By Sol Lilman
On June 18, 2025, the U.S. Supreme Court issued its decision in United States v. Skrmetti, upholding Tennessee’s Senate Bill 1 (SB1) – a law banning gender-affirming medical care, including hormone-replacement therapy and puberty blockers, for transgender minors. The 6–3 decision allows states to criminalize care when used to treat gender dysphoria, the distress caused when a person’s gender identity differs from their sex assigned at birth. AU denounced the decision as a nod to Christian Nationalists who want to legislate a narrow, religious view of gender.
The ultra-conservative justices’ decision argued the law does not draw distinctions based on sex, which would require it to undergo rigorous judicial scrutiny. Instead, it said SB1 only draws distinctions, and therefore regulates treatment, based on different medical diagnoses – gender dysphoria or something else. However, Justice Sonia Sotomayor, in her dissent, argued otherwise and said the law draws sex-based distinctions that are impermissible under the Equal Protection Clause of the Fourteenth Amendment. This attack on transgender youth follows a long legacy of intolerance and Christian Nationalism in the United States.
Christian Nationalism is an ideology that distorts Christian beliefs and the history of our country’s founding to assert the United States is a Christian nation and that our laws and policies must favor Christians. It implies that those who do not hold these values threaten an ideal moral and political order.
Christian Nationalism grew in prominence in the 1950s in part due to a campaign by corporations to undermine public support for President Franklin D. Roosevelt’s New Deal programs. Corporate interests partnered with conservative Christian leaders to frame unregulated capitalism as divinely sanctioned and the New Deal as un-American. This marked a turning point: religion was strategically merged with economic ideology. Christianity was now being positioned not just as a private faith but a political identity deserving state protection. (Read Bruce Gourley’s recent piece in AU’s Church & State magazine for more on this.)
By the 1960s and ’70s, Christian Nationalists emphasized the nuclear family as the ideal American unit and symbol of order. This was a reactionary response to progressive social movements and legal wins: the Civil Rights era, gay liberation, feminism, Green v. Connally (1971), which denied tax exemptions to segregated schools, and Roe v. Wade (1973), which protected abortion rights.
Organizing under the idea of “family values,” Christian Nationalists built “a political agenda that saw in the nuclear family the solution to social problems and the foundation of the nation.” Those who did not conform – predominantly queer and trans people, people of color, and people with nontraditional family structures – were further marginalized. The LGBTQ+ community was pathologized, demonized in the media, and excluded from jobs, housing, and public life. Systemic racism and mass incarceration destabilized communities of color, whose family structures were deemed illegitimate by Christian Nationalists. In the 1980s, campaigns advocated for so-called ideal natural families, targeting feminists, LGBTQ+ individuals, and sex educators as immoral elites in the process. There was a consolidation of social and political power by shaping law and public opinion to impose a social order that reflected one narrow set of religious beliefs.
This history still influences today’s political landscape. Transgender youth, as they grow in visibility, have become a target. Throughout this evolution, Christian Nationalists have maintained a false narrative in which they are protectors of order and marginalized because of their beliefs. They claim their liberties and traditional values are under threat from “gender ideology” and “radical gender theory.” They frame themselves as defenders of children, religious freedom, and traditional families against seemingly harmful, progressive agendas. In this narrative, transgender people are seen as threats because they destabilize the gender binary and nuclear family – pillars of the Christian Nationalist vision for America. Overall, the targeting of transgender youth follows the same guidebook against LGBTQ+ individuals in the past: creating moral panic and encouraging populism to gain political power.
The Christian Nationalist vision demands state enforcement, and policies like Tennessee’s SB1 are one way it is being realized. SB1 prohibits gender-affirming care when it conflicts with a child’s sex assigned at birth, effectively criminalizing medical treatment for trans youth. Though it claims to regulate the treatment available for a medical diagnosis – gender dysphoria – it punishes youth for not conforming to traditional gender norms.
To understand why this is transphobic, consider how gender distress is interpreted. A cisgender girl distressed by facial hair might receive medical treatment with little to no protest because she can potentially achieve normative femininity. If a cisgender boy were to seek the same care, his feelings might be pathologized as “gender dysphoria” because it defies normative masculinity. Treatments that accomplish the same medical result are prohibited if used to treat gender dysphoria for transgender children but allowed for cisgender children who want to affirm their gender assigned at birth. This double standard reveals the law’s real target: not the diagnosis but the defiance of gender norms.
Despite being masked in clinical or neutral language, SB1 legalizes discrimination. It denies life-saving care to transgender youth and reinforces oppressive gender roles by punishing nonconformity. These laws do not exist in isolation. In fact, Little v. Hecox and West Virginia v. B.P.J. are two cases about transgender athletes already set for hearing in the Supreme Court’s 2025-2026 term. These decisions are being celebrated by Christian Nationalists as moral victories, even when laws make no explicit reference to religion. Many Christian Nationalists described the Skrmetti decision as a “victory,” pointing to a much larger agenda: the tightening grip of the Christian Nationalist movement on public life and law.
Now is not the time for silence. This decision is part of a broader movement to use political power over people’s bodies, families, and lives. We must organize and join Americans United for Separation of Church and State’s fight to resist this agenda and protect the rights of transgender youth.
Sol Lilman is an outreach and legal intern with Americans United.
