The U.S. Supreme Court on Wednesday upheld a ban on medical interventions for transgender minors in Tennessee, with the three liberal justices dissenting in a ruling that will shield similar laws that block or restrict access to care in more than 20 other states.

Conservative Chief Justice John Roberts, writing for the majority, said questions about the “safety, efficacy, and propriety of medical treatments” should be resolved democratically. 

Liberal Justice Sonia Sotomayor argued, in her opinion, that the decision “authorizes, without second thought, untold harm to transgender children and the parents and families who love them,” adding that “Because there is no constitutional justification for that result, I dissent.”

Plaintiffs who challenged Tennessee’s ban were a doctor and three families argued that the policy violated the Equal Protection Clause of the 14th Amendment. 

They also emphasized that the care prohibited for minors in the state — puberty delaying medication, hormone therapy, and surgeries — is made available to patients younger than 18 if they are sought for reasons other than gender transitions.

The case, U.S. v. Skrmetti, was among the most anticipated of the court’s June term.

President Donald Trump in February formally reversed course from the Biden-Harris administration’s support for the plaintiffs challenging the Tennessee law, urging the Supreme Court to uphold the ban.

Attorneys, Democratic lawmakers, and medical groups object to the ruling

Representing the plaintiffs in the litigation challenging the ban were the Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Project, Lucas Cameron-Vaughn, senior staff attorney at the ACLU of Tennessee, Karen Loewy, director of constitutional law practice at Lambda Legal, Jennifer Levi, senior director of transgender and queer rights at GLAD Law, Shannon Minter, legal director of the National Center for Lesbian Rights, Sasha Buchert, counsel and director of the Nonbinary and Transgender Rights Project at Lambda Legal, and attorneys with the firm Akin Gump.

“Today’s ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution,” said Strangio, who is the first trans lawyer to argue before the Supreme Court. “Though this is a painful setback, it does not mean that transgender people and our allies are left with no options to defend our freedom, our health care, or our lives.”

“The Court left undisturbed Supreme Court and lower court precedent that other examples of discrimination against transgender people are unlawful,” Strangio said. “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.”

“This is a heartbreaking ruling, making it more difficult for transgender youth to escape the danger and trauma of being denied their ability to live and thrive,” said Buchert. “But we will continue to fight fiercely to protect them. Make no mistake, gender-affirming care is often life-saving care, and all major medical associations have determined it to be safe, appropriate, and effective. This is a sad day, and the implications will reverberate for years and across the country, but it does not shake our resolve to continue fighting.”

“The Court today failed to do its job,” said Levi. “When the political system breaks down and legislatures bow to popular hostility, the judiciary must be the Constitution’s backbone. Instead, it chose to look away, abandoning both vulnerable children and the parents who love them. No parent should be forced to watch their child suffer while proven medical care sits beyond their reach because of politics.”

“The Court’s ruling abandons transgender youth and their families to political attacks. It ignored clear discrimination and disregarded its own legal precedent by letting lawmakers target young people for being transgender,” said Minter. “Healthcare decisions belong with families, not politicians. This decision will cause real harm.”

In a press conference on Capitol Hill, Senate Democratic Leader Chuck Schumer (N.Y.) told reporters, “This Supreme Court seems to have forgotten that one of their jobs is to protect individual rights and protect individuals from being discriminated against. It’s an awful decision.”

“On the floor, we had a bill, that the Republicans wanted to take away these rights,” Schumer said. “And we got, I believe, every Democrat voting against it. So it failed because it needed 60 votes. So we’re going to explore every solution.” 

U.S. Rep. Pramila Jayapal (D-Wash.) also hosted a press conference, arguing that the court’s decision — and conservative-led efforts to restrict the rights and freedoms of transgender people more broadly — is of a piece with the Republican Party’s broader policy agenda, particularly in Trump’s second term.

