“Consolidating Skrmetti” – Poe v. Drummond and the Rational-Basis Standard for State Bans on Pediatric Gender-Transition Procedures

1. Introduction

Poe v. Drummond, decided by the United States Court of Appeals for the Tenth Circuit on 6 August 2025, is the first federal appellate decision to apply the Supreme Court’s newly-minted ruling in United States v. Skrmetti (2025) outside the Sixth Circuit. The case concerns Oklahoma Senate Bill 613 (“SB 613”), which forbids licensed health-care providers from performing certain gender-transition interventions—puberty blockers, cross-sex hormones, and gender-affirming surgeries—on individuals under 18.

Several transgender minors, their parents, and a treating physician (collectively “Plaintiffs”) sought a preliminary injunction, alleging violations of the Equal Protection and Due Process Clauses. The district court denied relief. On appeal, the Tenth Circuit affirmed, anchoring its reasoning in Skrmetti and elaborating a detailed analysis of parental-rights jurisprudence. Although the immediate holding merely sustains the denial of interim relief, the opinion effectively cements a two-step analytical framework—age plus medical-use classification tested under rational-basis review—for evaluating state restrictions on pediatric gender-transition care.

2. Summary of the Judgment

• Equal Protection: SB 613 classifies on the bases of age and medical use, not sex or transgender status; therefore, only rational-basis review applies. Oklahoma’s interest in protecting minors amidst medical uncertainty easily survives that standard.
• Due Process: Parents do not possess a “deeply rooted” fundamental right to obtain a particular medical treatment the State lawfully forbids. SB 613 therefore need only satisfy rational-basis scrutiny, which it does.
• Preliminary-Injunction Standard: Because Plaintiffs failed to show a likelihood of success on either claim, the court did not reach irreparable harm, balance of equities, or public-interest factors.

3. Analysis

3.1 Precedents Cited and Their Influence

• United States v. Skrmetti, 145 S. Ct. 1816 (2025) – The cornerstone precedent. Skrmetti held that Tennessee’s analogous statute warranted rational-basis review, rejected the extension of Bostock’s Title VII logic to constitutional claims, and likened the statute’s diagnostic exclusion to the pregnancy exclusion in Geduldig. The Tenth Circuit treats Skrmetti as controlling.
• Geduldig v. Aiello, 417 U.S. 484 (1974) – Provides the “lack-of-identity” template for distinguishing between a protected class and a medical condition unique to that class.
• Bostock v. Clayton County, 590 U.S. 644 (2020) – Plaintiffs invoked it; the court, echoing Skrmetti, declined to extend its but-for causation test beyond Title VII.
• Washington v. Glucksberg, 521 U.S. 702 (1997) and Dobbs v. Jackson Women’s Health Organization, 597 U.S. 215 (2022) – Supply the history-and-tradition methodology for identifying substantive-due-process rights.
• Prince v. Massachusetts, 321 U.S. 158 (1944) and Parham v. J.R., 442 U.S. 584 (1979) – Support state authority to override parental decisions to protect child welfare.

3.2 Legal Reasoning

1. Step One – Classification Analysis
   SB 613 distinguishes strictly by (a) age (minors vs. adults) and (b) purpose (treating gender dysphoria versus other diagnoses). Because minors of both sexes and of any gender identity are equally barred from the specified interventions when used for gender dysphoria, the statute is facially neutral as to sex and transgender status.
2. Step Two – Level of Scrutiny
   Neutral, non-fundamental classifications warrant rational-basis review. The court explicitly rejects intermediate scrutiny (sex) and heightened scrutiny (quasi-suspect classes), reaffirming that age and treatment-purpose are traditionally low-level classifications.
3. Step Three – Rational Relation
   Oklahoma’s asserted interests: (i) protecting minors from irreversible medical risk; (ii) waiting for clearer scientific consensus; (iii) preserving medical ethics until adulthood. The opinion collects evidence—ranging from contested studies on brain development to WPATH’s evolving standards—to show the legislature could rationally deem the risks substantial and the benefits uncertain.
4. Parental-Rights Analysis
   The court isolates the claimed liberty: access to gender-transition procedures for minors. Finding no “deeply rooted” historical tradition, it classifies the right as non-fundamental. Consequently, parental objections cannot trump the State’s child-welfare prerogative, again invoking rational-basis review.
5. Motive and “Pretext” Arguments
   Plaintiffs’ reliance on floor statements and prior bills did not establish an invidious purpose. The court re-endorses O’Brien (statements of single legislators rarely decisive) and notes that a law can be morally disfavored by some without being constitutionally hostile.

3.3 Impact of the Judgment

• Inter-Circuit Significance: After the Sixth Circuit/Supreme Court tandem in Skrmetti, the Tenth Circuit’s adoption signals a crystallizing national consensus that pediatric gender-transition bans typically survive constitutional challenge when framed as diagnosis-based and age-limited.
• Parental-Rights Doctrine: The opinion narrows the breadth of parental medical autonomy, aligning it with vaccination mandates and refusal-of-care jurisprudence—parents may veto unwanted treatment, but cannot compel forbidden treatment.
• Legislative Drafting Guidance: Legislatures aiming to regulate adolescent gender-transition care now possess a judicial roadmap: (1) age cutoff, (2) diagnosis-specific prohibition, (3) medical uncertainty findings. Courts are likely to defer unless plaintiffs can show suspect-class discrimination or undeniable scientific consensus.
• Effect on Pending Litigation: Cases in the Fourth, Ninth, and Eleventh Circuits challenging similar statutes will weigh Poe heavily. Plaintiffs must now devise arguments beyond Equal Protection and substantive Due Process—e.g., First Amendment (doctor speech) or statutory challenges (e.g., Medicaid pre-emption).
• Healthcare and Professional-Standards Debates: By highlighting the fluidity of international guidelines, the opinion reinforces calls for long-term outcome studies and may indirectly push medical bodies toward more conservative pediatric protocols to forestall sweeping prohibitions.

4. Complex Concepts Simplified

• Rational-Basis Review: The lowest constitutional hurdle. A law survives if any plausible reason can be imagined for it—it need not be the legislature’s actual reason.
• Intermediate / Strict Scrutiny: Heightened tests applied to suspect classifications (race, sex, religion) or fundamental rights. Government must show the law is substantially (intermediate) or narrowly (strict) tailored to an important/compelling purpose.
• “Deeply Rooted” Fundamental Right: A liberty interest protected from government interference only if it is anchored in long-standing historical practice and essential to ordered liberty.
• Bostock’s “But-For” Causation: In employment law, an employer discriminates “because of” sex if changing the employee’s sex alters the decision outcome. Skrmetti and now Poe limit this test to Title VII, not constitutional analysis.
• Pretext/Invidious Purpose: Even a facially neutral law fails if enacted because of (not merely in spite of) its adverse effects on a protected group. High evidentiary burden—usually requires explicit discriminatory statements or stark pattern.

5. Conclusion

Poe v. Drummond transforms United States v. Skrmetti from a single-state decision into a multi-circuit doctrine: statutes banning gender-transition interventions for minors will be judged under the forgiving rational-basis standard so long as they (1) apply equally to both sexes, (2) target use rather than identity, and (3) invoke plausible child-welfare concerns. In additionally dismissing the parental-rights challenge, the Tenth Circuit closes another pathway frequently pursued by challengers. Unless and until the Supreme Court revisits Skrmetti or grants transgender status quasi-suspect classification, state legislatures possess wide constitutional latitude to regulate or prohibit pediatric gender-transition care.