In United States v. Skrmetti, the Supreme Court upheld the constitutionality of Tennessee’s law, Senate Bill 1 (SB1) that bans most gender affirming care (GAC) for individuals under the age of 18. The Court’s decision most immediately affects children and adolescents seeking GAC. More broadly, Skrmetti also undermined constitutional guardrails that guarantee rigorous assessment of medical justifications for policies limiting the rights of transgender people and women. As a result of the Court’s reasoning, judges and policymakers will increasingly rely on medical evidence in such cases. This reliance on medical justifications, plus the relinquishment of judicial oversight, create both a need and responsibility for medical organizations to do whatever is possible to maintain evidentiary rigor in such situations.