Supreme Court upholds Tennessee youth transgender care ban

WASHINGTON — A divided Supreme Court on Thursday upheld a Tennessee law that restricts access to gender-affirming care for minors, in a ruling that shifts the contentious policy debates about transgender rights to the hands of lawmakers.

The 6-3 decision, written by Chief Justice John G. Roberts Jr., found that states can regulate or even ban gender-affirming treatment as part of their powers over medical care without running afoul of the Equal Protection Clause in the 14th Amendment to the Constitution.

Roberts wrote that there are “fierce scientific and policy debates” about the safety, efficacy and proper use of medical treatments for gender-affirming care, which have been debated by both proponents and detractors.

“The Equal Protection Clause does not resolve those disagreements. Nor does it afford us license to decide them as we see best,” the majority opinion said.

The role of the courts is not to judge the wisdom, fairness or logic of a policy, only to ensure that it doesn’t violate the 14th Amendment, Roberts wrote. “Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process,” he wrote.

The decision upholds a Tennessee law that bans puberty blockers, hormone therapy and surgery for minors for the purpose of medically transitioning their gender. It was one of a “growing number of states” that limited gender-affirming care for minors, the ruling states.

The majority found that Tennessee did not violate the 14th Amendment because the law restricted access to puberty blockers and other hormones based on different medical diagnoses, rather than by sex.

The state law also “clearly meets” a legal standard that lawmakers had reasons to do so, including risks such as irreversible sterility and adverse psychological consequences, Roberts wrote.

The law is similar to those in about two dozen states banning access to gender-affirming care for minors, and comes to the court as Republicans nationwide, including in Congress, have said they intend to impose more restrictions on the care.

Sen. Bill Hagerty, R-Tenn., praised the decision in a social media post Thursday as upholding the state law to “protect our children from life-altering transgender treatments.”

The dissenting justices and outside groups said the decision opens the door to further discrimination against transgender Americans.

Families and doctors of transgender children, as well as the Biden administration, challenged the law, arguing that it violates the 14th Amendment because it prohibits access to those medicines based on gender transition but not for other conditions, such as precocious puberty.

The state law allows minors to receive the same drugs for other purposes, such as precocious puberty or to deal with cancer diagnoses, according to court filings.

The Supreme Court decision states that because the law’s restrictions hinged on differing medical diagnoses, it did not classify based on sex, which would have triggered higher scrutiny under the 14th Amendment.

Under the law, “no minor may be administered puberty blockers or hormones to treat gender dysphoria, gender identity disorder, or gender incongruence; minors of any sex may be administered puberty blockers or hormones for any other purposes,” Roberts wrote.

Justice Clarence Thomas wrote a separate concurring opinion that criticized the Biden administration and families’ appeals to medical expertise. “When legislation does not cross constitutional lines, States must have leeway to effect the judgment of their citizens — no matter whether experts disagree,” Thomas wrote.

Thomas compared agreement with experts on gender-affirming care to the early 20th century eugenics movement.

Justice Sonia Sotomayor wrote a dissent, joined by Justice Ketanji Brown Jackson and in part by Justice Elena Kagan, that argued the majority was “retreating” from an important constitutional duty to protect vulnerable individuals and opening the door to further widespread discrimination.

The majority opinion “invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight” and “authorizes, without second thought, untold harm to transgender children and the parents who love them,” Sotomayor wrote.

Sotomayor said the majority had endorsed logic similar to Virginia’s defense of interracial marriage laws through appeals to the “science” on the risks of interracial marriage.

Thursday’s ruling will likely fuel the Trump administration’s push to roll back protections for transgender Americans and undercut a 2020 Supreme Court ruling which held that employers could not discriminate against transgender employees under Title VII of the Civil Rights Act.

Sotomayor herself pointed to actions by the Trump administration in her opinion, such as banning transgender service members from the military.

Republicans are poised to push forward nationwide bans on gender-affirming care. The budget reconciliation bill the the House passed last month includes a ban on the use of federal dollars for all transition care previously covered by Medicaid.

Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Project, who argued the case on behalf of Tennessee families, in a statement called the decision “a devastating loss” for transgender individuals and families nationwide in a statement Thursday.

“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,” Strangio said.

Strangio also pointed out that the decision didn’t explicitly touch on prior decisions holding that certain actions against transgender individuals could be considered discrimination.

The case is United States v. Skrmetti.