WASHINGTON — The Supreme Court on Wednesday upheld a Tennessee law restricting gender transition care for minors, delivering a major blow to transgender rights.

The 6-3 ruling is likely to have a broad impact as 24 other states have already enacted laws similar to the one in Tennessee, which bars gender transition surgery, puberty blockers and hormone therapy for youth.

Those laws now look set to survive similar legal challenges. The ruling does not affect states that do not have such bans, meaning care in those states will still be available.

The court was divided on ideological lines, with the six conservatives in the majority and the three liberals in dissent.

Writing for the majority, Chief Justice John Roberts concluded that the Tennessee law does not constitute a form of sex discrimination that would violate the Constitution’s 14th Amendment.

“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,” Roberts wrote. “The voices in these debates raise sincere concerns; the implications for all are profound.”

“The Equal Protection Clause does not resolve these disagreements,” he added.

Liberal Justice Sonia Sotomayor wrote in a dissenting opinion that contrary to the majority’s conclusion, the law does discriminate based on both sex and transgender status and should therefore be analyzed closely.

“By retreating from meaningful judicial review exactly where it matters most, the court abandons transgender children and their families to political whims,” she wrote. “In sadness, I dissent.”

Sotomayor also took the relatively unusual step of reading a summary of her decision from the bench in court, saying the impact of the decision is “incredibly dangerous.”

Trans rights activists have warned that a ruling allowing bans on care for trans minors could pave the way for similar restrictions aimed at adults.

“Today’s ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution,” Chase Strangio, a lawyer with the American Civil Liberties Union who represents the challengers, said in a statement.

Tennessee Attorney General Jonathan Skrmetti welcomed the decision as a win for “common sense over judicial activism.”

He added that legislators should give “careful scrutiny” before allowing such treatments, making judgments “based on science, not ideology.”

The legal challenge was brought by the administration of former President Joe Biden, as well as transgender teens and their families.

The ruling does not resolve all legal issues relating to the state bans, as it did not address a separate argument under the 14th Amendment that the laws violate the right of parents to make health care decisions for their children.

The court also did not rule on the question of whether laws that discriminate against transgender people are subject to what is called “heightened scrutiny,” meaning that judges should review them with a skeptical eye. But three of the conservative justices said transgender people are not a “suspect class,” meaning laws targeting them should not receive heightened scrutiny.

Other issues involving transgender rights, such as laws blocking transgender girls from participating in sports, are likely to reach the court in due course.

Upon taking office in January, President Donald Trump has set about unwinding Biden policies that sought to bolster transgender rights. Among other things, he signed an executive order seeking to restrict gender-affirming care for teenagers nationwide. A judge quickly blocked it.

Trump has also imposed new restrictions on transgender people serving in the military.

Enacted in 2023, the Tennessee law is among a wave of similar measures taken by states imposing restrictions on gender transition treatments. In defending its ban, the state’s lawyers pointed to similar measures taken in other countries, including in Europe.

Skrmetti emphasized in court papers the evolving debate over how best to treat minors diagnosed with gender dysphoria, the clinical term given to the distress people can experience when their gender identities are in conflict with the genders assigned to them at birth.

Major medical organizations say gender-affirming treatments are an effective way to treat gender dysphoria.

The challengers argued that the law is a form of sex discrimination that violates the 14th Amendment’s equal protection clause because the treatments at issue in the case — puberty blockers and hormone therapy — can be used in other situations.

The case marks the most significant ruling on transgender rights since the court in 2020, to the surprise of many, ruled that federal employment protections extend to gender identity, as well as sexual orientation.

The dispute reached the Supreme Court after the Cincinnati-based 6th U.S. Circuit Court of Appeals in 2023 rejected challenges to the Tennessee law and a similar measure in Kentucky.

A district court judge had blocked parts of the law, while concluding that the plaintiffs did not have legal standing to challenge the surgery ban. That provision of the law was not at issue before the Supreme Court.

CNN —

The Supreme Court on Wednesday upheld Tennessee’s ban on gender-affirming care for trans minors in a blockbuster ruling that will bolster efforts by conservative state lawmakers to pass and preserve other divisive laws targeting transgender Americans.

