Tennessee’s transgender laws form a connected set of rules that ban gender-affirming medical care for anyone under 18, define sex biologically across every state statute, require public school students to use restrooms and play sports according to their sex at birth, protect teachers who decline to use preferred pronouns, and prohibit changes to the sex listed on a Tennessee birth certificate. Because every one of these laws draws on the same statutory definition of sex, they operate as a package rather than as separate rules.
How Tennessee Defines Sex
The foundation is Tennessee Code 1-3-105, enacted through SB 1440. It defines sex as a person’s immutable biological sex determined by anatomy and genetics at the time of birth.1Tennessee General Assembly. Tennessee Code SB 1440 The provision sits in the general definitions chapter of the code, so it reaches every Tennessee statute, not only the laws targeting transgender issues.
The law also identifies what proves biological sex: a government-issued identification document that accurately reflects the sex listed on the person’s original birth certificate.1Tennessee General Assembly. Tennessee Code SB 1440 The word “original” does real work. An amended birth certificate from another state showing a different sex marker will not satisfy the definition, which is why Tennessee agencies, schools, and courts all start from the same reference point when a question of sex arises.
Ban on Gender-Affirming Care for Minors
SB 1 prohibits healthcare providers from performing or prescribing gender-affirming medical treatments for anyone under 18.2Tennessee General Assembly. Tennessee General Assembly – SB 0001 Two categories of treatment are covered: surgical procedures that modify the body to align with a gender identity different from the patient’s biological sex, and prescribing puberty blockers or cross-sex hormones for the same purpose.3Tennessee General Assembly. Tennessee Code 68-33-101 – Findings
The exceptions are narrow. Providers can still prescribe the same medications for conditions unrelated to gender identity, such as precocious puberty or a congenital hormone deficiency. Gender dysphoria, gender identity disorder, and gender incongruence are specifically excluded from the definition of “disease” that would trigger those exceptions.3Tennessee General Assembly. Tennessee Code 68-33-101 – Findings The same drug can be legal for one diagnosis and a violation for another.
Wind-Down for Patients Already in Treatment
Minors already receiving treatment when SB 1 took effect had until March 31, 2024, to end it. To qualify for that period, the treating physician had to certify in writing that abruptly stopping treatment would be physically harmful, include the supporting findings, and place the certification in the medical record.3Tennessee General Assembly. Tennessee Code 68-33-101 – Findings The window allowed continuation of an existing treatment, not the start of a new prohibited one.
Penalties and Lawsuits
The Tennessee Attorney General can sue any provider who knowingly violates the ban, seeking an injunction, disgorgement of profits from the procedure, and a civil penalty of up to $25,000 per violation.4Supreme Court of the United States. United States v. Skrmetti Providers also face license revocation through their state licensing board.
A private right of action lets a person who received prohibited treatment as a minor sue their provider for physical and emotional damages, with a window extending up to 30 years after the patient reaches adulthood. Neither parental consent nor the minor’s own consent is a defense to liability, and using the wind-down exception does not waive a former patient’s later right to sue.3Tennessee General Assembly. Tennessee Code 68-33-101 – Findings
What the Supreme Court Decided in Skrmetti
On June 18, 2025, the U.S. Supreme Court upheld SB 1 in United States v. Skrmetti, affirming the Sixth Circuit and resolving the central constitutional question against the challengers: prohibiting these treatments for minors does not violate the Fourteenth Amendment’s Equal Protection Clause.4Supreme Court of the United States. United States v. Skrmetti
The Court applied rational basis review, the most deferential standard in equal protection law. Tennessee’s stated justifications cleared that bar: the legislature had determined that puberty blockers and hormones carry risks for minors, including irreversible sterility and adverse psychological effects, and that minors lack the maturity to fully understand those consequences.4Supreme Court of the United States. United States v. Skrmetti
The Court rejected the argument that SB 1 classifies on the basis of sex or transgender status in a way that triggers heightened scrutiny. It also declined to extend Bostock v. Clayton County, the 2020 employment-discrimination ruling, to this context, noting that changing a minor’s sex or transgender status does not alter how SB 1 applies.4Supreme Court of the United States. United States v. Skrmetti The decision removed the most viable federal constitutional challenge to the ban.
Birth Certificates and State ID
Tennessee Code 68-3-203 states that the sex on an original birth certificate cannot be changed as a result of sex-change surgery.5Justia Law. Tennessee Code 68-3-203 – Amendment of Records Corrections are only allowed when an error was made at the time of filing, such as a clerical mistake. This restriction predates the recent wave of legislation.
The code-wide definition of sex reinforces it. Because Tennessee Code 1-3-105 ties the legal meaning of sex to anatomy and genetics at birth throughout the code, every state agency including the Department of Safety and Homeland Security follows the same rule when it issues driver’s licenses and state identification cards.1Tennessee General Assembly. Tennessee Code SB 1440 In practice, there is no path to change the sex marker on Tennessee-issued identity documents.
