Justice Sotomayor, with whom Justice Jackson joins, and with whom Justice Kagan joins as to all but Part V, dissenting.

To give meaning to our Constitution’s bedrock equal protection guarantee, this Court has long subjected to heightened judicial scrutiny any law that treats people differently based on sex. See United States v. Virginia, 518 U. S. 515, 533 (1996). If a State seeks to differentiate on that basis, it must show that the sex classification “serves important governmental objectives and that the discriminatory means employed are substantially related to the achievement of those objectives.” Ibid. (internal quotation marks omitted). Such review (known as intermediate scrutiny) allows courts to ascertain whether the State has a sound, evidence-based reason to distinguish on the basis of sex or whether it does so in reliance on impermissible stereotypes about the sexes.

Today, the Court considers a Tennessee law that categorically prohibits doctors from prescribing certain medications to adolescents if (and only if) they will help a patient “identify with, or live as, a purported identity inconsistent with the minor’s sex.” Tenn. Code Ann. §68–33–103(a)(1)(A) (2023). In addition to discriminating against transgender adolescents, who by definition “identify with” an identity “inconsistent” with their sex, that law conditions the availability of medications on a patient’s sex. Male (but not female) adolescents can receive medicines that help them look like boys, and female (but not male) adolescents can receive medicines that help them look like girls.

Tennessee’s law expressly classifies on the basis of sex and transgender status, so the Constitution and settled precedent require the Court to subject it to intermediate scrutiny. The majority contorts logic and precedent to say otherwise, inexplicably declaring it must uphold Tennessee’s categorical ban on lifesaving medical treatment so long as “‘any reasonably conceivable state of facts’” might justify it. Ante, at 21. Thus, the majority subjects a law that plainly discriminates on the basis of sex to mere rational-basis review. By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent.

I

A

Begin with the medical context in which Tennessee’s law operates. See Tenn. Code Ann. §68–33–101 et seq.; see also S. B. 1, 113th Gen. Assem., 1st Extra. Sess. (2023) (SB1). Doctors in the United States prescribe hormones and puberty inhibitors to treat a range of medical conditions. Often, they are administered to help minors conform to the typical appearance associated with their sex identified at birth. Sotomayor utilizes the phrase "identified at birth" throughout her dissent, where "assigned at birth" is the more correct term. However, as this is the phrase used by the majority, perhaps its use here has a purpose. Children who start experiencing puberty at a premature age (precocious puberty), for example, have long received puberty-delaying medications to stave off puberty until adolescence. See App. 22. Adolescent boys might also receive the hormone testosterone to initiate puberty delayed beyond its typical start. App. to Pet. for Cert. 266a. Without testosterone, puberty would “eventually initiate naturally” in most patients, but medication “is often prescribed to avoid some of the social stigma that comes from undergoing puberty later than one’s peers.” Ibid. Adolescent females with delayed puberty may receive the hormone estrogen for the same reason. Ibid.

After puberty begins, doctors may prescribe these same medicines to adolescents whose physical appearance does not align with what one might expect from their sex identified at birth. An adolescent female, for example, might receive testosterone suppressors and hormonal birth control to reduce the growth of unwanted hair on her face or body (sometimes called male-pattern hair growth or hirsutism). See ibid.; see also App. 100 (“[M]edications that are used to suppress testosterone can be used to address symptoms of polycystic ovarian syndrome, which can include unwanted facial hair and body hair, excessive sweating, and body odor”); Brief for Experts on Gender Affirming Care as Amici Curiae 12 (describing the prevalence of hirsutism in people identified as female at birth).¹ An adolescent male may also receive hormones to address a benign but atypical increase in breast gland tissue (known as gynecomastia), sometimes resulting from below-average testosterone levels. See, e.g., G. Kanakis et al., EAA Clinical Practice Guidelines—Gynecomastia Evaluation and Management, 7 Andrology 778, 779–780 (2019). Like any medical treatment, hormones and puberty blockers come with the potential for side effects. See, e.g., App. to Pet. for Cert. 266a–267a; App. 970–974; Brief for United States 45–46. Yet patients and their parents may decide to proceed with treatment on the advice of a physician, despite the accompanying medical risks.

Physicians prescribe these same medications to transgender adolescents, whose gender identity is inconsistent with their sex identified at birth. Hormones and puberty blockers help align transgender adolescents’ physical appearance with their gender identity, as they do when prescribed to adolescents who want to align their appearances with their sex identified at birth. The same puberty suppressants prescribed to pause the onset of precocious puberty can pause puberty for transgender adolescents, giving them “time to further understand their gender identity.” App. to Pet. for Cert. 256a.

Hormone therapy later allows transgender teens to initiate puberty consistent with their gender identity. That typically involves testosterone for adolescent transgender boys (who were identified as female at birth) and testosterone suppression and estrogen for adolescent transgender girls (who were identified as male at birth). Such treatments help adolescents identified as female at birth look more masculine and those identified as male at birth look more feminine. As is true for most medical treatment for minors, puberty blockers and hormones should be administered only after a comprehensive and individualized risk-benefit assessment, and with parental consent. See American Medical Association, Code of Medical Ethics, 2.2.1 Pediatric Decision Making (2022); E. Coleman et al., Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, 23 Int’l J. Transgender Health S1, S58 (2022).²

