The Tennessee gender-affirming care ban prohibits puberty blockers, cross-sex hormones, and gender-transition surgery for anyone under 18 when the treatment is meant to address gender dysphoria or help the minor live as a gender inconsistent with their biological sex. The law is codified at Tenn. Code Ann. § 68-33-101 through § 68-33-110, took effect on July 1, 2023, and the U.S. Supreme Court upheld it 6-3 in United States v. Skrmetti on June 18, 2025.1Supreme Court of the United States. United States v. Skrmetti, No. 23-477 Adults 18 and older can still legally receive this care in Tennessee, though a separate 2026 law now imposes reporting duties on their providers and insurers.
What the Law Prohibits for Minors
Under Tenn. Code Ann. § 68-33-103, a healthcare provider cannot knowingly perform or offer any medical procedure on a minor if the purpose is to help the minor live as a gender inconsistent with their biological sex, or to treat distress caused by a conflict between the minor’s sex and their gender identity.2Justia Law. Tennessee Code 68-33-103 – Prohibitions Three categories of treatment fall inside that prohibition:
- Puberty blockers, such as gonadotropin-releasing hormone agonists that suppress natural puberty.
- Cross-sex hormones, meaning testosterone or estrogen prescribed to induce physical characteristics of the opposite sex.
- Surgery that removes or alters healthy tissue to change the minor’s physical appearance to align with their gender identity.
Parental consent does not create a workaround. The statute states explicitly that neither the minor’s consent nor a parent’s consent is a defense to a violation, which overrides the common-law rule that a mature minor could agree to certain medical treatments.2Justia Law. Tennessee Code 68-33-103 – Prohibitions
Telehealth From Other States Is Covered
The ban follows the patient, not the provider. It applies to any prohibited procedure “performed or administered on a minor located in this state, including via telehealth.”2Justia Law. Tennessee Code 68-33-103 – Prohibitions A physician licensed in another state who prescribes puberty blockers or hormones to a minor physically located in Tennessee faces the same legal exposure as a Tennessee clinician.
Counseling and Therapy Are Not Restricted
The statute reaches medical procedures involving drugs and surgery. Talk therapy, counseling, and mental health treatment for gender dysphoria are not prohibited. A therapist can discuss gender identity with a minor patient without violating Chapter 33.
The Narrow Exceptions
The law allows treatments that would otherwise be banned in a short list of situations:2Justia Law. Tennessee Code 68-33-103 – Prohibitions
- Verifiable disorders of sexual development, including ambiguous external sex characteristics present at birth.
- Precocious puberty, where a child begins puberty abnormally early and a provider prescribes puberty-suppressing medication to treat that condition.
- Physical injury, infection, or disease unrelated to gender identity. The statute specifically excludes gender dysphoria, gender identity disorder, and gender incongruence from the definition of “disease.”
There is no exception for a minor who has been living as the opposite gender for years, and none for cases where a mental health provider recommends medical intervention. The carve-outs are strictly physiological.
A temporary grandfathering provision let providers continue an ongoing course of puberty blockers or hormones if the treating physician certified in writing that stopping would harm the minor. That window expired on March 31, 2024.3Tennessee General Assembly. Senate Bill 1 No minor in Tennessee can legally continue these treatments for gender dysphoria today, even if they started before the law existed.
Penalties for Violating the Ban
The law creates two enforcement paths, and both can run against the same provider for the same conduct.
Attorney General Civil Actions
The Tennessee Attorney General can sue any healthcare provider or person who knowingly violates the law, with 20 years from the date of the violation to file.4Justia Law. Tennessee Code 68-33-106 – Attorney General Enforcement Each prohibited procedure is a separate violation carrying a $25,000 civil penalty. The AG can also seek an injunction against further violations, disgorgement of profits from the procedure, and recovery of attorney’s fees and court costs.
Private Lawsuits With a 30-Year Window
The minor, or a parent, can sue the provider directly. The limitations period is 30 years from the date the minor turns 18, or 10 years from the minor’s death.5Tennessee General Assembly. Senate Amendment 1 to SB0001 A procedure performed on a 10-year-old in 2023 could give rise to a lawsuit as late as 2051. Private plaintiffs can seek compensatory damages, punitive damages, and attorney’s fees.
Loss of License
Under Tenn. Code Ann. § 68-33-107, a violation is treated as a threat to public health, safety, and welfare, which triggers emergency action by the provider’s licensing board.6Justia Law. Tennessee Code 68-33-107 – Healthcare Provider Regulatory Action The board must open proceedings under Title 63 once it learns of an alleged violation, and the emergency designation requires expedited handling rather than a routine administrative timeline.
Adults, and the New 2026 Reporting Law
Chapter 33 applies only to minors. Anyone 18 or older can legally receive puberty blockers, cross-sex hormones, and gender-affirming surgery in Tennessee, and providers who treat adults are not subject to the $25,000 penalties, private lawsuits, or licensing board actions created by that chapter.7LegiScan. Tennessee Senate Bill 1
Adult care now carries its own reporting regime. Governor Lee signed HB 0754 into law on May 15, 2026, as Public Chapter 932.8Tennessee General Assembly. House Bill 754 Providers delivering gender-affirming care, including care for adults, must report patient data to the Tennessee Department of Health: age, sex assigned at birth, diagnosis, treatment dates, medication details, and types of surgery. The data is published publicly. Any insurer that covers gender-affirming care must also cover detransition care, meaning medical and psychological support for people who choose to discontinue or reverse treatment. A provider who fails to report faces license suspension of at least six months, and the provider’s employer faces fines up to $150,000.