In a 6–3 decision on Wednesday, the Supreme Court upheld Tennessee’s ban on gender-affirming care for transgender minors, allowing similar laws in at least 24 other states to remain intact. The ruling represents the most significant rollback of transgender rights since Trump returned to the presidency—and it’s a green light for even more restrictions to come.
The case, United States v. Skrmetti, centered on whether Tennessee’s 2023 law banning puberty blockers, hormone therapy, and gender-affirming surgeries for youth violated the Constitution’s Equal Protection Clause. Chief Justice John Roberts, writing for the conservative majority, said it did not.
“The Equal Protection Clause does not resolve these disagreements,” Roberts wrote, referencing what he called “fierce scientific and policy debates” surrounding gender-affirming care.
The decision ignores years of evidence and expert consensus from major medical organizations, including the American Academy of Pediatrics and the Endocrine Society, that affirm the efficacy of transition-related care for trans youth.
“In Sadness, I Dissent”: A Supreme Court Ruling That Betrays Trans Youth
Justice Sonia Sotomayor, joined by Justices Elena Kagan and Ketanji Brown Jackson, delivered a blistering dissent. She accused the Court of “retreating from meaningful judicial review” and “abandoning transgender children and their families to political whims.”
Sotomayor also challenged the majority’s logic: Tennessee’s law allows the same medical treatments—such as hormone therapy and puberty blockers—for non-trans youth with other conditions, but bans them when used to affirm gender identity.
“That is textbook sex discrimination,” she wrote.
The ruling could have far-reaching implications. More than 300,000 youth between the ages of 13 and 17 in the U.S. identify as transgender, according to the Williams Institute. Now, many of them live in states where essential healthcare is effectively illegal.
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Trump’s Anti-Trans Agenda Gets Court Approval
The Supreme Court’s ruling bolsters the Trump administration’s aggressive rollback of transgender rights. Since January, Trump has signed executive orders attempting to restrict federal funding for gender-affirming care, limit trans participation in sports, and redefine sex as strictly binary in federal law.
In court, the Justice Department under Trump argued that states have broad leeway to regulate medical treatments, even if those treatments are only banned when used for gender transition.
The Court appeared to agree—applying the most deferential level of judicial review, called rational basis, which essentially allows lawmakers to act unless their decisions are entirely irrational. This approach almost always results in laws being upheld, no matter their discriminatory impact.
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What’s Next for Trans Youth?
The decision does not immediately impact states without bans, but it sets a precedent that could embolden future legislation—even against adults. Trans rights advocates warn that if courts are willing to let states ban care for minors under the guise of “protecting children,” it’s only a matter of time before similar arguments are used to restrict adult access.
It also leaves unresolved another constitutional question: whether these laws infringe on a parent’s right to make medical decisions for their child. That issue wasn’t addressed in this case—but legal experts expect it will resurface in future litigation.
For now, the message is clear: states can ban gender-affirming care for youth, even when the bans are rooted in discrimination, and even when families, doctors, and entire communities beg them not to.