Transgender adolescents’ access to hormones and puberty blockers (known as gender-affirming care) is not a matter of mere cosmetic preference. To the contrary, access to care can be a question of life or death. Some transgender adolescents suffer from gender dysphoria, a medical condition characterized by clinically significant and persistent distress resulting from incongruence between a person’s gender identity and sex identified at birth. App. to Pet. for Cert. 251a–252a. If left untreated, gender dysphoria can lead to severe anxiety, depression, eating disorders, substance abuse, self-harm, and suicidality. See, e.g., Coleman, 23 Int’l J. Transgender Health, at S62. Suicide, in particular, is a major concern for parents of transgender teenagers, as the lifetime prevalence of suicide attempts among transgender individuals may be as high as 40%.App. to Pet. for Cert. 264a. Tragically, studies suggest that as many as one-third of transgender high school students attempt suicide in any given year.³

When provided in appropriate cases, gender-affirming medical care can meaningfully improve the health and wellbeing of transgender adolescents, reducing anxiety, depression, suicidal ideation, and (for some patients) the need for more invasive surgical treatments later in life.⁴ That is why the American Academy of Pediatrics, American Medical Association, American Psychiatric Association, American Psychological Association, and American Academy of Child Adolescent Psychiatry all agree that hormones and puberty blockers are “appropriate and medically necessary” to treat gender dysphoria when clinically indicated. Id., at 285a.⁵

B

Tennessee has taken a different tack. The State enacted SB1 to categorically prohibit physicians from prescribing puberty blockers and hormone therapy for the purpose of treating gender dysphoria in minors. Tennessee’s blanket ban applies only when hormones and puberty blockers are prescribed to “[e]nabl[e] a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or to alleviate “discomfort or distress from a discordance between the minor’s sex and asserted identity.” Tenn. Code Ann. §68–33–103(a)(1). SB1 leaves untouched the use of the same drugs to treat any other medical condition, including delayed (or early) puberty and any other “physical or chemical abnormality present in a minor that is inconsistent with the normal development of a human being of the minor’s sex.” §68–33–102(1). In other words, SB1 allows physicians to help align adolescents’ physical appearance with their gender identity (despite associated risks) if it is consistent with their sex identified at birth, but not if inconsistent. Indeed, Tennessee’s stated interests in SB1 include “encouraging minors to appreciate their sex.” §68–33–101(m).

C

Tennessee’s ban applies no matter what the minor’s parents and doctors think, with no regard for the severity of the minor’s mental health conditions or the extent to which treatment is medically necessary for an individual child. The stories of the plaintiffs in this case reflect the stakes of that harsh reality.

Ryan Roe, now 16, felt as early as elementary school that he “was a boy.” App. to Pet. for Cert. 234a. Before puberty,Ryan thought “there wasn’t that much of a difference between boys and girls” and that he “could manage existing in the middle.” Ibid. As puberty approached, however, Ryan grew increasingly anxious about the impending changes to his body. He started throwing up every morning before school. As his voice changed, Ryan contemplated going mute. Id., at 235a. Eventually, after two years of psychotherapy and extensive consultations with his parents and doctors, Ryan’s physicians prescribed him testosterone. Ryan began to find his voice again. He started raising his hand in class, participating in school, and looking at himself in the mirror. Ryan attests that “[g]ender-affirming health care saved [his] life.” Id., at 234a. For Ryan’s parents, “[i]t is simply not an option to cut [him] off from this care.” Id., at 246a. “I worry about his ability to survive,” Ryan’s mother attests. “[L]osing him would break me.” Ibid.

L. W., too, began to question her gender as early as fourth grade. At the time, she felt like she was “drowning” and “trapped in the wrong body,” often sick at school because she “did not feel comfortable using the boy’s bathroom.” Id., at 223a. At age 13, L. W. and her parents sought out medical treatment. Puberty blockers and estrogen, prescribed to L. W. after consultation with her parents and doctors, changed her life. “We have a confident, happy daughter now, who is free to be herself,” her mom explains. App. 85. “As a mother, I could not bear watching my child go through physical changes that would destroy her well-being and cause her life-long pain.” Id., at 86.

Echoing a similar refrain, John Doe and his family attest that John felt from an early age he was a boy. He chose a male name for himself around the age of three. As puberty approached, John grew terrified of undergoing what he saw as “the wrong puberty,” recognizing that “some of those changes could be permanent.” App. to Pet. for Cert. 232a. After years of psychotherapy, he began taking puberty-delaying medication. His mother, who “shed many tears during the first year” of this process, acknowledges that “John’s gender transition has not been easy.” App. 95. Yet she attests that John’s access to medical treatment is “the one thing” that gives her hope that he can “have a fulfilling life.” Id., at 94.

D

Faced with the choice between leaving Tennessee in search of treatment and risking their children’s lives, Ryan, John, L. W., and their parents sued to enjoin SB1. The United States intervened in support.⁶ Together, they argued that SB1 unconstitutionally discriminates on the basis of sex and transgender status. After review of the factual record, the District Court agreed, holding that the law would likely fail intermediate scrutiny because its targeted ban on promoting inconsistency with sex was not substantially related to Tennessee’s asserted interest in protecting minors from dangerous medical procedures. L. W. v. Skrmetti, 679 F. Supp. 3d 668, 710 (MD Tenn. 2023).

A divided panel of the Sixth Circuit reversed. All three judges appeared to “accept the premise” that “the statut[e] treat[s] minors differently based on sex.” L. W. v. Skrmetti, 83 F. 4th 460, 481 (2023); see also id., at 484 (“[T]he necessity of heightened review . . . will not be present every time that sex factors into a government decision”). Yet the majority refused to apply intermediate scrutiny because it believed that the law did not necessarily “disadvantage ‘persons’ based on their sex.” Id., at 483. Because the Sixth Circuit never applied intermediate scrutiny to SB1, the only question this Court must decide is whether the Constitution required it to do so.

