By Andrew Chung
WASHINGTON (Reuters) -The U.S. Supreme Court backed a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors on Wednesday in a setback for transgender rights that could bolster efforts by states to defend other measures targeting transgender people.
The court, in a 6-3 ruling powered by its conservative justices, decided that the ban does not violate the U.S. Constitution’s 14th Amendment promise of equal protection, as challengers to the law had argued. The ruling affirmed a lower court’s decision upholding Tennessee’s law barring medical treatments such as puberty blockers and hormones for people under age 18 experiencing gender dysphoria. The Supreme Court’s three liberal justices dissented.
“Tennessee concluded that there is an ongoing debate among medical experts regarding the risks and benefits associated with administering puberty blockers and hormones to treat gender dysphoria, gender identity disorder and gender incongruence. (The law’s) ban on such treatments responds directly to that uncertainty,” conservative Chief Justice John Roberts wrote for the majority.
The ruling will have a broad impact as Tennessee’s law is one of 25 such policies enacted by conservative state lawmakers around the United States. Various other state restrictions have been enacted in recent years targeting transgender people, from bathroom use to sports participation, some limited to minors but others extending to adults.
Liberal Justice Sonia Sotomayor expressed dismay that the court largely deferred to the state legislature’s policy choices in upholding the ban.
“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,” Sotomayor wrote, joined by fellow liberal Justices Elena Kagan and Ketanji Brown Jackson.
Gender dysphoria is the clinical diagnosis for significant distress that can result from an incongruence between a person’s gender identity and the sex assigned at birth.
The dispute over transgender rights and Tennessee’s ban required the Supreme Court to confront a major flashpoint in the U.S. culture wars. Since returning to office in January, Republican President Donald Trump has taken a hardline stance against transgender rights.
The Justice Department under Democratic former President Joe Biden’s administration had challenged the law. Trump’s administration told the Supreme Court in February that Tennessee’s ban was not unlawful, reversing the position taken by the government under Biden.
Tennessee’s law, passed in 2023, aims to encourage minors to “appreciate their sex” by prohibiting healthcare workers from prescribing puberty blockers and hormones to help them live as “a purported identity inconsistent with the minor’s sex.”
Providers can be sued and face fines and professional discipline under the law for any violations. The law allows these medications to be used for any other purpose, including to address congenital defects, early-onset puberty or other conditions.
Tennessee Attorney General Jonathan Skrmetti welcomed Wednesday’s ruling, saying that the state legislature had “voted to protect kids from irreversible decisions they cannot yet fully understand.”
“In (Wednesday’s) historic Supreme Court win, the common sense of Tennessee voters prevailed over judicial activism,” Skrmetti added.
Several plaintiffs – three transgender minors and their parents, as well as a doctor who provides the type of care at issue – sued to challenge the Tennessee law’s legality. They were represented by the American Civil Liberties Union and LGBT rights group Lambda Legal. Biden’s Justice Department subsequently intervened in the lawsuit, opposing Tennessee’s law.
The challengers argued that the law discriminates against these adolescents based on sex and transgender status, violating the 14th Amendment.
‘DIGNITY AND EQUALITY’
ACLU lawyer Chase Strangio called Wednesday’s ruling “a devastating loss for transgender people, our families and everyone who cares about the Constitution.”
“We are as determined as ever to fight for the dignity and equality of every transgender person,” Strangio added.
The ruling will cause real harm by “letting lawmakers target young people for being transgender,” National Center for LGBTQ Rights Legal Director Shannon Minter said.
Tennessee has said it is banning “risky, unproven gender-transition interventions,” pointing to “scientific uncertainty,” tightened restrictions in some European countries and “firsthand accounts of regret and harm” from people who discontinue or reverse treatments.
Tennessee state lawmaker William Lamberth, a Republican who was a lead sponsor of the measure, said after the ruling: “For too long, the Left labeled these harmful drugs and barbaric procedures as ‘gender-affirming care,’ refusing to acknowledge they are unproven, irreversible and come with life-altering disfigurement.”
Medical associations, noting that gender dysphoria is associated with higher rates of suicide, have said gender-affirming care can be life-saving, and that long-term studies show its effectiveness.
Lucas Cameron-Vaughn, a lawyer at the ACLU of Tennessee, said, “This ruling creates a class of people who politicians believe deserve healthcare, and a class of people who do not.”
A federal judge blocked the law as likely violating the 14th Amendment but the Cincinnati-based 6th U.S. Circuit Court of Appeals later reversed the judge’s preliminary injunction.
In a June 11-12 Reuters/Ipsos poll of Americans, 53% of respondents said they supported “laws that prevent transgender children under the age of 18 from getting medical treatment related to gender identity and gender transitioning.” Another 28% opposed such laws and the rest were unsure or did not answer the question. Among Republicans, support for such laws was at 57% and opposition at 28%. Among Democrats, support was at 23% and opposition at 54%.
The Supreme Court on May 6 permitted Trump’s administration to implement his ban on transgender people in the military while legal challenges play out. Trump since returning to office has taken actions targeting “gender ideology” and declaring that the U.S. government will recognize two sexes: male and female. Trump issued executive orders curtailing gender-affirming medical treatments for youth under 19 and excluding transgender girls and women from female sports, while rescinding Biden’s orders combating discrimination against gay and transgender people.
(Reporting by Andrew Chung in Washington; Additional reporting by John Kruzel in Washington and Jonathan Allen in New York; Editing by Will Dunham)
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