Understanding Gender-Affirming Care in Tennessee

What is Gender-Affirming Care?

              Gender-affirming care encompasses a wide spectrum of medical, psychological, behavioral, and social interventions designed to support individuals whose gender identity differs from the sex they were assigned at birth. The care is highly individualized and may involve:

• Counseling and psychological support.
• Non-medical interventions such as speech therapy and hair removal.
• Physical modifications like breast binding, genital tucking, and hip padding.

These treatments aim to help individuals align their lived experience with their gender identity. Access to this care for minors has become a point of legal and political contention in the United States. Numerous states, including Tennessee, have passed laws that prohibit or restrict access to such care for minors.

Current Tennessee Law on Gender-Affirming Care

              In 2023, Tennessee passed Senate Bill 1, a law prohibiting healthcare providers from offering gender-affirming medical treatments to minors (now codified at TN Code Title 68, Chapter 33, §§ 101-109 (2024)). The law specifically bans medical interventions intended to:

• Enable a minor to identify with a gender inconsistent with their sex assigned at birth.
• Alleviate discomfort or distress stemming from that inconsistency.

The prohibition extends to medical procedures and the distribution of hormones and puberty blockers. The law applies both to procedures performed within Tennessee and to procedures performed on minors located in Tennessee, regardless of where the provider is based.

Violations can result in regulatory discipline for the healthcare provider. Additionally, the Attorney General can bring actions against healthcare providers who violate the law with a potential civil penalty of $25,000 per violation. Healthcare providers are held liable for their violation of the law regardless of consent on behalf of the minor. Private individuals, such as the minor or their parent, can also bring a private cause of action against the healthcare provider if they did not consent to the treatment.

              However, Senate Bill 1 includes several exceptions for certain medical conditions. Procedures may still be performed on minors to treat a congenital defect, precocious puberty, disease (excluding gender dysphoria and related diagnoses), or a physical injury. Additionally, any treatment that began before the law took effect on July 1, 2023, may continue under certain conditions.

              The Tennessee legislature supported the law with findings that emphasize potential risks, including:

• Permanent sterilization.
• Increased risk of disease or psychological harm.
• The experimental nature of certain gender-affirming treatments.

Lawmakers argued that minors, those under 18 years of age, may not possess the maturity to make decisions with life-altering consequences. Additionally, many who seek care experience gender dysphoria, which may or may not continue into adulthood. They urged that procedures intended to affirm gender identity are harmful to minors and that the state has an encouraging interest in encouraging minors to appreciate their sex. They also raised concerns about the medical community’s motivations, suggesting that financial incentives could be driving the provision of such care.

Challenges to the Tennessee Law

              Soon after its enactment, the Tennessee law was challenged in federal court. Opponents argue that the law violates the U.S. Constitution’s guarantees of due process and equal protection, citing that similar treatments are allowed for non-gender-related reasons.

              Although the Sixth Circuit Court of Appeals upheld the law’s constitutionality, the case – United States v. Skrmetti – was accepted by the United States Supreme Court for further review on the issue of equal protection. The Court heard arguments on December 4, 2024, and a decision is expected by summer 2025.

The case has attracted national attention, with public statements from political figures highlighting its divisive nature. President Trump voiced support for the law in early 2025, a position contrary to that of former President Biden, who opposed such state-level bans.

Conclusion

              Until the Supreme Court issues a ruling, Tennessee’s law remains in effect. Healthcare providers are legally prohibited from offering gender-affirming care to minors when the intent is to affirm a gender identity different from the minor’s assigned sex at birth.

              The forthcoming decision in United States v. Skrmetti will likely have significant implications – not just for Tennessee, but for similar laws across the country. As the legal and social debates continue, the outcome will play a crucial role in shaping the future of healthcare access for transgender minors in the United States.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.