II

A

The level of constitutional scrutiny courts apply in reviewing state action is enormously consequential. Where a state law neither “proceeds along suspect lines nor infringes fundamental constitutional rights,” reviewing courts generally uphold a challenged law under the Equal Protection Clause so long as “any reasonably conceivable state of facts . . . could provide a rational basis for the classification.” FCC v. Beach Communications, Inc., 508 U. S. 307, 313 (1993). That lenient standard, which the majority erroneously applies today, demands hardly more than a cursory glance at the State’s reasons for legislating.

This Court has long recognized, however, that a more “searching” judicial review is warranted when the rights of “discrete and insular minorities” are at stake. United States v. Carolene Products Co., 304 U. S. 144, 153, n. 4 (1938). Because such minorities often face systemic barriers to vindicating their interests through the political process, courts have a comparative advantage over the elected branches in safeguarding their rights. Ibid. Such judicial scrutiny is at its apex in reviewing laws that classify on the basis of race and national origin. States may not enact laws that classify on those bases unless they can pass through the “daunting two-step examination known in our cases as ‘strict scrutiny.’” Students for Fair Admissions, Inc. v. President and Fellows of Harvard College, 600 U. S. 181, 206 (2023); see id., at 206–207 (“Under that standard we ask . . . whether the racial classification is used to ‘further compelling governmental interests’” and then “whether the government’s use of race is ‘narrowly tailored—meaning ‘necessary’—to achieve that interest”).

For nearly half a century, the Court has applied a different standard, known as intermediate scrutiny, to all “statutory classifications that distinguish between males and females.” Nevada Dept. of Human Resources v. Hibbs, 538 U. S. 721, 728 (2003); see Craig v. Boren, 429 U. S. 190, 197–199 (1976). States can differentiate on the basis of sex only to “‘serv[e] important governmental objectives’” and only if the sex classification is “‘substantially related to the achievement of those objectives.’” Hibbs, 538 U. S., at 728. The standard is an intermediate one because it strikes an important balance. On the one hand, there are some genuine “[p]hysical differences between men and women,” so not all sex-based legislation is discriminatory or constitutionally proscribed. Virginia, 518 U. S., at 533. On the other hand, sex-based legislation always presents a serious risk of invidious discrimination that relies on “overbroad generalizations about the different talents, capacities, or preferences of males or females.” Ibid. Intermediate scrutiny is the core judicial tool to differentiate innocuous sex-based laws from discriminatory ones.

B

SB1 plainly classifies on the basis of sex, so the Constitution demands intermediate scrutiny. Recall that SB1 prohibits the prescription of hormone therapy and puberty blockers only if done to “enable a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or to alleviate “discomfort or distress from a discordance between the minor’s sex and asserted identity.” Tenn. Code Ann. §68–33–103(a)(1). Use of the same drugs to treat any other “‘disease’” is unaffected. §68–33–103(b)(1)(A). Physicians may continue, for example, to prescribe hormones and puberty blockers to treat any “physical or chemical abnormality present in a minor that is inconsistent with the normal development of a human being of the minor’s sex.” §68–33–102(1).

What does that mean in practice? Simply that sex determines access to the covered medication. Physicians in Tennessee can prescribe hormones and puberty blockers to help a male child, but not a female child, look more like a boy; and to help a female child, but not a male child, look more like a girl. Put in the statute’s own terms, doctors can facilitate consistency between an adolescent’s physical appearance and the “normal development” of her sex identified at birth, but they may not use the same medications to facilitate “inconsisten[cy]” with sex. All this, the State openly admits, in service of “encouraging minors to appreciate their sex.” §68–33–101(m).

Like any other statute that turns on inconsistency with a protected characteristic, SB1 plainly classifies on the basis of sex. A simple analogy illustrates the point. Suppose Tennessee prohibited minors from attending “‘any services, rituals, or assemblies if done for the purpose of allowing the minor to identify with a purported identity inconsistent with the minor’s religion.’” Brief for Yale Philosophers as Amici Curiae 10. No one would seriously dispute that such a rule classifies on the basis of religion. Whether the law prohibits a minor from attending any particular religious service turns on the minor’s religion: A Jewish child can visit a synagogue but not a church, while a Christian child can attend church but not the synagogue.

SB1 operates in the same way. Consider the mother who contacts a Tennessee doctor, concerned that her adolescent child has begun growing unwanted facial hair. This hair growth, the mother reports, has spurred significant distress because it makes her child look unduly masculine. The doctor’s next step depends on the adolescent’s sex. If the patient was identified as female at birth, SB1 allows the physician to alleviate her distress with testosterone suppressants. See App. to Pet. for Cert. 266a (describing such treatments); App. 100 (same). What if the adolescent was identified male at birth, however? SB1 precludes the patient from receiving the same medicine.

Now consider the parents who tell a Tennessee pediatrician that their teenage child has been experiencing an unwanted (but medically benign) buildup of breast gland tissue. See supra, at 3. Again, the pediatrician’s next move depends on the patient’s sex. Identified male at birth? SB1 allows the physician to prescribe hormones to reduce the buildup of such tissue. Yet a child identified as female at birth experiencing the same (or more) distress must be denied the same prescription. In both scenarios, SB1 “provides that different treatment be accorded to [persons] on the basis of their sex,” and therefore necessarily “establishes a classification subject to scrutiny under the Equal Protection Clause.” Reed v. Reed, 404 U. S. 71, 75 (1971).⁷ The Sixth Circuit apparently agreed. 83 F. 4th, at 481 (accepting the premise that “the statut[e] treat[s] minors differently based on sex”).

