The US Supreme Court on Wednesday upheld a Tennessee state law prohibiting gender-affirming medical treatments for transgender minors, marking a significant development in a contentious cultural and political battle.
In a 6-3 ruling, the Court sided with the state’s law that bans hormone therapy, puberty blockers, and gender transition surgeries for individuals under 18. The six conservative justices rejected the legal challenge, while the three liberal justices dissented strongly.
This decision is poised to influence similar laws in two dozen Republican-led states that have enacted restrictions on gender-affirming care for transgender youth.
Chief Justice John Roberts, writing for the majority, emphasised that the Court’s role is limited to ensuring laws do not violate constitutional protections. “The court’s role is not to judge the wisdom, fairness, or logic of the law but only to ensure it does not violate equal protection guarantees,” Roberts stated. “It does not.”
The case was originally heard in December, with the Justice Department under President Joe Biden opposing the Tennessee law. The administration argued that the law violated the Constitution’s Equal Protection Clause by denying transgender minors access to medically necessary care permitted for others.
Since then, Republican President Donald Trump has taken office and issued an executive order in January restricting gender transition procedures for those under 19. While no federal law explicitly bans gender-affirming treatments, the order ended federal support for such care through Medicaid, Medicare, and Defense Department health programs.
The ruling drew swift reactions from both sides. The American Academy of Pediatrics condemned the decision, warning it “sets a dangerous precedent for legislative interference in the practice of medicine.” The organisation reaffirmed that gender-affirming care is medically necessary, supported by extensive research and clinical consensus, and vital to the health and dignity of transgender youth.
Conversely, the conservative legal group Alliance Defending Freedom praised the ruling as a “huge win for children” and a step toward ending what it called “dangerous experiments on kids.”
During the Supreme Court hearings, Tennessee’s Solicitor General Matthew Rice argued that the law protects minors from risky and irreversible medical interventions. Meanwhile, Chase Strangio of the American Civil Liberties Union, representing transgender youths and their families, called the law a sweeping ban that overrides parental and medical decisions, causing suffering to those denied care.
Trump’s executive order had framed gender transition procedures for minors as harmful and called for an end to what it described as “maiming and sterilising” children, asserting that the federal government would no longer support these treatments.
According to UCLA’s Williams Institute, about 1.6 million people aged 13 and older in the US identify as transgender, highlighting the wider social implications of policies governing gender-affirming care.
