Updated June 18, 2025 at 5:53 PM EDT
The U.S. Supreme Court on Wednesday upheld laws in roughly half the states that ban gender affirming medical care for transgender minors. The vote was 6-3, along ideological lines.
The case was brought by transgender children and their parents in Tennessee who claimed that the state's ban on hormone treatments and puberty blockers for transgender minors discriminated on the basis of sex. They contended that they were being denied equal protection of the law because the same medications that are banned for minors with gender dysphoria, are permitted for other minors with conditions such as endometriosis and early or late onset puberty.
But writing for the conservative court's supermajority, Chief Justice John Roberts rejected that argument entirely.
He said that laws like Tennessee's that turn on age or medical use, are not subject to the kind of heightened legal scrutiny that courts use to look at workplace sex discrimination, for instance. Instead, the court applied the lowest level of legal scrutiny, called rational basis, meaning that if there is any rational justification for the law, it passes constitutional muster.
Acknowledging what he called "the fierce scientific and policy debates about the safety, efficacy and propriety of medical treatments in an evolving field," Roberts said that it is not the court's job to judge "the wisdom or fairness" of Tennessee's law.
The court's job, he said, is only to determine whether the law violates the constitution's guarantee of equal protection of the law. Having concluded that the law does not unconstitutionally discriminate, he said, the court leaves these policy questions "to the people, their elected representatives, and the democratic process."
Reaction to the decision was swift. "There's no sugar coating this opinion," said Jennifer Levi, a senior director at GLAD Law, an advocacy organization for LGBTQ rights. "It means that in more than half the states where the care is banned, families won't be able to get the care that their children need."
"The court really abdicated its responsibility to protect a vulnerable group," she added.
In a rare dissent, read from the bench, Justice Sonia Sotomayor echoed that sentiment. Because the Tennessee law explicitly classifies its ban on the basis of sex and transgender status, she said, both the constitution and precedent require that the court subject the law to a higher level of scrutiny.
Instead, she said, the majority "contorts logic and precedent to say otherwise," retreating from meaningful judicial review "exactly when it matters most."
To make her point, Sotomayor noted that judicial scrutiny has long played an essential role in guarding against legislative efforts to impose the state's view on how people of a particular race or sex should live, or look or act. Pointing to what she called a "hauntingly familiar passage" in Virginia's 1967 brief defending its ban on interracial marriage, Sotomayor noted that the court did not "defer to the wisdom of the state legislature." Indeed, the court's 1967 landmark ruling struck down the ban on interracial marriage.
Contrary to that decision, she said that the court now abandons children and their families to "political whims," adding, "In sadness, I dissent."
Joining her in full was Justice Ketanji Brown Jackson. Justice Elena Kagan partially joined. She too would have required a higher level of scrutiny, but she would have stopped there. Given the extensive, and disputed evidence presented in the lower courts, she said, the court should have sent the case back down to determine whether the state law was based on stereotypes and prejudices or legitimate state interests.
While the court's majority opinion gave states broad powers to ban or regulate transgender medical care for minors, it left unresolved a number of questions that very likely will reach the Supreme Court next term.
Among them is a challenge to the Trump administration's ban on transgender people in the military, and a challenge to the administration's policy denying passports for transgender individuals, unless they list as their gender as their sex at birth.
Also not resolved by Wednesday's ruling are cases involving bans on transgender participation in school sports. Federal law bars discrimination based on sex in any education program or activity that receives federal funding.
John Bursch, who argued and won the case on behalf of the conservative Alliance Defending Freedom said that "about half the states have adopted laws that prohibit boys who identify as girls from participating in girls sports teams."
As he noted, two of those cases are currently pending before the Supreme Court.
Farther down the road is another question — whether states can ban medical care for transitioning adults.
"I think there would be a rational basis to also prohibit it for adults, and that would be up to the states to decide," said Bursch.
The court will be back Friday with more opinions.
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