Tennessee, too, essentially concedes the point. It admits that a prohibition on wearing clothing “‘inconsistent with’” the wearer’s sex would trigger intermediate scrutiny, as would a law prohibiting professionals from working in jobs “‘inconsistent with’” their sex. Brief for Respondents 25. That is because for some jobs and some outfits, “a male can have the job” or wear the outfit, “and a female cannot.” Ibid. SB1 draws exactly the same kind of sex-based line: For some treatments that help adolescents look and feel more masculine, a male minor can have the treatment, and a female minor cannot.⁸

That SB1 conditions a patient’s access to treatment even in part on her sex is enough to trigger intermediate scrutiny. This Court’s equal protection precedents ask only whether a law “differentiates on the basis of gender.” Sessions v. Morales-Santana, 582 U. S. 47, 58 (2017). If so, the law “attract[s] heightened review under the Constitution’s equal protection guarantee.” Ibid. A long line of this Court’s equal protection precedents confirms that much.See Hibbs, 538 U. S., at 728 (“[S]tatutory classifications that distinguish between males and females are subject to heightened scrutiny”); Virginia, 518 U. S., at 531 (“Parties who seek to defend gender-based government action must demonstrate an ‘exceedingly persuasive justification’ for that action”); J. E. B. v. Alabama ex rel. T. B., 511 U. S. 127, 136 (1994) (“[A]ll gender-based classifications today” “warran[t] . . . heightened scrutiny”). That is why an Alabama statute that “authoriz[es] the imposition of alimony obligations on husbands, but not on wives,” “‘establishes a classification subject to scrutiny under the Equal Protection Clause’”: The plaintiff, “Mr. Orr[,] bears a burden he would not bear were he female.” Orr v. Orr, 440 U. S. 268, 273, 278 (1979).

This Court’s decision in Bostock v. Clayton County, 590 U. S. 644 (2020), confirms the classification on SB1’s face. As Bostock explained in the context of Title VII’s prohibition on employment discrimination, “it is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex.” Id., at 660. In deciding that discrimination based on incongruence between sex and gender identity was discrimination “because of sex,” Bostock asked the very same question our equal protection precedents do: whether “changing the employee’s sex would have yielded a different choice by the employer.” Id., at 659–660; cf. Students for Fair Admissions, Inc., 600 U. S., at 231 (applying strict scrutiny to government actions that treat people differently “on the basis of race”).⁹ The answer was clearly yes, for the simple reason that discrimination against transgender employees necessarily “penalizes a person identified as male at birth for traits or actions that it tolerates in an employee identified as female at birth.” Bostock, 590 U. S., at 660. Nor was it a defense to liability that the discrimination might apply equally to both sexes: “[A]n employer who fires a woman, Hannah, because she is insufficiently feminine and also fires a man, Bob, for being insufficiently masculine” in both cases “fires an individual in part because of sex.” Id., at 659. The same is true of SB1. By depriving adolescents of hormones and puberty blockers only when such treatment is “inconsistent with” a minor’s sex, the law necessarily deprives minors identified as male at birth of the same treatment it tolerates for an adolescent identified as female at birth (and vice versa).

III

Notwithstanding that SB1 distinguishes between males and females in the medical treatments it authorizes, the Sixth Circuit declined to apply intermediate scrutiny. It believed SB1’s treatment of both sexes to be “evenhande[d],” 83 F. 4th, at 479, meaning (in the panel’s judgment) the classifications were not “invidious” or “unfai[r].” Id., at 483–484. Intermediate scrutiny, of course, is how this Court determines whether a particular sex-based classification is invidious or unfair. See, e.g., Virginia, 518 U. S., at 531. The Sixth Circuit thus effectively held that intermediate scrutiny did not apply to SB1 because it thought SB1 might well pass such scrutiny. Even the majority today does not endorse this circular approach.¹⁰

Though it skirts the Sixth Circuit’s error, the majority rests its conclusion on an equally implausible ground: that SB1’s prohibition on treatments “inconsistent with [a] minor’s sex” contains no sex classification at all. Tenn. Code Ann. §68–33–103(a)(1). As the statute’s text itself makes clear, that conclusion is indefensible.

A

How does the majority wriggle itself (and the Sixth Circuit) free of any obligation to take a closer look? It abstracts away the sex classification on SB1’s face, asserting that the law classifies based only on “age” and “medical purpose.” The theory, apparently, is that SB1 is sex neutral because it simply allows doctors to “administer puberty blockers or hormones to minors to treat certain conditions but not to treat gender dysphoria.” Ante, at 9. Unlike a law that prohibits attendance at a religious service “inconsistent with” the attendee’s religion, the majority says, “[a] law prohibiting the administration of specific drugs for particular medical uses” simply does not trigger heightened scrutiny. Ante, at 14.

The problem with the majority’s argument is that the very “medical purpose” SB1 prohibits is defined by reference to the patient’s sex. Key to whether a minor may receive puberty blockers or hormones is whether the treatment facilitates the “medical purpose” of helping the minor live or appear “inconsistent with” the minor’s sex. That is why changing a patient’s sex yields different outcomes under SB1. Again, take the adolescent distressed by newly developing facial hair. Was the patient identified female at birth? SB1 authorizes the prescription of medication. Male at birth? SB1 prohibits it.

For truly sex-neutral laws, it is impossible to imagine a single scenario where changing a patient’s sex yields a different result. To borrow from the majority’s catalog of apparently benign medical-use distinctions, imagine Tennessee allowed consumption of DayQuil to ease coughs, but not minor aches and pains. See ante, at 12. The regulated medical purposes (treatment of coughs, aches, and pains) are unrelated to sex, so a patient’s sex will never determine whether she can consume DayQuil. All that matters is whether the patient has a cough.

