Attorney General Marshall: Supreme Court Agrees on Tennessee’s Case, States Can Impose Age Limits on Sex-Change Procedures

(Montgomery, Ala) – Alabama Attorney General Steve Marshall issued a statement celebrating today’s U.S. Supreme Court decision in United States v. Skrmetti. The 6-3 decision upheld Tennessee’s law imposing age-based restrictions on access to sex-change procedures against an Equal Protection Clause challenge by the Biden Administration and the ACLU. The decision clears the way for enforcement of similar laws in over 25 States, including Alabama, that prohibit doctors from prescribing puberty blockers, cross-sex hormones, or surgeries to children for the purpose of gender transition.

“Until a few years ago, the notion of providing sex-change procedures to children was practically unthinkable,” said Attorney General Marshall. “So was the idea that the judiciary is the best branch to sort through the evidence and decide that kids suffering from gender-related psychological distress must be allowed to take powerful hormones that risk permanently changing their bodies and leaving them sterilized. I applaud the Supreme Court for recognizing that state governments have the authority and responsibility to regulate medicine in the face of medical interest groups that have placed radical gender ideology over evidence-based medicine and patient welfare.”

Alabama enacted its law restricting access to sex-change procedures for minors in 2022 and was immediately sued by the Biden Administration and well-funded activist organizations like the ACLU and SPLC. As part of that lawsuit, Alabama engaged in extensive court-ordered discovery regarding the reliability of the “Standards of Care” promulgated by the World Professional Association for Transgender Health (WPATH) that American medical organizations and plaintiffs across the country told courts to defer to. The documents Marshall received in discovery from WPATH showed a medical, legal, and political scandal about the Standards, and plaintiffs challenging Alabama’s law dismissed their claims in full.

Marshall also supported Tennessee in its defense of its law. Last October, prior to oral argument in the Skrmetti case, Marshall filed an amicus brief with the Supreme Court providing evidence of what Alabama had uncovered. The brief discussed how authors intentionally manipulated the WPATH standards to cover up the lack of evidence supporting sex-change procedures to minors, used the Standards of Care as a political and legal document, disregarded the principles of evidence-based medicine they said they followed, failed to properly manage conflicts of interest, and suppressed publication of evidence reviews and dissenting opinions. As one document from WPATH revealed, at least some authors of the Standards of Care chose not to conduct evidenced-based review of the recommendations because they did not want to have to report what they found. As the WPATH author put it: “Our concerns, echoed by the social justice lawyers we spoke with, is that evidence-based review reveals little or no evidence and puts us in an untenable position in terms of affecting policy or winning lawsuits.” Alabama’s amicus brief was cited in both Chief Justice Roberts’s majority opinion and Justice Thomas’s concurrence.

“The political and legal scandal Alabama uncovered underscores why the Constitution places the authority to regulate medicine with the States, not with activist organizations like WPATH or their friends at the ACLU,” said Attorney General Marshall. “Laws like Alabama’s and Tennessee’s are unfortunately very necessary to protect vulnerable children from so-called medical ‘standards’ that were created for the express purpose of ‘affecting policy’ and ‘winning lawsuits,’ not to accurately reflect the science or help children. We are glad that the Supreme Court has upheld these laws, and glad that President Trump’s administration is also taking steps to rid medicine of harmful gender ideology. I look forward to our partnership to root out these radical policies that are directly harming our children and their future.”

Over the last three years, Alabama Attorney General Marshall has led the fight against the Biden administration’s push for irreversible sex-change procedures for minors, successfully defending Alabama’s law and leading briefs in support of other states’ laws. In May 2025, the U.S. Department of Health and Human Services extensively discussed the revelations Alabama uncovered in a comprehensive review of pediatric gender dysphoria, as did Justice Thomas today.