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

In a significant ruling, the Supreme Court on Wednesday affirmed Tennessee’s prohibition on gender-affirming care for transgender minors. This decision, passed by a 6-3 conservative majority, is set to embolden efforts by conservative legislators in other states to enact similar laws targeting the transgender community. The verdict marks a major setback for the transgender rights movement during a period of heightened legislative activity critical of trans issues. Republican-led states have been pushing for laws affecting transgender lives, particularly focusing on younger demographics, since 2020. Former President Donald Trump, during his re-election campaign, had made curtailing transgender rights part of his platform, further advancing measures to reverse precedents that benefit the transgender community. Tennessee’s model has been mirrored by about half of U.S. states.

Opinions differ in federal courts regarding the constitutionality of these laws, with the Tennessee case, initiated by the Biden administration, being the first of its kind to reach the Supreme Court. Chief Justice John Roberts penned the majority opinion, with the support of his conservative peers, while three liberal justices dissented. “This case involves intense debates over the safety, efficacy, and appropriateness of medical treatments in a rapidly developing field,” Roberts stated, acknowledging the sincere concerns on both sides but concluding that the Equal Protection Clause does not settle these disputes. Following the court’s decision, judges are likely to evaluate similar bans under the least stringent level of judicial review, making it easier for such laws to be upheld.

Justice Sonia Sotomayor, representing the court’s liberal wing, expressed her disapproval by reading her dissent from the bench, a rare act. “The court abandons transgender children and their families to political whims,” she lamented. Her dissent argued that the conservative majority was avoiding earlier rulings that determined laws impacting transgender individuals inherently discriminated based on sex. “The majority refuses to recognize explicit sex classification,” Sotomayor contended, “which damages the Equal Protection Clause and encourages discrimination masked in plain sight.”

Political dynamics shifted while the case awaited judgment. Since retaking office, Trump has targeted transgender rights, including policy changes within the military and restrictions on nonbinary gender markers on passports. Polls have shown waning support among Democrats for transgender rights, such as the participation of transgender girls in girls’ sports. Tennessee’s SB 1, effective as of 2023, restricts hormone therapy and puberty blockers for transgender minors and imposes civil penalties on violating medical professionals. It also bans gender-affirming surgeries, although this was not the focus of the case.

The legislation prohibits the administration of care aimed at aligning a minor’s identity with a gender differing from their biological sex, tackling perceived issues of gender dysphoria. The legal challenge was initially brought forward by three transgender minors in Tennessee, their families, and a local doctor experienced in treating minor gender dysphoria, later supported by the Biden administration. Despite differing views on the law’s constitutional standing at lower federal courts, the Supreme Court’s involvement followed Trump’s re-election, a campaign heavily marked by promises to further limit transgender rights.

Under Trump’s presidency, support for the suit opposing Tennessee’s law was reversed, with the Justice Department withdrawing Biden’s backing of the challengers. A growing number of GOP-governed states have since enacted similar healthcare restrictions. The Williams Institute at UCLA School of Law reports over 110,000 teenagers reside in states with such limitations on puberty blockers and hormone therapy, which a divided Cincinnati appeals court allowed to proceed in 2023.

A crucial issue before the Supreme Court was whether the Tennessee law constituted sex-based discrimination. The Biden administration argued the statute discriminated by allowing medical treatments based on sex when the same treatments would be blocked in gender transition scenarios. Past rulings, namely the 2020 Bostock v. Clayton County decision, highlighted the inclusion of sexual orientation and gender identity within sex discrimination under federal law, a point dividing the conservative bench. Conversely, Tennessee upheld that their law is age-related, not sex-based, emphasizing regulations on medical interventions meant to facilitate gender transitions, a stance that seemed to resonate with the court during December’s arguments.