In 2019, the congresswoman shared that her daughter, then 22, was trans. When asked on Wednesday whether her staunch opposition to the ruling was both professional and personal, Jayapal said, “I’m not speaking about my personal situation these days” but her family aside, “it’s also personal to me as a member of Congress that represents families who are experiencing the same kinds of issues and the same kind of fear that I hear from people across the country.”

She added, “And so I think what’s important is to recognize that trans people are a tiny percentage of the country and are doing no harm to anyone else. And despite the disinformation, the lies that are being circulated about trans people, I think that we are powerful when we come together, when we realize that these attacks are coordinated and are really about the same thing, which is exerting power over us and taking away our rights in a democracy that should be about allowing everyone to contribute their full selves.”

U.S. Sen. Ed Markey (D-Mass.) said: “Today, hate won. The far-right justices of the Supreme Court endorsed hate and discrimination by delivering a win for Republicans who have relentlessly and cruelly attacked transgender Americans for years. With 25 states already having laws in place that ban gender-affirming care for trans youth, the Supreme Court has cleared the way for families in half of the country to no longer access the medically necessary and life-saving care they need for their children.”

The senator continued, “But here is what no Court nor politician can ever change: trans people will continue to exist. Their health care is lifesaving and essential, and trans rights are human rights. We have a fight ahead of us, but discrimination and hate cannot and must not win.” 

U.S. Sen. Jeff Merkley (D-Ore.) said: “Access to medically-necessary care for trans youth saves lives, and the U.S. Supreme Court’s callous decision puts trans youth and their families at risk.

“MAGA extremists across the nation will not stop at banning medically-necessary gender-affirming care for trans youth. The Court’s life-altering decision lays out the playbook for extremist politicians to continue their crusade against trans people and further exclude them from daily life. And this is just the beginning—this decision opens the floodgates for MAGA extremists in state legislatures and Congress to ban medically-necessary care, from gender-affirming care to abortion access.

“This is just wrong—everyone should have access to the care they need, when they need it. No exceptions.

“Let’s get politicians out of the exam room. We will continue to fight these divisive policies in communities nationwide to fully realize the vision of America as a land of freedom and equality for all, and I won’t rest until my Equality Act is signed into law to deliver on this fundamental promise.”

“Today’s decision by the Supreme Court is devastating for young transgender Americans and their families who live in states that decide to put divisive and dehumanizing politics over people,” said U.S. Rep. Mark Takano (D-Wis.), chair of the Congressional Equality Caucus.

“The Court’s ruling upholding Tennessee’s cruel and politically-motivated ban on medically-necessary care for young trans people undermines the ability of transgender patients, their families, and doctors to make medical decisions about accessing evidence-based care without politicians’ interference,” he said.

The congressman added, “The law the Court upheld is an attack on some of the most vulnerable in our community—but we still have other tools to challenge anti-trans laws in courts across the country. As Chair of the Equality Caucus, I am committed to continuing to lead elected officials from across the country in the fight for full equality for transgender people under the law here in Congress.”

“Every parent wants to keep their child healthy. Parents and trans young people have the right to make private health care decisions with their doctors. Today’s ruling allowing Tennessee politicians to interfere in private health care decisions is not only draconian, it’s dangerous and hateful,” said U.S. Rep. Becca Balint (D-Vt.). “I want families who are feeling scared today about the consequences of this decision to know that I’m with you. I’m fighting for you in Congress every single day, and I will not back down.” 

Jayapal, Markey, Merkley, Takano, and Balint were among the 164 members of Congress who filed an amicus brief urging the court to preserve access to care.

New York Attorney General Letitia James also released a statement: “At a time when LGBTQ+ communities are under relentless attack, this decision is dangerous and a profound disappointment. Gender-affirming care is essential and lifesaving health care, and denying young people access to it will have devastating consequences.

“Let me be clear: gender-affirming care remains legal and protected in New York, including for young people.

