Supreme Court Upholds Ban On Gender-Affirming Care For Minors

Topline

The Supreme Court upheld Tennessee’s law restricting gender-affirming medical treatments for minors, dealing a blow Wednesday to transgender rights that could have consequences nationwide, as more than two dozen states have imposed similar laws.

A transgender rights supporter rallies outside the U.S. Supreme Court on December 4, 2024 in … More Washington, DC.

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Key Facts

The Supreme Court ruled 6-3 along party lines to uphold a federal appeals court ruling that backed Tennessee’s law, which ensures the law will stay in place.

The court was asked to weigh in on the legality of Tennessee’s law, which bans medication treatments that enable “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”

Chief Justice John Roberts wrote for the court’s majority that Tennessee’s law is not subject to a heightened level of judicial review—which would make it easier to strike down—and doesn’t unlawfully discriminate on the basis of sex, because it’s only based on a person’s age and their medical condition, in that it doesn’t allow treatments for minors who have gender dysphoria and other similar conditions.

Roberts argued the law also doesn’t discriminate based on a person’s transgender status, because transgender people could still seek medical treatments like puberty blockers for other medical conditions besides gender dysphoria.

The ruling upholds state bans on gender-affirming care for minors, but does not affect states where such treatments are still allowed, and does not make an overarching decision on whether or not the treatments should be outlawed—with Roberts writing the issue should be “appropriately left to the people, their elected representatives, and the democratic process.”

Liberal Justices Sonia Sotomayor and Ketanji Brown Jackson dissented from the opinion—with Sotomayor writing the court was “retreating from meaningful judicial review exactly where it matters most” and “abandon[ing] transgender children and their families to political whims”—and Justice Elena Kagan also dissented, but said while she thinks the law should be subject to greater scrutiny, she doesn’t have a view on whether or not it would be upheld under a stricter legal test.

Crucial Quote

“Our role is not ‘to judge the wisdom, fairness, or logic’ of the law before us … but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment,” Roberts wrote in his opinion for the court, noting the “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.”

What To Watch For

The court’s ruling was focused on Tennessee’s law specifically, so while it’s likely to make it harder for other similar state laws to be struck down, it does not prevent transgender rights advocates from bringing other lawsuits in the future challenging anti-transgender policies. It also does not affect other protections for LGBTQ rights that the court has previously issued, such as its ruling in 2020 that ensured workplace protections from LGBTQ-based discrimination.

Chief Critic

The American Civil Liberties Union and Lambda Legal, which brought the case against the Tennessee law, denounced the court’s decision on Wednesday, with Chase Strangio, Co-Director of the ACLU’s LGBTQ & HIV Project, describing it as “a devastating loss for transgender people, our families, and everyone who cares about the Constitution.” The ruling “mak[es]

it more difficult for transgender youth to escape the danger and trauma of being denied their ability to live and thrive,” Sasha Buchert, Counsel and Director of the Nonbinary and Transgender Rights Project at Lambda Legal said in a statement, adding that “the implications [of the ruling] will reverberate for years and across the country, but it does not shake our resolve to continue fighting.”

What Is Gender-Affirming Care?

The term “gender-affirming care” broadly refers to treatments “designed to support and affirm an individual’s gender identity,” according to the World Health Organization. Leading medical organizations in the U.S. broadly support the use of such care, including for minors, with the American Medical Association arguing “trans and non-binary gender identities are normal variations of human identity and expression, and … forgoing gender-affirming care can have tragic health consequences, both mental and physical.” The Tennessee case specifically focuses on medical treatments of providing puberty blockers or hormones, but gender-affirming care could also refer to psychological or behavioral treatments as well, like counseling or speech therapy. Hormone treatments help people physically transition genders, while puberty blockers are designed to delay the physical changes of puberty for transgender or gender non-conforming youth. The Mayo Clinic notes they are not permanent and puberty changes would resume whenever a person stops taking them. Gender-affirming care could also refer to surgical procedures used to transition a person’s gender, and those procedures are banned under Tennessee’s law. They weren’t at issue in the lawsuit, however, because evidence shows such procedures are exceedingly rare among transgender youth.

What Other States Does The Supreme Court’s Ruling Affect?

Tennessee is one of 26 states with laws in place that target gender-affirming care in some form, according to the pro-LGBTQ+ rights organization Human Rights Campaign, though some have been blocked in court. The states with such laws in place are Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia and Wyoming. The court’s ruling Wednesday will likely ensure those laws remain in place, and that any future state or federal laws could be declared lawful.

Key Background

The Supreme Court took up the Tennessee case after a federal district court previously blocked the law, but an appeals court reversed that ruling, allowing the ban to take effect. The court’s ruling comes as transgender rights have become an increasingly fraught political issue in the wake of President Donald Trump’s inauguration, as the Trump administration has taken steps to roll back policies recognizing Americans’ chosen gender identities. The president signed executive orders barring the government from recognizing anything other than Americans’ biological sex and reinstated his transgender military ban, among other moves. The 6-3 conservative Supreme Court has a mixed record when it comes to LGBTQ+ issues in the past: The high court issued a landmark ruling in support of transgender rights in 2020, when it ruled federal workplace anti-discrimination laws protect gay and transgender employees. It has also issued multiple rulings against LGBTQ+ rights, however, such as siding with a web designer in 2023 who refused to create websites for same-sex weddings and letting Trump’s renewed ban on transgender Americans serving in the military take effect in May. The transgender healthcare suit was one of several LGBTQ+-rights focused cases the court took up this term, along with a case regarding whether parents should be allowed to opt their children out of school instruction on sexual orientation and gender identity. The court also announced it will hear a case next term regarding the legality of state bans against “conversion therapy” that seeks to change minors’ sexual orientation.