Tennessee’s ban on gender-affirming care prohibits doctors and other healthcare providers from prescribing puberty blockers, giving hormone therapy, or performing surgery on anyone under eighteen when the purpose is gender transition. The law, Senate Bill 1, took effect July 1, 2023, and the U.S. Supreme Court upheld it 6–3 on June 18, 2025 in United States v. Skrmetti.1Supreme Court of the United States. United States v. Skrmetti The grace period for patients already in treatment expired on March 31, 2024, and a separate 2026 law extends restrictions to TennCare coverage for enrollees of all ages.
What’s Banned for Minors
The statute targets three categories of care when used to help a minor live as a gender inconsistent with their biological sex or to treat distress from that inconsistency:2Justia Law. Tennessee Code 68-33-103 – Prohibitions
- Puberty blockers that suppress the hormones triggering secondary sex characteristics.
- Testosterone or estrogen prescribed to induce changes aligned with the minor’s gender identity rather than biological sex.
- Surgery that removes or alters healthy tissue for gender-transition purposes, including chest surgery and genital reconstruction.
The ban reaches care delivered inside Tennessee and care provided by telehealth to a minor located in the state.2Justia Law. Tennessee Code 68-33-103 – Prohibitions A separate section makes it illegal for anyone to knowingly provide hormones or puberty blockers to a minor outside the restrictions of the chapter.3Justia Law. Tennessee Code 68-33-104 – Distribution of Hormones or Puberty Blockers
The law evaluates each treatment by its purpose, not by the drug or procedure itself. The same medication prescribed for a different medical reason remains legal, which is why the statute’s exceptions matter so much.
Medical Exceptions
Providers may still prescribe restricted medications or perform surgery on minors in four situations:2Justia Law. Tennessee Code 68-33-103 – Prohibitions
- Congenital defects, including disorders of sex development sometimes called intersex conditions.4Justia Law. Tennessee Code 68-33-102 – Chapter Definitions
- Precocious puberty, where blockers are used to correct abnormally early development.
- Disease, such as cancer or endocrine disorders. Gender dysphoria, gender identity disorder, and gender incongruence are specifically excluded from the statute’s definition of “disease.”
- Physical injury requiring surgical or hormonal intervention.
The congenital-defect carve-out means a child born with ambiguous anatomy or atypical chromosomal patterns can still receive medical care at the discretion of physician and family. The law draws a hard line between those physical conditions and psychological diagnoses.
Parental Consent Isn’t a Defense
Consent from a parent or guardian does not shield a provider from liability. Even when both parents fully support the treatment, a provider who performs it faces the same penalties.2Justia Law. Tennessee Code 68-33-103 – Prohibitions The statute also overrides any common-law rule that would otherwise let a minor consent to medical treatment for gender-transition purposes. That is unusual: most medical regulations defer heavily to parental decision-making, and this one does not.
Penalties for Providers
The law creates several enforcement paths that reach well past a licensing reprimand.
The Tennessee Attorney General can sue any provider or facility that violates the ban, and a court can impose a civil penalty of $25,000 per violation.5Tennessee General Assembly. Tennessee Code 68-33-101 – Findings Each treatment could count as a separate violation, so a provider treating multiple patients faces compounding liability.
Parents and legal guardians also have a private right of action. They can sue for compensatory damages, which may include the cost of the prohibited treatment and any resulting harm, and successful plaintiffs can recover attorney fees and court costs.5Tennessee General Assembly. Tennessee Code 68-33-101 – Findings
The most striking piece is the limitations period for the minor patients themselves. A person who received prohibited care before turning eighteen has thirty years after reaching adulthood to file a lawsuit.5Tennessee General Assembly. Tennessee Code 68-33-101 – Findings A provider who treats a sixteen-year-old could face suit as late as the patient’s forty-eighth birthday.
The Board of Medical Examiners and the Board of Nursing can also take disciplinary action against a provider’s license.