“To the transgender community in Tennessee and across the country: We stand proudly with you. We are strongest together, and we will not let this decision weaken our resolve to build a safer, more just, inclusive, and compassionate nation for all.”

Also issuing a statement was a coalition of seven medical associations that had submitted an amicus brief supporting the plaintiffs — American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Psychiatric Association, Endocrine Society, the National Association of Pediatric Nurse Practitioners, and the American Pediatric Society.

The organizations said:

“As experts dedicated to providing patients with compassionate, evidence-based care every day, we are disappointed in the United States vs. Skrmetti decision, which increases the likelihood that other states will limit or eliminate families’ and patients’ ability to access medical care.

“As doctors, nurse practitioners, and nurses, we believe that every patient is different. Decisions about medical care must be based on individualized assessments by qualified professionals in consultation with the patient and their parents or legal guardians and guided by well-designed medical evidence. This Supreme Court decision strips patients and families of the choice to direct their own health care.

“Every patient should have access to the medical care they need. Health care professionals must be able to rely on their training, education, and expertise to provide appropriate care based on the needs and values of each patient and their family, without bans or interference.”

LGBTQ and civil rights advocacy groups object to the ruling

Allison Scott, president of the Campaign for Southern Equality, said ““I am heartbroken today. No one should be forced to leave their home state to access healthcare – and it is outrageous to see the U.S. Supreme Court uphold these bans and continue to allow the government to interfere with the personal medical decisions of families.”

“The Court’s ruling can’t change what we know in our bones: our identities, our families, and our lives are strong, worthy, and not up for debate by extremists,” she said. “The Trans Youth Emergency Project will be here to help families navigate this painful time.” 

“Today, the Supreme Court took the place of parents and doctors and stripped away their ability to make private, lifesaving decisions for their children,” said GLAAD President and CEO Sarah Kate Ellis. “This ruling is a chilling step toward unchecked government overreach, intruding on the most personal aspects of our private lives.”

She added, “All families are now less safe and left vulnerable to politicians and a Court that has abandoned its duty to protect personal liberties. Every family deserves the freedom to make the medical decisions that help their children live, thrive, and be well.”

“This is a devastating and deeply dangerous decision that carries irreversible harm to transgender youth and their families. The majority’s opinion politicizes decades of medical consensus, ignores the Constitution’s mandate of equal protection, and turns its back on youth and their families,” said Skye Perryman, president and CEO of Democracy Forward.

“Our team at Democracy Forward will continue to work every day to support transgender people, including young people, their families, and communities, and we will never give up making the Constitution’s guarantee of equal protection under the law a reality for all people,” she said.

National LGBTQ Task Force President Kierra Johnson said: “Gender affirming care can mean the difference between life and death for our transgender youth. Today, the Supreme Court rejected the science and authorization of gender affirming care, upheld harmful bans, and denied the lived experiences of trans youth.   

“The Supreme Court has now rolled back critical protections against discrimination on the basis of sex. This is an especially devastating moment for transgender youth, their parents and their doctors across the country. Tennessee’s ban on essential medical care — and other similar state bans — will continue to wreak havoc on the lives of these families.  

“What we know is this: transgender youth denied access to appropriate medical care are in danger of worse physical and mental health outcomes.  

“Americans look to the Supreme Court as the highest court of the land, making decisions with long term impact in these critical times; decisions that speak to the value certain communities. Transgender youth are often overlooked, undervalued, and lack the protection that they deserve as both minors and transgender community members. Gender dysphoria impacts more than the physicality of a person and, when left untreated, may result in anxiety and depression. When there is no legal doctrine that speaks to pertinence of gender affirming care, it shows that the law is not on their side, discrediting and disenfranchising a community while obliterating their humanity. ”

Imara Jones, CEO of TransLash Media, said: Today the Supreme Court used the greatest hits of discredited anti-trans, pseudoscientific ideas in order to rule against the equal access of trans kids to healthcare. This is healthcare that is safe, supported by every mainstream medical association, and which is granted with the consent of youth’s parents.  