The 6-3 decision by a conservative majority is a major blow to the transgender community and its advocates at a critical time. Since 2020, Republican-led states around the country have passed a wave of laws regulating the lives of trans Americans, with a particular focus on minors. And President Donald Trump, who ran for reelection in part on ending the “transgender lunacy,” has taken several steps intended to roll back gains made by that community.

Roughly half of the nation’s states have bans similar to Tennessee’s. Federal courts have disagreed on the constitutionality of those laws, and the Tennessee case, filed by the Biden administration, was the first to reach the high court.

The court’s majority opinion was penned by Chief Justice John Roberts and joined by the other five members of the conservative wing. The three liberals dissented.

“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,” Roberts wrote. “The voices in these debates raise sincere concerns; the implications for all are profound. The Equal Protection Clause does not resolve these disagreements.”

Moving forward, under the court’s ruling, judges examining bans like Tennessee’s – and, potentially, other restrictive laws – will do so under the lowest standard of judicial review, meaning those other laws are more likely to be upheld by courts.

The court “abandons transgender children and their families to political whims,” Justice Sonia Sotomayor, a member of the court’s liberal wing, wrote in dissent, taking the rare step of reading from the bench. “In sadness, I dissent.”

The liberal wing argued that the court’s conservative majority had tied itself in knots trying to avoid earlier precedents that said laws affecting transgender Americans necessarily discriminated on the basis of sex.

“The majority refuses to call a spade a spade,” Sotomayor wrote. “Instead, it obfuscates a sex classification that is plain on the face of this statute, all to avoid the mere possibility that a different court could strike down SB1, or categorical healthcare bans like it.”

Sotomayor wrote that the court’s opinion does “irrevocable damage to the Equal Protection Clause and invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight.”

Tennessee Attorney General Jonathan Skrmetti, a Republican who argued the case at the court, described the outcome as a “common sense” win over “judicial activism.”

“This victory transcends politics,” he said. “It’s about real Tennessee kids facing real struggles. Families across our state and our nation deserve solutions based on science, not ideology.”

Groups advocating for transgender Americans decried the decision.

Chase Strangio, a lawyer with the American Civil Liberties Union who represents the minors challenging Tennessee’s law and who also argued in court, said in a statement that the ruling “is a devastating loss for transgender people, our families, and everyone who cares about the Constitution.”

Politics hovers over decision

The politics of the issue shifted while the case was pending on the Supreme Court’s docket. Since returning to power in January, Trump has attempted to remove transgender Americans from the military – the justices in early May allowed that policy to take effect – and the president signed an executive order barring nonbinary markers on US passports. Some polling has suggested softening support for transgender gains among Democrats, including on the issue of transgender girls playing on girls sports teams.

Tennessee’s SB 1 bans hormone therapy and puberty blockers for transgender minors in the state and imposes civil penalties for doctors who violate the prohibitions. It also bans gender-affirming surgeries, though that provision was not at issue in the case. The law took effect in 2023.

Specifically, the law prohibits providers from administering such care if the purpose is to enable “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex,” or treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”

SB 1 was initially challenged by three trans minors in Tennessee, their parents and a doctor in the state whose practice included treating minors for gender dysphoria. The Biden administration later joined that lawsuit, and lower federal courts came to differing conclusions as to the law’s constitutionality.

The case landed at the court weeks after Trump was reelected following an election cycle in which he amplified a pledge to further curtail civil rights for trans people during the closing days of his campaign. Shortly after taking office, Trump’s Justice Department told the high court that it was no longer backing the challengers to the Tennessee law, reversing the Biden Justice Department’s position in the case.

A slew of other GOP-led states have passed similar health care bans in recent years. Today, more than 110,000 teenagers live in states where restrictions on puberty blockers and hormone therapy exist, according to the Williams Institute at UCLA School of Law.

A divided court of appeals in Cincinnati in 2023 allowed the ban to take effect.

