Supreme Court OKs Tennessee ban on gender-affirming care for kids, a
setback for transgender rights
[June 19, 2025]
By MARK SHERMAN
WASHINGTON (AP) — The Supreme Court on Wednesday upheld Tennessee's ban
on gender-affirming care for transgender minors, a jolting setback to
transgender rights.
The justices' 6-3 decision in a case from Tennessee effectively protects
from legal challenges many efforts by President Donald Trump's
Republican administration and state governments to roll back protections
for transgender people. Another 26 states have laws similar to
Tennessee's.
Chief Justice John Roberts wrote for a conservative majority that the
law banning puberty blockers and hormone treatments for trans minors
doesn't violate the Constitution's equal protection clause, which
requires the government to treat similarly situated people the same.
“This case carries with it the weight of fierce scientific and policy
debates about the safety, efficacy, and propriety of medical treatments
in an evolving field. The voices in these debates raise sincere
concerns; the implications for all are profound,” Roberts wrote. “The
Equal Protection Clause does not resolve these disagreements. Nor does
it afford us license to decide them as we see best.”
In a dissent for the court's three liberal justices that she summarized
aloud in the courtroom, Justice Sonia Sotomayor wrote, “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."
The law also limits parents' decision-making ability for their
children's health care, she wrote.
Efforts to regulate transgender people's lives
The decision comes amid other federal and state efforts to regulate the
lives of transgender people, including which sports competitions they
can join and which bathrooms they can use. In April, Trump’s
administration sued Maine for not complying with the government’s push
to ban transgender athletes in girls sports.
The Republican president also has sought to block federal spending on
gender-affirming medical care for those under age 19 — instead promoting
talk therapy only to treat young transgender people. And the Supreme
Court has allowed him to kick transgender service members out of the
military, even as court fights continue. The president signed another
order to define the sexes as only male and female.
The debate even spilled into Congress when Delaware elected Democrat
Sarah McBride as the first transgender member of the House. Her election
prompted immediate opposition among Republicans, including House Speaker
Mike Johnson of Louisiana and Rep. Nancy Mace of South Carolina, over
which bathroom McBride could use.
Some providers have stopped treatment already
Several states where gender-affirming care remains in place have adopted
laws or state executive orders seeking to protect it. But since Trump’s
executive order, some providers have ceased some treatments. For
instance, Penn Medicine in Philadelphia announced last month it wouldn't
provide surgeries for patients under 19.
The president of the American Academy of Pediatrics, Dr. Susan Kressly,
said the organization is “unwavering” in its support of gender-affirming
care and “stands with pediatricians and families making health care
decisions together and free from political interference.”
Five years ago, the Supreme Court ruled LGBTQ people are protected by a
landmark federal civil rights law that prohibits sex discrimination in
the workplace. That decision is unaffected by Wednesday’s ruling.
But the justices declined to apply the same sort of analysis the court
used in 2020 when it found “sex plays an unmistakable role” in
employers’ decisions to punish transgender people for traits and
behavior they otherwise tolerate. Roberts joined that opinion written by
Justice Neil Gorsuch, who was part of Wednesday's majority.
Justice Amy Coney Barrett also fully joined the majority but wrote
separately to emphasize that laws classifying people based on
transgender status should not receive any special review by courts.
Barrett, also writing for justice Clarence Thomas, wrote that “courts
must give legislatures flexibility to make policy in this area.”
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Chief Justice of the U.S. Supreme Court John Roberts speaks
during a lecture to the Georgetown Law School graduating class of
2025, in Washington, May 12, 2025. (AP Photo/Manuel Balce Ceneta,
File)
 ‘A devastating loss' or a
'Landmark VICTORY’
Chase Strangio, the American Civil Liberties Union lawyer who argued
the case for transgender minors and their families, called the
ruling "a devastating loss for transgender people, our families, and
everyone who cares about the Constitution.”
Mo Jenkins, a 26-year-old trans woman who began taking hormone
therapy at 16, said she was disheartened but not surprised by the
ruling. “Trans people are not going to disappear," said Jenkins, a
Texas native and legislative staffer at the state capitol in Austin.
Texas outlawed puberty blockers and hormone treatment for minors in
2023.
Tennessee's leading Republican elected officials all praised the
outcome. Attorney General Jonathan Skrmetti on social media called
the ruling a “Landmark VICTORY for Tennessee at SCOTUS in defense of
America’s children!”
There are about 300,000 people between the ages of 13 and 17 and 1.3
million adults who identify as transgender in the U.S., according to
the Williams Institute, a think tank at the UCLA School of Law that
researches sexual orientation and gender identity demographics.
When the case was argued in December, then-President Joe Biden's
Democratic administration and families of transgender adolescents
called on the high court to strike down the Tennessee ban as
unlawful sex discrimination and to protect the constitutional rights
of vulnerable Americans.
They argued the law violates the equal protection clause of the 14th
Amendment in part because the same treatments that the law prohibits
for transgender minors can be used for other purposes.
Soon after Trump took office, the Justice Department told the court
its position had changed.
A major issue in the case was the appropriate level of scrutiny
courts should apply to such laws.
The lowest level is known as rational basis review, and almost every
law looked at that way is upheld. Indeed, the federal appeals court
in Cincinnati that allowed the Tennessee law to be enforced held
that lawmakers acted rationally to regulate medical procedures.
The appeals court reversed a trial court that employed a higher
level of review, heightened scrutiny, which applies in cases of sex
discrimination. Under this more searching examination, the state
must identify an important objective and show the law helps
accomplish it.
Roberts' 24-page majority opinion was devoted almost entirely to
explaining why the Tennessee law, called SB1, should be evaluated
under the lower standard of review. The law's restrictions on
treating minors for gender dysphoria turn on age and medical use,
not sex, Roberts wrote.
Doctors may prescribe puberty blockers and hormone therapy to minors
of any sex to treat some disorders, but not those relating to
transgender status, he wrote.
But in her courtroom statement, Sotomayor asserted that similar
arguments were made to defend the Virginia law prohibiting
interracial marriage that the Supreme Court struck down in 1967.
“A ban on interracial marriage could be described in the same way as
the majority described SB1,” she said.
Roberts rejected the comparison.
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Associated Press writers Geoff Mulvihill, in Cherry Hill, N.J., and
Nadia Lathan in Austin, Texas, contributed to this report.
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