So too for New York’s ban on assisted suicide, which the majority equates to SB1. Ante, at 10. In Vacco v. Quill, 521 U. S. 793 (1997), this Court subjected the assisted-suicide ban to rational-basis review because it neither “treat[ed] anyone differently from anyone else” nor “dr[ew] any distinctions between persons.” Id., at 800. In New York, the Court explained, “[e]veryone” can “refuse unwanted lifesaving medical treatment” and “no one is permitted to assist a suicide.” Ibid. Yet unlike for SB1, neither sex nor any other protected characteristic distinguished the terminally ill patient who could permissibly “‘hasten death’” from another prohibited from doing so. Id., at 800–801. All that mattered was the patient’s existing connection to life-support systems: Those connected could lawfully hasten death by discontinuing treatment, while others (who required a prescription for lethal medication to do so) could not. The patient’s sex (or race, or national origin) would never decide the outcome. SB1, by contrast, renders every treatment decision it regulates dependent on two things: a minor’s sex identified at birth, and the consistency of the requested treatment with that sex.

That the majority finds a way to recast SB1 in sex neutral terms is no evidence that SB1 is sex neutral in the way hypothetical prohibitions on DayQuil or assisted suicide would be. Contra, ante, at 14. The majority emphasizes that, in Tennessee, “no minor may be administered puberty blockers or hormones to treat gender dysphoria,” while “minors of any sex may be administered puberty blockers or hormones for other purposes.” Ante, at 13. But nearly every discriminatory law is susceptible to a similarly race- or sex-neutral characterization. A prohibition on interracial marriage, for example, allows no person to marry someone outside of her race, while allowing persons of any race to marry within their races. See Loving v. Virginia, 388 U. S. 1, 9 (1967).¹¹ The same is true of a hypothetical law prohibiting attendance at services “inconsistent with” a child’s religion, while allowing all children to attend religion-consistent services. See supra, at 11. Indeed, the majority itself seems to recognize that laws prohibiting professions “inconsistent” with a person’s sex, marriages “inconsistent” with a person’s race, or religious services “inconsistent” with a person’s faith must be subject to heightened review, even if rewritten as ostensibly neutral prohibitions on sex-, race-, and faith-inconsistent behavior. See ante, at 13–14. And although the majority insists that its logic would not apply to the hypothetical religion-consistent services law, ante, at 14, it offers no principled reason to differentiate that law from SB1’s prohibition on promoting “inconsisten[cy] with” the patient’s sex.

B

Recognizing, perhaps, that this Court already decided in Bostock that discrimination based on incongruence between sex and gender identity was itself discrimination “because of sex,” the majority seeks to distinguish Bostock away. Unlike in Bostock, the majority urges, “changing a minor’s sex or transgender status does not alter the application of SB1.” Ante, at 19. Again, it emphasizes that no “medical treatment” under SB1 is actually doled out on the basis of sex, because (it says) medical “treatment” necessarily encompasses “both a given drug and the specific indication for which it is being administered.” Ante, at 12–13, 18–19. The majority’s logic is as follows: “If a transgender boy [who was identified as female at birth] seeks testosterone to treat his gender dysphoria, SB1 prevents a healthcare provider from administering it to him.” Ante, at 19. “If you change his biological sex from female to male,” the majority says, “SB1 would still not permit him the hormones he seeks because he would lack a qualifying diagnosis for the testosterone—such as a congenital defect, precocious puberty, disease, or physical injury.” Ibid.

As should be abundantly clear by this point, the majority’s recharacterization of SB1 is impossible to reconcile with the statute’s plain terms. SB1 allows physicians to prescribe hormones and puberty blockers to treat not just some defined category of cancers and rashes, but any “physical or chemical abnormality present in a minor that is inconsistent with the normal development of a human being of the minor’s sex.” §68–33–102(1). If a minor has some physical “abnormality” (say, medically benign facial hair) typically perceived as “inconsistent” with her sex identified at birth (female), SB1 deems it a “congenital defect” that physicians can treat. Change the patient’s sex from female to male, and the law now forbids providing the same drugs to rid the minor of the same facial hair. In other words, SB1 makes explicit that the very reason why a doctor can treat an adolescent female for “hirsutism (male-pattern hair growth),” but not gender dysphoria is that the former will promote consistency with sex, while the latter does the opposite. Cf. ante, at 20 (majority opinion). As was true in Bostock, then, the law deprives minors of medical treatment based, in part, on sex.

To be sure, when the hypothetical minor is male, not female, the patient’s diagnosis may well change too: The female adolescent distressed by facial hair might receive a diagnosis of hirsutism while the male adolescent may be diagnosed with gender dysphoria. See supra, at 3, 11; see also ante, at 20 (majority opinion). The same, however, was true in Bostock. When an employer fires an employee because she is transgender, the Court explained, “two causal factors may be in play”: the individual’s sex and the sex “with which the individual identifies.” 590 U. S., at 661. Yet so long as the plaintiff ’s sex is “one but-for cause of that decision,” the employer discriminates on the basis of sex. Id., at 656. So too with SB1. Sex and diagnosis may both “be in play.” Id., at 661. As long as sex is one of the law’s distinguishing features, however, the law classifies on the basis of sex, and the Equal Protection Clause requires application of intermediate scrutiny.

C

In a final bid to avoid applying our equal protection precedents, the majority asserts that “mere reference to sex” is insufficient to trigger intermediate scrutiny, especially in the “medical context.” Ante, at 10. Of course, not every legislative mention of sex triggers intermediate scrutiny. A law mandating that no person, “regardless of sex,” can consume a dangerous drug, for example, would be subject to rational-basis review. Yet SB1 does not just mention sex. It defines an entire category of prohibited conduct based on inconsistency with sex. And it is hard to imagine a law that prohibits conduct “inconsistent with” sex that could avoid intermediate scrutiny.

