Supreme Court Hears Challenge to Tennessees SB 1, Justices Divided Over Whether Law Classifies by Birth Sex

Solicitor General Prelogar told the Supreme Court on argument day that Tennessees SB 1 draws a sex-based line on its face by banning medications "when and only when it's inconsistent with the patient's birth sex," and she urged the justices to treat the statute as a facial sex-based classification deserving heightened scrutiny or, at minimum, to remand for that analysis. "SB 1 categorically bans treatment when and only when it's inconsistent with the patient's birth sex," she said, arguing that the statute leaves no individualized exception even where doctors and parents have concluded treatment is medically necessary.

The Court's questioning, spanning discussions of medical evidence, doctrine, and democratic decisionmaking, focused on two central questions: whether SB 1 actually classifies on the basis of birth sex (or instead draws lines on the basis of age and medical purpose), and if it does, what level of judicial review and remedial relief are appropriate.

Justices pressed both sides about evolving international guidance and the evidence base. Justice Alito cited recent European reports and asked whether the Solicitor General would stand by her petitions claim that "overwhelming evidence" supports benefits from puberty blockers and hormones; Prelogar replied that some European bodies have restricted new prescriptions but have…