School Restrooms, Locker Rooms, and Sleeping Arrangements
The Tennessee Accommodations for All Children Act, enacted through HB 1233, governs multi-occupancy restrooms, locker rooms, changing rooms, showers, and sleeping arrangements during school-sponsored activities in public schools.6Tennessee General Assembly. Tennessee Accommodations for All Children Act – HB 1233 Students must use facilities designated for their biological sex, using the same definition and evidence rules from the general code.
A student who is unwilling or unable to do so for any reason can submit a written request for a reasonable accommodation. The law defines reasonable accommodations as access to a single-occupancy restroom or changing facility, or use of an employee restroom. An accommodation cannot include access to the facility designated for the opposite sex while members of that sex are or could be present.6Tennessee General Assembly. Tennessee Accommodations for All Children Act – HB 1233
A student whose written accommodation request is denied has a private right of action unless the school shows the accommodation would create an undue hardship. A separate right of action exists if a student who has given written notice later encounters a person of the opposite sex in a facility designated for their sex. Suits must be filed within two years, can be brought in chancery court in the county where the incident occurred, and prevailing plaintiffs can recover monetary damages for psychological, emotional, and physical harm.6Tennessee General Assembly. Tennessee Accommodations for All Children Act – HB 1233
School Sports Eligibility
HB 1895 and SB 1861, codified at Tennessee Code 49-6-310, require public schools to determine a student’s eligibility for gender-segregated sports teams based on the student’s sex at the time of birth.7Tennessee General Assembly. HB 1895 – Legislation The enforcement mechanism is financial. The commissioner of education is authorized to withhold state education funds from any local education agency that refuses to comply, with the state board of education setting rules on how much.8Tennessee General Assembly. Tennessee Code Annotated Section 49-6-310 A school unable to comply because of a court order prohibiting enforcement is exempt from the funding penalty.
Pronouns in Public Schools
SB 466 addresses pronoun use for public school employees. Teachers and other school staff are not required to refer to a student by a preferred pronoun that is inconsistent with the student’s biological sex.9Tennessee General Assembly. SB 466 – Legislation The law also shields school employees from civil liability and adverse employment action for using the pronoun that matches the student’s biological sex, even over a student’s or parent’s objection. It does not prohibit a teacher from using a preferred pronoun voluntarily.
The Adult Cabaret Law Is Not in Effect
SB 3 from the 113th General Assembly created an offense for performing “adult cabaret entertainment” on public property or where a minor could view the performance, with the definition covering performances by “male or female impersonators” that met existing standards for material harmful to minors. A first violation was a Class A misdemeanor and repeat offenses a Class E felony.10Tennessee General Assembly. Senate Bill 0003
The law was signed in March 2023 and never meaningfully took effect. U.S. District Judge Thomas Parker struck it down before its April 1, 2023, effective date, ruling that it violated the First Amendment and separation-of-powers principles. The judge found the law overly broad, capable of sweeping in protected expression in nearly any public space, and said its “predominant concerns involved the suppression of unpopular views.” He also noted that existing Tennessee obscenity statutes already covered most of the conduct the new law targeted. As of 2026, this law is not enforceable.
Federal Rules That Now Overlap With Tennessee’s
A January 20, 2025, executive order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” directed federal agencies to define sex as an immutable biological classification of male or female, to stop communications that “promote or otherwise inculcate gender ideology,” and to offer only male or female options on agency forms.11The White House. Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government
Several changes followed. The Department of Education’s April 2024 rule expanding Title IX to cover gender identity was vacated by a federal court in January 2025, returning the regulations nationwide to their 2020 form; the court held that the Department had exceeded its authority. In January 2026, the EEOC voted to rescind its 2024 guidance that had classified intentional misgendering and denial of gender-affirming bathroom access as workplace harassment under Title VII. The Department of Health and Human Services rescinded its guidance interpreting Section 1557 of the Affordable Care Act to cover gender identity discrimination.
One federal protection remains: the Supreme Court’s 2020 holding in Bostock v. Clayton County that firing or refusing to hire someone simply for being gay or transgender violates Title VII. Federal courts can still find that specific forms of harassment violate Title VII regardless of current agency guidance.
Passports and Social Security
The executive order also directed the State Department and Department of Homeland Security to require that passports, visas, and Global Entry cards reflect the holder’s sex assigned at birth. The “X” gender marker option previously available for passports has been removed. Documents already issued with a gender identity marker or X designation remain valid until they expire or are replaced, but any renewal or reissuance will reflect biological sex at birth.11The White House. Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government The Social Security Administration no longer permits changes to sex designations on Social Security records. Name changes are still available through the standard Form SS-5 process with proper documentation, but the sex marker stays as it appears in existing records. For Tennessee residents, state-level and federal-level identity documents now operate under functionally identical rules.