L. W. v. Jonathan Skrmetti, 73 F.4th 408

Background

Tennessee enacted the "Prohibition on Medical Procedures Performed on Minors Related to Sexual Identity," banning gender-affirming surgeries and the prescribing/administration of puberty blockers and cross-sex hormones to minors, with exceptions for congenital defects/precocious puberty/disease and a "continuing care" carve-out through March 31, 2024.
Enforcement mechanisms include state enforcement by the Attorney General, professional discipline by regulators, and a private right of action; plaintiffs did not challenge the private cause of action.
Plaintiffs (three transgender minors, their parents, and a physician) sued, alleging violations of the Fourteenth Amendment’s Due Process and Equal Protection Clauses and moved for a preliminary injunction blocking the law’s restrictions on hormones and puberty blockers.
The district court issued a facial, statewide injunction as to hormones and blockers (but not surgeries), finding likely violations of parental due process rights and equal protection (sex discrimination and that transgender persons are a quasi‑suspect class).
Tennessee appealed and sought an emergency stay of the preliminary injunction pending appeal; the Sixth Circuit granted the stay and expedited the appeal.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Scope of relief: facial invalidation and statewide injunction	The Act is facially unconstitutional as to hormones/blockers; statewide relief is appropriate.	Plaintiffs must meet Salerno: show no set of valid applications; nationwide/statewide injunction exceeds parties’ injuries.	Court: Facial invalidation unlikely under Salerno; statewide injunction likely abused discretion—stay granted.
Due Process: parental right to direct children’s medical care	Parents have a fundamental right to obtain gender‑affirming treatments for minors.	No deeply rooted historical right to access new/experimental medical treatments; States may regulate to protect minors.	Court: Plaintiffs unlikely to show a new substantive due process right; state regulation in this unsettled medical area is permissible.
Equal Protection: sex discrimination / transgender as quasi‑suspect class	The law discriminates on the basis of sex/gender identity and triggers heightened scrutiny.	The ban applies to minors of both sexes and is at most rationally related to legitimate state interests; transgender status is not a recognized quasi‑suspect class.	Court: Skeptical that heightened scrutiny applies; rational‑basis review likely governs; plaintiffs unlikely to prevail.
Stay factors / preliminary injunction standard	Injunction necessary to prevent irreparable harm to minors denied treatment.	State would suffer irreparable harm from inability to enforce legislation and to protect children; public interest favors enforcement.	Court: Considering likelihood of success and other factors, stay granted pending appeal and appeal expedited.

Key Cases Cited

United States v. Salerno, 481 U.S. 739 (U.S. 1987) (establishes the strict standard for facial challenges)
Washington v. Glucksberg, 521 U.S. 702 (U.S. 1997) (substantive due process requires rights to be deeply rooted in history and tradition)
Dobbs v. Jackson Women’s Health Org., 142 S. Ct. 2228 (U.S. 2022) (endorses deference to state regulation of certain medical procedures and presumption of validity for state laws)
Troxel v. Granville, 530 U.S. 57 (U.S. 2000) (recognizes parental rights to make decisions concerning children)
Parham v. J.R., 442 U.S. 584 (U.S. 1979) (states retain authority to protect children’s welfare over parental choices)
Abigail All. for Better Access to Dev. Drugs v. von Eschenbach, 495 F.3d 695 (D.C. Cir. 2007) (no constitutional right to access experimental/off‑label drugs)
United States v. Virginia, 518 U.S. 515 (U.S. 1996) (sets intermediate scrutiny standard for sex classifications)
City of Cleburne v. Cleburne Living Ctr., 473 U.S. 432 (U.S. 1985) (discusses suspect and quasi‑suspect class recognition)
Bostock v. Clayton County, 140 S. Ct. 1731 (U.S. 2020) (interprets Title VII’s prohibition on sex discrimination to cover sexual orientation and gender identity in employment contexts)
Mazurek v. Armstrong, 520 U.S. 968 (U.S. 1997) (describes the burden required to obtain injunctive relief)
Winter v. NRDC, 555 U.S. 7 (U.S. 2008) (sets the standard for preliminary injunctive relief)