What Happens to Patients Already in Treatment
When SB1 took effect, minors already on gender-affirming treatment were not cut off immediately. Providers could continue existing treatment through March 31, 2024, but only if the treating physician certified in writing that abruptly stopping would harm the minor, included the clinical findings supporting that judgment, and placed the certification in the patient’s medical record. The wind-down could not be used to start new treatments or switch to a different restricted procedure.2Justia Law. Tennessee Code 68-33-103 – Prohibitions
That deadline has passed. Since April 1, 2024, no provider in Tennessee may lawfully perform any restricted procedure on a minor for gender-transition purposes, regardless of when the patient’s care originally began.
The Supreme Court’s Skrmetti Decision
Three transgender minors, their parents, and a physician challenged SB1 under the Equal Protection Clause of the Fourteenth Amendment. On June 18, 2025, the Supreme Court ruled 6–3 in favor of Tennessee.6Legal Information Institute. United States v. Skrmetti
The majority held that SB1’s restrictions turn on age and medical purpose rather than sex, so the law does not trigger the heightened scrutiny courts apply to sex-based classifications. Under rational basis review, the Court found the law “clearly meets” the standard.1Supreme Court of the United States. United States v. Skrmetti
Justices Sotomayor, Kagan, and Jackson dissented, arguing the law classifies by sex because the same medication is permitted for one sex and prohibited for the other depending on whether the treatment matches the patient’s biological sex.1Supreme Court of the United States. United States v. Skrmetti
The result is that SB1 is fully enforceable and no longer subject to serious federal constitutional challenge on equal-protection grounds.
TennCare and Insurance Changes Coming in 2026
Two 2026 laws expand Tennessee’s approach beyond providers and beyond minors.
HB2498, effective July 1, 2026, bars TennCare from covering or reimbursing any procedure performed to enable a person to live as a gender inconsistent with their biological sex or to treat distress from that inconsistency.7Tennessee General Assembly. HB2498 The TennCare ban applies to enrollees of every age, not just minors, and includes the same exceptions for congenital defects, precocious puberty, disease, and physical injury. Enrollees already receiving TennCare-funded treatment when the law takes effect have until March 31, 2027, to wind down care under physician certification.
HB0754, signed May 7, 2026, requires any insurance policy issued or renewed in Tennessee that covers gender-transition procedures to also cover detransition procedures.8Tennessee General Assembly. House Bill (HB) 0754 It applies to policies both on and off the marketplace exchange. The Department of Commerce and Insurance has 90 days to apply for a federal waiver to add detransition procedures to the state’s essential health benefits for marketplace plans.
Neither statute bars private insurers from covering gender-affirming care for adults. But adults who rely on Medicaid will lose that coverage starting in mid-2026.
Adults, Therapy, and Out-of-State Care
Adults in Tennessee face no state-level prohibition on gender-affirming medical care. The ban applies only to those under eighteen. Adults can obtain hormone therapy and surgical procedures from willing providers, though TennCare coverage disappears in July 2026.
SB1 also does not restrict talk therapy, psychological counseling, or social transition, meaning changes to name, pronouns, clothing, or presentation.4Justia Law. Tennessee Code 68-33-102 – Chapter Definitions A separate Tennessee law permits counselors to refuse clients whose goals conflict with the counselor’s sincerely held principles as long as a referral is provided, but that law is not specific to gender identity.
SB1 itself does not penalize families who travel to another state for treatment.2Justia Law. Tennessee Code 68-33-103 – Prohibitions A later law, HB2310, added civil penalties for adults who help a minor travel out of state for gender-affirming care without parental permission. Parents, legal guardians, anyone the parents designate, and common carriers such as airlines and rideshare services are exempt.
Some families look to states with shield laws that protect providers who deliver gender-affirming care to out-of-state patients. Those laws generally block enforcement of another state’s ban against providers within the shield state, but they do not override Tennessee law inside Tennessee. The Tennessee Attorney General has taken the position that the state may seek out-of-state medical records related to gender-affirming care, a position that has not yet been tested in court. Families considering out-of-state care should consult an attorney who understands how both states’ laws interact.