“Moreover, the Court could only issue such a ruling by overlooking the obvious: The denial of equal access to healthcare for trans kids is sex discrimination. Gender-affirming treatments are allowed for some children but not others under the Tennessee law SB1, which explicitly states as one of its goals to encourage minors to ‘appreciate their sex.’

“So what they did here is the equivalent of denying a person’s race, in order to declare that racial discrimination laws don’t apply.

“Now, while the Skirmetti ruling is not as sweeping as it could have been, because it leaves the door open to future cases on sports and bathrooms, it will likely turbocharge attempts to exempt trans people from Constitutional protections. What the court has done is give these efforts the sheen of judicial legitimacy, and a road map for how to do so, by directing them to leave out the explicit targeting of trans people. 

“Because as long as the attempts to push trans people outside of the bounds of public life using the law are implicit, then governmental entities have free reign to do so, now.

“The success of manipulating legal, scientific, and media organizations with anti-trans disinformation by Christian Nationalist and authoritarian entities is crystal clear in this decision.”

“LPAC is devastated that the Supreme Court has turned away from experts like the American Academy of Pediatrics and hard data showing that health care for trans youth improves physical and mental health, and instead succumbed to political pressure,” said Janelle Perez, executive director of LPAC. “This cruel decision opens the floodgates for politicians to decide what we and our children need to be healthy. These are decisions that should be made by families and healthcare providers, not politicians.”

Human Rights Campaign President Kelley Robinson said: “Today’s Supreme Court decision is a devastating blow to transgender youth and the families who love them, but it will not break our resolve. Families may now have to make the heartbreaking choice to leave their state or split their families, or take on extensive financial burdens, in order to ensure that their kids can access medically necessary care. 

“This Court chose to allow politicians to interfere in medical decisions that should be made by doctors, patients, and families—a cruel betrayal of the children who needed them to stand up for justice when it mattered most.

“As parents, advocates, and community leaders, we know that our fight doesn’t end in courtrooms—it lives in our communities, our hearts, and our unwavering commitment to each other. Still, we will not be deterred. We will support families forced to make impossible choices, fund legal challenges, and build a movement so powerful that no politician can ignore us. Together, we will turn this pain into power and keep fighting until every transgender person in America can live with dignity, safety, and the freedom to be who they are.”

Tennessee AG and Log Cabin Republicans celebrate the ruling

Tennessee Attorney General Jonathan Skrmetti said, “In today’s historic Supreme Court win, the common sense of Tennessee voters prevailed over judicial activism. A bipartisan supermajority of Tennessee’s elected representatives carefully considered the evidence and voted to protect kids from irreversible decisions they cannot yet fully understand.”

The AG continued, “I commend the Tennessee legislature and Governor Lee for their courage in passing this legislation and supporting our litigation despite withering opposition from the Biden administration, LGBT special interest groups, social justice activists, the American Medical Association, the American Bar Association, and even Hollywood.”

Log Cabin Republicans interim executive director Ed Williams released the following statement: 

“The U.S. Supreme Court just upheld Tennessee’s law prohibiting trans medical surgeries and treatments for minors. This decision is not ‘anti-trans.’ It is a historic and critical win for children and common-sense. The majority of Americans support equal treatment for trans Americans and protections from discrimination. They also back laws like Tennessee’s, which protect children from receiving life-altering and irreversible medical procedures or treatments often pushed on them by a zealous cabal that views children as pawns in their gender ideology crusade.

“LGBT conservatives have long believed there is a middle-road that upholds respect, inclusion, and protection for trans Americans while curbing the excesses of a radical political movement attempting to push its bizarre agenda in sports, schools, governments, and hospitals. Today’s Supreme Court is a step in the right direction.”

The Washington Blade will update this story.