The Supreme Court's Ban on Gender-Affirming Medical Care

On June 18, 2025, in the case of United States v. Skrmetti, the Supreme Court of the United States upheld Tennessee’s ban on gender-affirming medical care (GAMC) for minors. The court found that this law was constitutional, effectively prohibiting youths with gender dysphoria from gaining access to medically necessary gender-affirming puberty blockers, hormone treatments, and surgeries in their states. The courts found that states have a right to regulate medical procedures, including bans on procedures that they believe are harmful or risky. The court rejected the plaintiff’s arguments that such a ban violated their right to equal protection under the law. The plaintiff had argued that the bans on GAMC discriminated against them based on sex or gender. In her dissenting opinion, Justice Sonja Sotomayor wrote that the court’s ruling would have “untold harm to transgender children and the parents and families who love them.”

Extensive research has indicated that access to gender-affirming medical care can improve the quality of life of youth with gender dysphoria, including improvements related to anxiety, depression, suicidal ideation, and ability to succeed in school (Abreu and colleagues, 2022; Barsky, 2024b; Coleman, E., and colleagues, 2022). Gender-affirming medical care for youth is supported by many health and mental health organizations that specialize in serving transgender individuals and people with gender dysphoria. These associations include the American Psychological Association [APA] (2024) and World Professional Association for Transgender Health [WPATH] (Coleman, E., and colleagues, 2022). Essentially, the Supreme Court’s decision allows states to forbid transgender youth from having certain forms of medical care that are well-supported as evidence-based practices. It also overrules parents’ rights to make healthcare decisions for their children. This decision not only affects individuals in Tennessee but also individuals in all 26 states that have similar bans (Human Rights Campaign, 2024).

Professional Obligations and Options

For psychologists and other mental health professionals (MHPs), this GAMC ban raises several ethical, clinical, and legal issues. From an ethics perspective, MHPs are supposed to honor a client’s right to self-determination and facilitate access to needed services (American Counseling Association, 2014; American Psychological Association, 2017; National Association of Social Workers, 2021). However, when needed services such as GAMC are criminalized, MHPs could put themselves and their clients in legal peril if they try to facilitate access to GAMC within their state. Clinically, if MHPs do nothing to assist their minor clients in need of GAMC, then they could be placing their clients at risk of suicide, depression, anxiety, and related psychological and social concerns. Although anti-GAMC laws prohibit certain types of medical interventions for minors, it is important to recognize that they do not prohibit or criminalize other types of gender-affirming care.

Some options that MHPs may consider include:

1. Providing transgender clients and family members with supportive and gender-affirming counseling or therapy;
2. Validating clients’ concerns and reinforcing family and peer support (including participation in transgender support groups);
3. Exploring the wishes, reactions, and concerns of transgender clients and family members about the ban on GAMC;
4. Assessing clients for psychosocial concerns such as depression, anxiety, suicidal ideation, and problems related to family, school, or peer relations, and offer appropriate forms of support;
5. Discussing the possibility of social transitions, such as changes in names, pronouns, clothing, hair, and voice, and strategically coming out to particular friends, family, teachers, or others (Coleman and colleagues, 2022; Reynolds and Goldstein, 2014);
6. Exploring the possibility of moving (temporarily or permanently) to a state or country that is supportive of GAMC (for example, help families research out-of-state providers, telehealth services, and legal routes to obtain care; and help families access funding if needed)
7. Helping transgender clients cope with the ban until they are 18, and discuss options that they could consider once they reach this age.

On a macro level, MHPs may work with various civil rights and transgender support organizations to advocate for legislative changes, including access to puberty blockers, gender-affirming hormone therapies, and surgeries. MHPs can provide expert testimony and documentary evidence to support such bans (Barsky, 2024b). They can also educate physicians, teachers, clergy, and other community members about the needs of transgender clients and options for services. For MHPs in other states that allow GAMC, it may be helpful to conduct research to document the risks, benefits, and effectiveness of GAMC. When legislators or courts are considering whether to support GAMC, it is important to have current, long-term, and rigorous research to inform their decisions.

Conclusion

The Skrmetti decision strips legal protections from gender-affirming medical care for minors in multiple states, closing pathways to evidence-based medical treatments and placing youth at greater mental health risk. It is important for MHPs to understand the nature of these bans, including what they prohibit and what they do not prohibit. For MHPs who are uncertain about the impact of a particular state law on their practice and their clients, it is vital to reach out to attorneys who specialize in this area, including attorneys who work for civil rights and transgender support groups. While these bans criminalize certain types of medical interventions, they do not prevent MHPs from providing gender-affirming therapy, counseling, and support. Mental health professionals must remain vigilant, intentional, and innovative—providing affirmation, thorough assessment, client navigation, and community advocacy. Although specific medical treatments are curtailed, social and psychological care remains accessible, indispensable, and potentially lifesaving. Indeed, the need for these services may be even greater after the recent Supreme Court decision.