Tennessee’s SB1 win at the Supreme Court is a major moment—but not a secure one. Built on rational basis, not state sovereignty, the ruling is vulnerable to reversal. Here's how to fortify it before it gets the Roe treatment.
Why Tennessee’s Win on SB1 May Be Eventually Doomed to the Same Constitutional Unraveling That Toppled Roe—and How to Fortify It
By Kelly Jackson | TruthWire Commentary
On June 18, 2025, the U.S. Supreme Court handed Tennessee a decisive legal victory in United States v. Skrmetti, upholding the state’s ban on gender transition procedures for minors. The decision affirms Tennessee’s authority to prohibit puberty blockers, cross-sex hormones, and sex-modification surgeries for children under 18 when performed for the purpose of facilitating a gender transition.
But while the ruling resolves the immediate legal challenge, its long-term durability remains uncertain. TruthWire consulted constitutional attorneys and reviewed the ruling in depth to answer a critical question:
Was this a ruling built to last—or merely a procedural win that risks the same constitutional collapse as Roe v. Wade?
The majority’s reasoning in Skrmetti rests narrowly on procedural neutrality and rational basis review—not on state sovereignty, federalism, or any substantive doctrine anchored in the constitutional text. As a result, the very legal strategy that secured the win could become its undoing.
What the Court Held—and Why It Matters
Chief Justice Roberts, writing for the 6–3 majority, emphasized that SB1 applies equally to all minors regardless of sex or gender identity:
“The law prohibits all persons from performing specified medical procedures on all minors if the procedures are for the purpose of enabling the minor to identify with a sex different from the minor’s sex at birth. It does not discriminate based on sex or transgender status.”
The Court declined to apply heightened scrutiny and instead applied rational basis review, under which a law is presumed constitutional if it is reasonably related to a legitimate state interest.
Tennessee’s justifications for SB1—protecting the health and well-being of minors, ensuring medical caution in the face of long-term unknowns, and regulating the medical profession—were deemed more than sufficient:
“Tennessee’s interest in protecting the health and well-being of minors and regulating the medical profession is not only legitimate but ‘compelling.’”
The majority repeatedly emphasized the unsettled nature of the science around pediatric gender transition:
“Where medical evidence is inconclusive, states are not required to await scientific unanimity before acting to protect the health and welfare of their citizens.”
“Medical knowledge evolves. Legislative judgments made in light of present uncertainty may be revisited if future evidence compels a different result.”
That deference to legislative discretion—and the acknowledgment that current medical knowledge is fluid—is what gave the Court its legal footing.
But it’s also what makes the ruling vulnerable.
The Danger of Doctrinal Minimalism
What the Court did not do is assert that the State of Tennessee has an enduring constitutional right to regulate the health and safety of its residents—especially children—under the 10th Amendment and the principle of federalism.
Instead of rooting its holding in structural constitutional authority, the majority built its analysis on what is “reasonable” under current facts. That decision may have been strategically safe—but it is legally precarious.
If the FDA approves puberty blockers and cross-sex hormones for minors with gender dysphoria—if professional associations expand their support for early transition—if public opinion shifts—then a future court could find SB1 no longer rational.
Rational basis is not timeless. It floats with the winds of public perception, medical consensus, and political ideology. In short, the Court won this battle on grounds that may shift underfoot the moment the cultural narrative changes.
A Precedent with the Same Fault Lines as Roe
The parallels to Roe v. Wade are not abstract. That decision, too, was hailed as a definitive constitutional moment. But it rested on shifting sands—emerging medical doctrine, privacy jurisprudence, and a trimester framework not rooted in the text of the Constitution.
Justice Ruth Bader Ginsburg herself criticized Roe’s approach as overreaching and underdeveloped:
“Doctrinal limbs too swiftly shaped… may prove unstable.”
They did. In Dobbs v. Jackson (2022), the Court finally struck down Roe, not because abortion policy had changed, but because its constitutional logic had never been sound.
The danger with Skrmetti is similar. Because the Court avoided federalism and based its reasoning entirely on temporary factors—legislative judgment amid uncertainty—any reversal in those conditions invites reversal in law.
This is not a constitutional victory. It is a contingent one.
What Can Be Done to Fortify It?
TruthWire consulted legal experts and analyzed legal strategies across state and federal jurisprudence to identify clear actions Tennessee and like-minded states can take now to ensure that SB1 is not merely upheld in the present, but protected against future judicial erosion.
1. Ground Future Legislation in Federalism and State Sovereignty
Tennessee should explicitly invoke its powers under the Tenth Amendment and historical precedent affirming state authority over public health, medical licensure, and child welfare.
Future bills should begin with a constitutional preamble that makes this authority unambiguous:
“This law is enacted pursuant to the State of Tennessee’s authority under the Tenth Amendment to regulate the health, safety, and welfare of its citizens, including minors…”
This structural grounding shifts the debate from evolving science to fixed constitutional principle.
2. Codify Comprehensive Legislative Findings
The durability of SB1 would improve significantly with a more expansive legislative record. Lawmakers should formally adopt findings that document:
- The irreversible and experimental nature of gender transition in minors;
- The lack of long-term outcome data;
- International reversals of pediatric transition protocols (e.g., Sweden, U.K., Finland);
- The increased incidence of regret and detransition;
- The unique vulnerability of minors in making life-altering medical decisions.
Creating a robust, evidence-based record provides future courts with justification to defer—even if political winds shift.
3. Enshrine Medical Safeguards in State Constitutional Language
Lawmakers could pursue a state constitutional amendment affirming the state’s authority to restrict high-risk or experimental medical treatments for minors, regardless of future federal or professional body endorsements.
Such an amendment would insulate SB1 from future reinterpretation by federal courts, especially if crafted to reinforce parental rights, bodily integrity of minors, and state autonomy.
4. Strengthen Parental Rights and Consent Protections
Lawmakers can simultaneously bolster parental rights statutes to emphasize that the state does not permit irreversible medical procedures on children without full, informed, and biologically grounded consent.
In doing so, the policy becomes harder to attack as “anti-trans” and more defensible as “pro-parent and pro-child protection.”
5. Broaden the Legal Defense Strategy
Legal advocates defending SB1 in future cases must emphasize:
- The historical precedent of age-based medical restrictions;
- The constitutional principle that states—not courts—determine acceptable risk;
- A comparison to other areas of restricted access (alcohol, smoking, tattoos, Schedule I drugs, etc.) to highlight logical consistency.
The goal must be to shift the lens: this is not a novel restriction targeting a minority group, but a routine exercise of power to protect children from irreversible harm.
Conclusion
United States v. Skrmetti is a victory—but it is not yet a constitutional milestone. It is a ruling grounded in what Tennessee did—not in who has the right to do it. That difference is not semantic—it is structural.
If the cultural narrative changes, if medical associations harden their positions, or if judicial composition shifts, the same reasoning used to uphold SB1 could be used to dismantle it. Just like Roe, this is a precedent standing on soft ground—facts and policy, not enduring law.
Tennessee—and every state pursuing similar protections—must now decide: Will this ruling stand as a fleeting moment of common sense, or will it be secured as a lasting expression of state sovereignty and child protection?
That choice cannot be left to the courts. It must be made in the legislature, in the constitution, and in the structure of the law itself.
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