[10] The suit was brought by three transgender teens and their families as well as a Tennessee doctor who treats youth with gender dysphoria.

[12][13][14] Biden administration Solicitor General Elizabeth Prelogar has advocated for the plaintiff's right to be a girl in Tennessee.

[11] Chief Judge Jeffrey Sutton wrote that the Tennessee state government was likely to succeed upon their appeal and that the right of parents to control the medical care of their children is not a fundamental right because it is not "deeply rooted in this Nation's history and tradition," a standard set by the Supreme Court in Washington v. Glucksberg (1997).

"[16] By a 2–1 vote in September 2023, the Sixth Circuit panel reversed the district court's preliminary injunction, with Sutton again writing for the majority and White again dissenting.

Because the law allows the use of puberty blockers and hormones for reasons unrelated to transition, the government argues, a patient's sex becomes a determining factor in deciding whether these treatments are permissible; for example, a male adolescent would be permitted to take testosterone as a treatment for delayed puberty, but the same medication would be disallowed for a patient whose birth sex is female (taking it for the purposes of inducing physical changes consistent with a masculine or nonbinary gender identity).

[11][18] The government and families also pointed to the Supreme Court's decision in Bostock v. Clayton County (2020), which upheld that both sexual orientation and gender identity are protected classed covered by anti-discrimination laws under Title VII of the Civil Rights Act of 1964.

[21] The state further argues that even if the bill were considered to discriminate on transgender status, the court should not "get back in the fraught business of creating suspect classes".

[23] Whereas the government's petition alleged a violation of the Equal Protection Clause, the plaintiffs filed a separate petition for certiorari, which the court did not grant, which additionally presented the theory that the bill violated the Due Process Clause by denying parents the right to make medical decisions for their children.

[11][8] On November 21, 2024, it was discovered that four of the doctors that were testifying in favor of Tennessee's ban, namely Paul Hruz, Michael Laidlaw, James Cantor, and Stephen B. Levine, had previously been reprimanded by various courts across the country as "conspiratorial, deeply biased, far off and deserving very little weight", three of them had never provided healthcare to transgender youth, and who LGBTQ+ advocates and trans healthcare experts say repeatedly peddle misinformation about transgender health care.

[27] The Endocrine Society filed a brief stating the ban "irreparably harms adolescents with gender dysphoria by denying crucial care to those who need it.

[31] Prelogar represented the government,[32] and was joined by ACLU attorney Chase Strangio who argued for the private plaintiffs.

[33][34][35] From their lines of questioning, court observers opined that Justices Elena Kagan, Sonia Sotomayor and Ketanji Brown Jackson appeared to favor the arguments made by the plaintiffs whereas Justices Clarence Thomas, Samuel Alito, Brett Kavanaugh and John Roberts appeared to favor the arguments made by Tennessee.

[36][37][38] Barrett was described as seeming sympathetic to Tennessee's position, though was acknowledged as having been less direct in her questioning than Roberts, Thomas, Alito and Kavanaugh.