Supreme Court Upholds Tennessee Ban on Certain Gender-Affirming Care for Minors

6-3 ruling says state law does not violate Equal Protection Clause

Tone & Political Bias: Weakly Right-Leaning

Why: The decision defers to state legislatures and reflects a judicial restraint approach, aligning with conservative legal principles.

What Happened

The U.S. Supreme Court on Wednesday upheld a Tennessee law that bans certain gender-affirming medical treatments for minors. The ruling was 6-3, with the conservative majority siding in favor of the state law and the three liberal justices dissenting.

Chief Justice John Roberts wrote the majority opinion, which concluded that the law does not violate the Equal Protection Clause of the Fourteenth Amendment. The decision allows Tennessee’s restrictions on puberty blockers and hormone therapy for transgender youth to remain in effect.

Justice Sonia Sotomayor issued a strong dissent, read from the bench, accusing the court of failing to protect vulnerable children and leaving them to the "political whims" of lawmakers.

What the Law Says

Tennessee’s law prohibits doctors from prescribing puberty blockers and hormone therapy to individuals under 18 for the purpose of gender transition. It also bars surgeries related to gender transition for minors, though such surgeries are rarely performed on children.

The state argued that the ban is a reasonable regulation designed to protect children from what it called “irreversible and experimental” procedures. Lawmakers passed the law in 2023, citing concerns about long-term health impacts and the need for more scientific data.

The plaintiffs, including families of transgender youth and medical professionals, challenged the law on constitutional grounds, arguing that it discriminates based on sex and violates parental rights.

Supreme Court’s Rationale

Roberts’ opinion emphasized the court’s reluctance to intervene in areas of active public debate and evolving scientific understanding. He acknowledged that gender-affirming care is a controversial and complex issue, stating, “The voices in these debates raise sincere concerns; the implications for all are profound.”

He noted that the court found no constitutional violation and viewed the state’s regulation as within its legal authority. “We leave questions regarding its policy to the people, their elected representatives, and the democratic process,” Roberts wrote. The ruling sets a precedent for other states with similar laws to maintain or expand restrictions on transgender health care for minors.

Dissenting Views

Justice Sotomayor strongly disagreed with the ruling and read her dissent aloud — a rare and symbolic move in the court. She said the decision undermines the court’s role in protecting individual rights, especially when unpopular minorities are affected.

“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,” Sotomayor said.

She criticized the majority for disregarding the rights of transgender youth and the medical consensus supporting gender-affirming care as necessary for the well-being of some minors.

What Comes Next

The ruling clears the way for Tennessee and other states to enforce or expand bans on certain gender-related treatments for minors. More than 20 states have passed laws similar to Tennessee’s since 2021.

Legal experts note that the decision does not prevent future challenges on other grounds or in other courts, but it does signal the Supreme Court’s current stance on deferring such issues to state lawmakers.

The Biden administration had supported the challenge to the law, arguing that it discriminates based on sex and violates federal protections. The administration has also proposed rules aimed at strengthening LGBTQ+ rights in health care under federal law, but these efforts now face additional legal and political obstacles.

Key Context

• This is the first time the Supreme Court has ruled on the constitutionality of gender-affirming care restrictions for minors.

• The ruling may influence pending legal battles in states like Florida, Texas, and Missouri.

• Medical groups, including the American Academy of Pediatrics, support gender-affirming care as safe and necessary for some transgender youth. However, critics argue the field lacks long-term research and caution against early intervention.