WASHINGTON — The Supreme Court ruled Wednesday that states may ban hormone treatments for transgender teens, rejecting the claim that such gender-based discrimination is unconstitutional.
In a 6-3 decision, the justices said states are generally free to decide on proper standards of medical care, particularly when health experts are divided.
Chief Justice John G. Roberts, writing for the court, said the state decides on medical regulations. “We leave questions regarding its policy to the people, their elected representatives, and the democratic process,” he said.
In dissent, Justice Sonia Sotomayor said the law “plainly discriminates on the basis of sex… 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.” Justices Elena Kagan and Ketanji Brown Jackson agreed.
The ruling upholds laws in Tennessee and 23 other Republican-led states, all of them adopted in the past four years.
Tennessee lawmakers said the number of minors being diagnosed with gender dysphoria had “exploded” in recent years, leading to a “surge in unproven and risky medical interventions for these underage patients.”
California and other Democratic-led states do not prohibit doctors from prescribing puberty blockers or hormones for those under age 18 who are diagnosed with gender dysphoria.
While the court’s ruling in the Tennessee case should not directly affect California’s law, the Trump administration seeks to prevent the use of federal funds to pay for gender affirming care.
This could affect patients who rely on Medicaid and also restrict hospitals and other medical clinics from providing hormones and other medical treatments for minors.
Wednesday’s decision highlights the sharp turn in the past year on trans rights and “gender affirming” care.
Solicitor Gen. Elizabeth Prelogar, representing the Biden administration, had appealed to the Supreme Court in November 2023, and urged the justices to strike down the red-state laws.
She spoke of a broad consensus in favor of gender affirming care. It was unconstitutional, she argued, for states to ban “evidence-based treatments supported by the overwhelming consensus of the medical community.”
But Republican lawmakers voiced doubt about the long-term effect of these hormone treatments for adolescents.
Their skepticism was reinforced by the Cass Report from Britain, which concluded there were not long-term studies or reliable evidence in support of the treatments.
Trans-rights advocates argued the court should have deferred to parents and their doctors, not state lawmakers.
“The court today failed to do its job,” said Jennifer Levi, GLAD Law senior director of transgender and queer rights. “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.”
Lawyers for Lambda Legal and the ACLU called it “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.”
“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,” said Sasha Buchert, a Lambda attorney.
Upon taking office in January, President Trump targeted transgender people without specifically mentioning them.
He said his administration would “recognize two sexes, male and female. These sexes are not changeable and are grounded in fundamental and incontrovertible reality.”
His administration later said its ban on gender affirming care for minors would extend to medical facilities receiving federal funds.