Nor does the fact that SB1 concerns the “medical context” change the relevant analysis. Ibid. No one disputes that “[s]ome medical treatments and procedures are uniquely bound up in sex” or that there are “biological differences between men and women.” Ibid. That there are such physical differences is, after all, one of the reasons why sex is not altogether a proscribed classification. See Virginia, 518 U. S., at 533. A law that allowed only women to receive certain breast cancer treatments, for example, might well be consistent with the Constitution’s equal protection mandate if the State establishes that the relevant treatments are suited to women’s (and not men’s) bodies. Cf. ante, at 11 (noting “‘many’ breast cancer treatments [are] approved for women only”). Laws that differentiate based on biological distinctions between men and women are precisely the sort that States might successfully defend under intermediate scrutiny. Biological differences between the sexes, however, are no reason to skirt such scrutiny altogether.

Fashioning a medical-context-only exception also runs counter to decades of equal protection precedents. This Court has clarified that, although not every sex-based distinction is “marked by misconception and prejudice,” Tuan Anh Nguyen v. INS, 533 U. S. 53, 73 (2001), every sex-based distinction does warrant intermediate scrutiny. See J. E. B., 511 U. S., at 136 (“[A]ll gender-based classifications today” “warran[t] . . . heightened scrutiny” (emphasis added)).

Take, for example, Tuan Anh Nguyen, where this Court assessed the constitutionality of a law imposing one set of citizenship-acquisition requirements on children born abroad out of wedlock to U. S. citizen mothers and another on those born of U. S. citizen fathers. 533 U. S., at 60. The Court ultimately decided that the “different set of rules” for fathers and mothers was “neither surprising nor troublesome from a constitutional perspective” because “[f]athers and mothers are not similarly situated with regard to the proof of biological parenthood.” Id., at 63. We reached that conclusion, however, only after demanding of the Government an explanation for why that sex classification “‘serve[d] “important governmental objectives”’” and how “‘“the discriminatory means employed” [were] “substantially related to the achievement of those objectives.”’” Id., at 60 (quoting Virginia, 518 U. S., at 533). In no sense did the biological differences between the sexes relieve courts of the obligation to examine the sex classification with a careful constitutional eye. Nor is any medical-context exception necessary because intermediate scrutiny itself allows the State to maintain classifications where justified by biology.

IV

Having blithely dispensed with the notion that SB1 classifies on the basis of sex, the majority next asserts that “SB1 does not classify on the basis of transgender status.” Ante, at 16. That too is contrary to the statute’s text and plainly wrong.

SB1 prohibits Tennessee physicians from offering hormones and puberty blockers to allow a minor to “identify with” a gender identity inconsistent with her sex. Tenn. Code Ann. §68–33–103(a)(1)(A). Desiring to “identify with” a gender identity inconsistent with sex is, of course, exactly what it means to be transgender. The two are wholly coextensive. See Oxford English Dictionary (3d ed., Dec. 2023), https://www.oed.com/dictionary/transgender_adj (Transgender, when used as an adjective, means “a person whose sense of personal identity and gender does not correspond to that person’s sex at birth . . . ”). That is why it would defy common sense to suggest an employer’s policy of firing all persons identifying with or living as an identity inconsistent with their sex does not discriminate on the basis of transgender status.

Left with nowhere else to turn, the Court hinges its conclusion to the contrary on the by-now infamous footnote 20 of Geduldig v. Aiello, 417 U. S. 484 (1974), which declared that discrimination on the basis of pregnancy is not discrimination on the basis of sex. See id., at 496–497, n. 20. The footnote reasoned that, although “only women can become pregnant,” “[n]ormal pregnancy is an objectively identifiable physical condition with unique characteristics” and “lawmakers are constitutionally free to include or exclude pregnancy from the coverage of legislation . . . on any reasonable basis, just as with respect to any other physical condition.” Ibid. The takeaway, according to the majority, is that “not . . . every legislative classification concerning pregnancy is a sex-based classification,” and so (apparently) not every legislative classification concerning “gender incongruence” (at least in the context of medical treatments) classifies on the basis of transgender status. Id., at 496, n. 20.

Geduldig was “egregiously wrong” when it was decided, both “[b]ecause pregnancy discrimination is inevitably sex discrimination” and because discrimination against women is so “tightly interwoven with society’s beliefs about pregnancy and motherhood.” Coleman v. Court of Appeals of Md., 566 U. S. 30, 56–57 (2012) (Ginsburg, J., dissenting). That the majority must resuscitate so unpersuasive a source, widely rejected as indefensible even 40 years ago, is itself a telling sign of the weakness of its position. See S. Law, Rethinking Sex and the Constitution, 132 U. Pa. L. Rev. 955, 983 (1984) (“Criticizing Geduldig has . . . become a cottage industry”). That the Court today extends Geduldig’s logic for the first time beyond pregnancy and abortion is more troubling still. Divorced from its fact-specific context, Geduldig’s reasoning may well suggest that a law depriving all individuals who “have ever, or may someday, menstruate” of access to health insurance would be sex neutral merely because not all women menstruate.

In any event, even Geduldig’s faulty reasoning cannot save the majority’s conclusion that SB1 is innocent of transgender discrimination. Unlike pregnancy, a desire to “identify with, or live as, a purported identity inconsistent with [one’s] sex,” Tenn. Code Ann. §68–33–103(a)(1)(A), is not some “objectively identifiable physical condition” that legislatures can target without reference to sex or transgender status, Geduldig, 417 U. S., at 496, n. 20. And while not all women are pregnant, ibid., all transgender people, by definition, “identify with, or live as, a purported identity inconsistent with [their] sex,” Tenn. Code Ann. §68–33–103(a)(1)(A). So, unlike the classes of pregnant persons and women, the class of minors potentially affected by SB1 and transgender minors are one and the same.

