the contrary, such treatments carry harmful lifelong consequences, including infertility, total loss of adult sexual function, and increased risk of several other serious medical conditions,” OCPA and Do No Harm’s brief stated.
The Oklahoma law was upheld by a district judge, but the plaintiffs have appealed the decision to the U.S. Court of Appeals for the Tenth Circuit. On Oct. 29, 2024, the Tenth Circuit issued an order stating that the court would take no action on the case “pending the Supreme Court’s issuance of a decision in United States v. Skrmetti.”
Stitt welcomed news of the U.S. Supreme Court’s ruling.
“Kids can’t smoke, drink, or get a tattoo—who in their right mind thinks it’s a good idea for kids to permanently alter their bodies?” Stitt wrote on X. “We passed the ban in Oklahoma, and I’m glad to see Tennessee’s law upheld at the Supreme Court.”
Senate Majority Floor Leader Julie Daniels, a Bartlesville Republican who authored SB 613, said the U.S. Supreme Court’s ruling on the Tennessee law makes clear that Oklahoma’s law is also constitutional.
“These procedures are far from settled science,” Daniels said. “We shouldn’t be experimenting with our children in this manner. These children are in real distress, and in Oklahoma, we are prioritizing their behavioral and mental health care rather than offering surgeries they may regret for the rest of their lives.”
Former House Speaker Charles McCall, an Atoka Republican who led that chamber when SB 613 passed, also welcomed news of the U.S. Supreme Court’s ruling.
“The Supreme Court got it right,” McCall wrote in a post on X. “Today’s decision upholding Tennessee’s law to protect kids from irreversible gender procedures is a major victory for families and for common sense. This should have been implemented immediately and never held up. In Oklahoma, we led the way with SB 613—legislation I proudly championed to ban gender surgeries and hormone treatments for minors. We said loud and clear: our children are not political experiments.”
Oklahoma Attorney General Gentner Drummond said the U.S. Supreme Court’s decision upholding the Tennessee law in Skrmetti is a significant victory for Oklahoma as well.
“This ruling is a tremendous victory for Oklahoma’s children, ensuring they will not be subjected to the consequences of these life-altering surgeries,” Drummond said. “The practice is unconscionable, and I appreciate the court’s ruling that we as a state have the right to protect Oklahoma children from this irreparable harm.”
Freedom Oklahoma, which describes itself as only statewide 2SLGBTQ+ advocacy organization, had a decidedly different take on the court’s ruling. In a graphic posted on X, officials with the group wrote, “F--- the court.”
NOTE: This story has been updated since publication to include comments from state Sen. Julie Daniels, former House Speaker Charles McCall and Freedom Oklahoma.

Ray Carter
Director, Center for Independent Journalism
Ray Carter is the director of OCPA’s Center for Independent Journalism. He has two decades of experience in journalism and communications. He previously served as senior Capitol reporter for The Journal Record, media director for the Oklahoma House of Representatives, and chief editorial writer at The Oklahoman. As a reporter for The Journal Record, Carter received 12 Carl Rogan Awards in four years—including awards for investigative reporting, general news reporting, feature writing, spot news reporting, business reporting, and sports reporting. While at The Oklahoman, he was the recipient of several awards, including first place in the editorial writing category of the Associated Press/Oklahoma News Executives Carl Rogan Memorial News Excellence Competition for an editorial on the history of racism in the Oklahoma legislature.