By Ann E. Marimow, Casey Parks —
Supreme Court allows Tennessee ban on gender-transition care for minors
A divided Supreme Court on Wednesday cleared the way for states to ban certain gender transition treatments for minors, a landmark decision on a polarizing issue the Trump administration has seized on in initiatives targeting transgender rights.
In one of the most high-profile cases of the term, the court’s conservative majority upheld a Tennessee law that prohibits minors from using hormones and puberty blockers for gender transition.
The court’s decision, written by Chief Justice John G. Roberts Jr., affects the law in Tennessee and has implications for more than 20 other states that have banned similar treatments as a growing – but still small – number of young people seek to delay puberty as part of a gender transition. But the basis for the court’s ruling, legal experts said, appears to leave open opportunities for advocates to challenge other bans involving bathroom use, sports participation and military service.
Roberts said Tennessee’s law does not discriminate on the basis of sex and thatcourts must give elected officials wide discretion to pass legislation when there isscientific and policy debate about the safety of medical treatments in an evolving field. He acknowledgedthat “the voices in these debates raise sincere concerns; the implications for all are profound.”
“We leave questions regarding its policy to the people, their elected representatives, and the democratic process,” Roberts wrote.
The court’s three liberal justices dissented.
Justice Sonia Sotomayor read a lengthy summary of her dissent from the bench, saying Tennessee’s law banned lifesaving medical treatment and plainly discriminates.
“By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims,” Sotomayor wrote, adding: “In sadness, I dissent.”
The ruling is only the second time the justices have addressed transgender rights. In 2020, the Supreme Court’s ruling inBostock v. Clayton County said an employer who fires a worker “merely for being gay or transgender” unlawfully discriminates “because of such individual’s sex.”
The court’s 6-3 decision Wednesday left for another day the question of whether the reasoning in Bostock applies in other contexts and has yet to grapple with other looming legal questions about transgender athletes and access to bathrooms and health care.
In a statement, Tennessee Attorney General Jonathan Skrmetti praised the decision as a win for Tennessee voters and the lawmaking process.
“A bipartisan supermajority of Tennessee’s elected representatives carefully considered the evidence and voted to protect kids from irreversible decisions they cannot yet fully understand,” Skrmetti said.
ACLU attorney Chase Strangio, who represented the families behind the court challenge, called the ruling a painful setback.
“Today’s ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution,” said Strangio, the first openly transgender attorney to argue before the court. “We are as determined as ever to fight for the dignity and equality of every transgender person and we will continue to do so with defiant strength, a restless resolve, and a lasting commitment to our families, our communities, and the freedom we all deserve.”
Cathryn Oakley, senior director of legal policy for the Human Rights Campaign, said that while the ruling was “devastating and really scary” for families with trans children, the question before the Supreme Court and its ruling were somewhat narrow.
“There are a lot of remaining legal pathways to challenge these laws,” Oakley said of litigation involving other bans. “My heart is broken for these kids who are not going to be able to receive the medical care they need to thrive and be well, but it’s not over by any stretch.”
Soon after returning to the White House, President DonaldTrump signed orders halting transgender or nonbinary passport applications, transferring incarcerated trans women to solitary confinement and implementing policies that could cut off young people’s access to gender transition care nationwide.
Those efforts have mostly been blocked by courts. But the justices have allowed the administration to bar transgender troops from serving in the military while litigation continues.
Attorney General Pam Bondi applauded the court’s decision in a post on X and encouraged other states to “follow Tennessee’s lead and enact similar legislation to protect our kids.”
The Supreme Court’s ruling in the Tennessee case will provide direction to lower courts that are also grappling with similar issues. An appeals court in Ohio in March blocked the state’s ban on treatments for young people, finding the law “unconstitutional on its face.”
The Tennessee statuteadopted in 2023 prohibits young people from using hormones and puberty blockers for gender transition care that most leading medical organizations say are safe and effective but that the state characterizes as unproven and risky. A small fraction of young people who identify as transgender participate in the medical treatments.
Tennessee’s law says the state has an interest in “encouraging minors to appreciate their sex” and in prohibiting treatments that “might encourage minors to become disdainful of their sex.”
The challenge was brought by transgender teens, their parents and a doctor who treats young people whose gender identity is different from their sex assigned at birth.
At issue for the justices was whether Tennessee’s law violates the equal protection clause of the Constitution. The families had asked the Supreme Court to find that the law amounts to sex discrimination and should be subject to a higher standard of legal review than the lower court applied. That standard would have made it more difficult for the state to justify the ban.
The U.S. Court of Appeals for the 6th Circuit in 2023 said the Tennessee law regulates gender transition treatments for all minors, regardless of sex, and concluded that statelawmakers could have rationally determined that the law was an appropriate response to perceived risks associated with the treatments.
The Supreme Court affirmed that decision Wednesday. The majority embraced Tennessee’s claim that the law imposes age limits and restrictions on medical treatments for certain purposes but does not make distinctions based on sex.
“The law does not prohibit conduct for one sex that it permits for the other,” wrote Roberts, who was joined in full by Justices Clarence Thomas, Neil M. Gorsuch, Brett M. Kavanaugh and Amy Coney Barrett.
The law, the court said, treats all transgender boys and transgender girls the same way. Under the Tennessee law, no minor may be administered puberty blockers or hormones to treat gender dysphoria, gender identity disorder, or gender incongruence. The court’s decision does not have implications for adult care.
The majority also said courts should not second guess state lawmakers in an area of scientific debate. The opinion pointed to some European countries that have raised concerns about potential harms for young people using puberty blockers and hormones and studies showing insufficient data about the long-term effects. U.S. experts have disputed the characterization of some European findings.
In dissent, Sotomayor agreed with the Biden administration and the American Civil Liberties Union that the measure discriminates based on sex because an adolescent assigned female at birth, for instance, cannot receive puberty-delaying treatments or testosterone to live as a male, but an adolescent assigned male at birth could receive such treatments.
“By depriving adolescents of hormones and puberty blockers only when such treatment is ‘inconsistent with’ a minor’s sex, the law necessarily deprives minors identified as male at birth of the same treatment it tolerates for an adolescent identified as female at birth (and vice versa),” wrote Sotomayor, joined by Justice Ketanji Brown Jackson and in part by Justice Elena Kagan.
She invoked two landmark Supreme Court decisions that eliminated discriminatory policies and said the majority was shirking its responsibility. In Loving v. Virginia, the court struck down bans on interracial marriage. In United States v. Virginia, the court held unconstitutional the Virginia Military Institute’s male-only admissions policy.
“Those laws, too, posed politically fraught and contested questions about race, sex, and biology,” Sotomayor wrote.
Sotomayor said the majority should have instead sent the case back to the appeals court to determine whether Tennessee’s categorical ban on the treatments sufficiently protects the health of transgender teens or instead rests on unlawful stereotypes about how boys and girls should look and act. She noted that if left untreated, gender dysphoria can lead to severe depression, anxiety and self-harm.
The majority, she said, “authorizes, without second thought, untold harm to transgender children and the parents and families who love them.”
Surveys have found that roughly 40 percent of transgender youths nationwide – and 93 percent of transgender youths in the South – live in states with a ban. Though many families have moved because of the bans, many others either can’t or do not want to relocate, said Jasmine Beach-Ferrara, executive director of Campaign for Southern Equality.
Instead, they travel long distances every few months for follow-up appointments and prescription refills. Over the past two years, Beach-Ferrara’s Asheville, North Carolina-based organization has spent $600,000 to help 1,200 families travel for medical care, sometimes up to four times a year. The nonprofit has worked this year to raise additional money to grow that program.