That SB1 discriminates on the basis of transgender status is yet another reason it must be subject to heightened scrutiny. For one, this Court already decided in Bostock that “it is impossible to discriminate against a person for being . . . transgender without discriminating against that individual based on sex,” 590 U. S., at 660, and sex discrimination is of course subject to heightened scrutiny. Nor should there be serious dispute that transgender persons bear the hallmarks of a quasi-suspect class.¹² See Cleburne v. Cleburne Living Center, Inc., 473 U. S. 432, 441 (1985) (describing the standard).

Transgender people have long been subject to discrimination in healthcare, employment, and housing, and to rampant harassment and physical violence. See Grimm v. Gloucester Cty. School Bd., 972 F. 3d 586, 611 (CA4 2020) (detailing that history); see also K. Barry, B. Farrell, J. Levi, & N. Vanguri, A Bare Desire To Harm: Transgender People and the Equal Protection Clause, 57 B. C. L. Rev. 507, 556–557 (2016) (describing Congress’s exclusion of transgender people from the Fair Housing Act, Americans with Disabilities Act, and Rehabilitation Act). Individuals whose gender identity diverges from their sex identified at birth (whether labeled as “transgender” at the time or not), moreover, have been subject to a lengthy history of de jure discrimination in the form of cross-dressing bans, police brutality, and anti-sodomy laws. See, e.g., K. Redburn, Before Equal Protection: The Fall of Cross-Dressing Bans and the Transgender Legal Movement, 1963–86, 40 L. and Hist. Rev. 679, 685, 687 (2022); A. Lvovsky, Vice Patrol 29, 108 (2021); W. Eskridge, GayLaw: Challenging the Apartheid of the Closet 328–337 (1999) (cataloging state consensual sodomy laws, 1610–1988). Beginning in 1843, cities ranging from “major metropolitan centers such as Chicago and Los Angeles to small cities and towns including Cheyenne, Wyoming and Vermillion, South Dakota” enacted ordinances that (most commonly) criminalized any person “‘appear[ing] upon any public street or other public place . . . in a dress not belonging to his or her sex.’” Redburn, 40 L. and Hist. Rev., at 687. In any event, those searching for more evidence of de jure discrimination against transgender individuals, see ante, at 7–9 (BARRETT, J., concurring), need look no further than the present. The Federal Government, for example, has started expelling transgender servicemembers from the military and threatening to withdraw funding from schools and nonprofits that espouse support for transgender individuals.¹³

Transgender persons, moreover, have a defining characteristic (incongruence between sex and gender identity) that plainly “‘bears no relation to [the individual’s] ability to perform or contribute to society.’” Cleburne, 473 U. S., at 441. As a group, the class is no more “‘large, diverse, and amorphous,’” ante, at 4 (opinion of BARRETT, J.); ante, at 14 (Alito, J., concurring in part and concurring in judgment), than most races or ethnic groups, many of which similarly include individuals with “‘a huge variety’” of identities and experiences, ante, at 5 (opinion of BARRETT, J.). (Not all racial, ethnic, or religious minorities, for example, “‘carry an obvious badge’ of their membership in the disadvantaged class.” Cf. ante, at 16 (opinion of Alito, J.).)¹⁴ As evidenced by the recent rise in discriminatory state and federal policies and the fact that transgender people “are underrepresented in every branch of government,” Grimm, 972 F. 3d, at 611–613, moreover, the class lacks the political power to vindicate its interests before the very legislatures and executive agents actively singling them out for discriminatory treatment. See Lyng v. Castillo, 477 U. S. 635, 638 (1986). In refusing to say as much, the Court today renders transgender Americans doubly vulnerable to statesanctioned discrimination.¹⁵

V

SB1’s classifications by sex and transgender status clearly require the application of intermediate scrutiny. The majority’s choice instead to subject SB1 to rational-basis review, the most cursory form of constitutional review, is not only indefensible as a matter of precedent but also extraordinarily consequential. Instead of scrutinizing the legislature’s classifications with an eye towards ferreting out unconstitutional discrimination, the majority declares it will uphold Tennessee’s ban as long as there is “‘any reasonably conceivable state of facts that could provide a rational basis for the classification.’” Ante, at 21 (quoting Beach Communications, Inc., 508 U. S., at 313; emphasis added). That marks the first time in 50 years that this Court has applied such deferential review, normally employed to assess run-of-the-mill economic regulations, to legislation that explicitly differentiates on the basis of sex. As a result, the Court never even asks whether Tennessee’s sex-based classification imposes the sort of invidious discrimination that the Equal Protection Clause prohibits.

The majority says that it does not want to “second-guess the lines that SB1 draws,” ante, at 22, or to “resolve” disagreements about the safety and efficacy of “medical treatments in an evolving field,” ante, at 24. The concurrences, too, warn that applying intermediate scrutiny in this case may “require courts to oversee all manner of policy choices normally committed to legislative discretion,” including in “areas of legitimate regulatory policy . . . ranging from access to restrooms to eligibility for boys’ and girls’ sports teams.” Ante, at 5, 6 (opinion of BARRETT, J.); see also ante, at 4 (Thomas, J., concurring) (highlighting the potential for “‘high-cost, high-risk lawsuit[s]’”). Looking carefully at a legislature’s proffered reasons for acting, as our equal protection precedents demand, is neither needless “secondguess[ing],” ante, at 22 (majority opinion), nor judicial encroachment on “areas of legitimate regulatory policy,” ante, at 6 (opinion of BARRETT, J.). After all, “‘closely scrutiniz[ing] legislative choices’” is exactly how courts distinguish “legitimate regulatory polic[ies]” from discriminatory ones. Ibid.

