US supreme court upholds Tennessee ban on youth gender-affirming care

A Tennessee state law banning gender-affirming care for minors can stand, the US supreme court has ruled, a devastating loss for trans rights supporters in a case that could set a precedent for dozens of other lawsuits involving the rights of transgender children.

The case, United States v Skrmetti, was filed last year by three families of trans children and a provider of gender-affirming care. In oral arguments, the plaintiffs – as well as the US government, then helmed by Joe Biden – argued that Tennessee’s law constituted sex-based discrimination and thus violated the equal protection clause of the 14th amendment. Under Tennessee’s law, someone assigned female at birth could not be prescribed testosterone, but someone assigned male at birth could receive those drugs.

Tennessee, meanwhile, has argued that the ban is necessary to protect children from what it termed “experimental” medical treatment. During arguments, the conservative justices seemed sympathetic to that concern, although every major medical and mental health organization in the US has found that gender-affirming care can be evidence-based and medically necessary. These groups also oppose political bans on such care.

All six of the supreme court’s conservative justices joined in at least part of the decision to uphold the law, although several also wrote their own concurring opinions. In his majority decision, Chief Justice John Roberts emphasized that the ruling primarily rested on the justices’ finding that the law did not violate the equal protection clause, rather than on an ideological opposition to trans rights.

“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. He added: “We leave questions regarding its policy to the people, their elected representatives, and the democratic process.”

In recent years, the question of transgender children and their rights has consumed an outsized amount of rightwing political discourse. Since 2021, 26 states have passed bans on gender-affirming care for minors, affecting nearly 40% of trans youth in the US. Twenty-six states have also outlawed trans kids from playing on sports teams that correspond with their gender identity.

Many of these restrictions have been paused by court challenges, but the supreme court’s decision could have vast implications for those lawsuits’ futures. A study by the Trevor Project, a mental health nonprofit that aims to help LGBTQ+ kids, found that anti-trans laws are linked to a 72% increase of suicide attempts among trans and nonbinary youth.

Justice Sonia Sotomayor dissented from the majority opinion, alongside Justices Ketanji Brown Jackson and Elena Kagan. Because the law discriminates on the basis of sex, Sotomayor argued in her dissent, it should face higher legal scrutiny than the majority decided to give it.

“Male (but not female) adolescents can receive medicines that help them look like boys, and female (but not male) adolescents can receive medicines that help them look like girls,” 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.”