Indeed, judicial scrutiny has long played an essential role in guarding against legislative efforts to impose upon individuals the State’s views about how people of a particular sex (or race) should live or look or act. Women, it was once thought, were not suited to attend military schools with men. Virginia, 518 U. S., at 520–523, 540–541. Men and women, others said, should not marry those of a different race. Loving, 388 U. S., at 4. Those laws, too, posed politically fraught and contested questions about race, sex, and biology. In a passage that sounds hauntingly familiar to readers of Tennessee’s brief, Virginia argued in Loving that, should this Court intervene, it would find itself in a “bog of conflicting scientific opinion upon the effects of interracial marriage, and the desirability of preventing such alliances, from the physical, biological, genetic, anthropological, cultural, psychological, and sociological point of view.” Brief for Appellee in Loving v. Virginia, O. T. 1966, No. 395, p. 7. “In such a situation,” Virginia continued, “it is the exclusive province of the Legislature of each State to make the determination for its citizens as to the desirability of a policy of permitting or preventing such [interracial] alliances—a province which the judiciary may not constitutionally invade.” Id., at 7–8.

This Court, famously, rejected the States’ invitation in Loving to “defer to the wisdom of the state legislature” based on assertions that “the scientific evidence is substantially in doubt.” 388 U. S., at 8. In considering the constitutionality of Virginia’s male-only military academy, too, the Court itself assessed the “opinions of Virginia’s expert witnesses” that “‘[m]ales tend to need an atmosphere of adversativeness,’” while “‘[f]emales tend to thrive in a cooperative atmosphere.’” 518 U. S., at 541. What the Court once recognized as an imperative check against discrimination, it today abandons.

Yet the task of ascertaining SB1’s constitutionality is a familiar one. Tennessee has proffered an undoubtedly important interest in “protect[ing] the health and welfare of minors” by prohibiting medical procedures that carry “risks and harms.” Tenn. Code Ann. §§68–33–101(a), (b)–(e); see New York v. Ferber, 458 U. S. 747, 756–757 (1982) (States’ “interest in ‘safeguarding the physical and psychological well-being of a minor’” is “‘compelling’”). All, including the Solicitor General, agree that the State may strictly regulate access to cross-sex hormones and puberty blockers to achieve that purpose. See Tr. of Oral Arg. 39–40, 152–153 (agreeing that West Virginia’s more tailored limitations on gender-affirming care would likely survive intermediate scrutiny). It may well be, too, that “[d]eference to legislatures” is “particularly critical” in this context, where the provision of medical care to minors is at issue. Ante, at 22 (opinion of Thomas, J.). But that does not change the Court’s obligation, as mandated by our precedents, to determine whether the challenged sex classification in SB1’s categorical ban is tailored to protecting minors’ health and welfare, or instead rests on unlawful stereotypes about how boys and girls should look and act. See Virginia, 518 U. S., at 533. Infusing that antecedent legal question with a host of evidence relevant only to the subsequent application of judicial scrutiny, as Justice Thomas would have us do, see ante, at 7–22, simply puts the cart before the horse.

The present record offers reason to question (as the District Court did) whether Tennessee’s categorical ban on treating gender dysphoria bears the “requisite direct, substantial relationship” to its interest in protecting minors’ health. Mississippi Univ. for Women v. Hogan, 458 U. S. 718, 725 (1982). Tennessee has offered little evidence, for example, that it is more dangerous to receive puberty blockers to “identify with, or live as, a purported identity inconsistent with the minor’s sex” than to treat other conditions like precocious puberty.¹⁶ Why, then, does SB1 proscribe the regulated medications to treat gender dysphoria, while leaving them available for myriad other purposes? So too is it difficult to ignore that Tennessee professes concern with protecting the health of minors while categorically banning gender-affirming care for even those minors exhibiting the most severe mental-health conditions, including suicidality.

The majority’s choice to avoid applying intermediate scrutiny is all the more puzzling, however, because this Court need not itself resolve these questions or wade into what it dubs the “fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field.” Ante, at 24. The Sixth Circuit never even asked whether the challenged sex classification in SB1 “serves ‘important governmental objectives’” or is “‘substantially related to the achievement of those objectives.’” Virginia, 518 U. S., at 533. All the United States requested of this Court was confirmation that intermediate scrutiny applied. Brief for United States 32. On remand, the courts could have taken due account of the “[r]ecent developments” that (according to the majority) “underscore the need for legislative flexibility in this area,” including a recent report from England’s National Health Service on the use of puberty blockers and hormones to treat transgender minors. Ante, at 23. Yet the majority inexplicably refuses to take even the modest step of requiring Tennessee to show its work before the lower courts.

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This case presents an easy question: whether SB1’s ban on certain medications, applicable only if used in a manner “inconsistent with . . . sex,” contains a sex classification. Because sex determines access to the covered medications, it clearly does. Yet the majority refuses to call a spade a spade. Instead, it obfuscates a sex classification that is plain on the face of this statute, all to avoid the mere possibility that a different court could strike down SB1, or categorical healthcare bans like it. The Court’s willingness to do so here does irrevocable damage to the Equal Protection Clause and invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight. It also authorizes, without second thought, untold harm to transgender children and the parents and families who love them. Because there is no constitutional justification for that result, I dissent.