In the courtroom

Inside the courtroom, Roberts read excerpts of his opinion for seven minutes. The chief spoke in his usual flat, steady manner, with a tone that suggested things were straightforward: this isn’t a classification based on sex, he said, adding that the law drew lines based on age and medical use. He referred to medical studies, highlighting various risks with the treatments, and closed with an admonition that the question was a matter for lawmakers to hash out.

Sotomayor, reading her dissent, spoke for more than twice as long. She spoke emphatically and with urgency about the potential costs to trans youth and of the majority abandoning the crucial role of judicial review.

She repeated the line from her opinion that she was dissenting in “sadness.”

One of the key questions for the high court was whether the law discriminated based on sex – a finding that would trigger a tougher review by courts under the 14th Amendment. The Biden administration noted that a child born as a girl would be entitled to puberty blockers and estrogen under the state’s law for certain medical conditions, but a child born as a boy would not be entitled to those treatments to live as a female.

“That is sex discrimination,” the Biden administration told the Supreme Court.

The argument rested in part on a blockbuster decision in 2020 called Bostock v. Clayton County, which found that federal law prohibits workplace discrimination on the basis of sex “necessarily” also covers gay and transgender workers. That 6-3 decision divided conservatives on the court.

Tennessee countered its law was based on age, not sex, and prohibits the use of the drugs for the specific purpose of facilitating a gender transition. The state argued it had a compelling interest in “encouraging minors to appreciate their sex” and argued it is empowered to make decisions regulating medical treatments. That was an argument that appeared to find a receptive audience when the case was argued in December.

CNN Chief Supreme Court Analyst Joan Biskupic contributed to this report.

This story has been updated with additional details.

A U.S. Supreme Court decision released Wednesday about a Tennessee law that bans transgender health care for children could have impacts on groups challenging Florida‘s own law.

The U.S. Supreme Court in a 6-3 decision ruled that Tennessee’s law, which bans children from accessing hormone therapy and other medical interventions, isn’t sex discrimination and doesn’t violate the Equal Protection Clause in the Constitution.

The ruling means groups challenging similar laws targeting medical care for gender dysphoria could face an uphill battle in court.

Last year, a Florida federal judge struck down a state law that banned medical treatments for children with gender dysphoria, saying it was unconstitutional.

Florida appealed, and the case is still pending in court.

Here’s what to know about what the U.S. Supreme Court ruling could mean for Florida’s case.

What is the Florida law?

Florida’s law, passed in 2023 and pushed by Gov. Ron DeSantis, prohibits children from receiving treatments like puberty blockers, hormone therapy or sex reassignment surgeries for gender dysphoria.

That’s also what the Tennessee law does. But Florida’s law is broader.

Florida law also restricts how adults can receive medical treatment for gender dysphoria. Adults can get treatment from physicians only, not nurse practitioners or other health care providers.

A group of plaintiffs challenging Florida’s law have targeted the restrictions for adults along with the broad ban on children’s treatments.

How is it similar to and different from the SCOTUS case?

Plaintiffs’ lawyers argued Florida’s law is a violation of the Equal Protection Clause in the Constitution, saying it discriminates based on transgender status and sex.

In the Tennessee case, lawyers arguing against the state law made a similar argument. But the U.S. Supreme Court rejected it. The court sided with Tennessee, which argued that the laws were limiting access based on age and medical purpose, not sex discrimination.

But unlike in the case the U.S. Supreme Court weighed in on, the lawyers challenging Florida’s law have argued that the law deserves more scrutiny because it was motivated by anti-transgender animosity from lawmakers.

The federal judge that deemed Florida’s law unconstitutional agreed that dislike of transgender people motivated the law. Wednesday’s Supreme Court ruling noted that a law would deserve more scrutiny if it was motivated by unjust discrimination.

Moving forward, courts looking at Florida’s law will have to consider that separate argument, which has not yet been ruled on by any higher court.

What comes next?

In January, the 11th Circuit Court of Appeals heard arguments about the Florida ban.

During those arguments, one judge asked the state’s attorney if he thought the court should wait for “further legal developments from the Supreme Court.”

An attorney representing the state, Mohammad Jazil, said the court should wait, because “Florida’s law is nearly identical to Tennessee’s.”

It’s not clear when the court’s three-judge panel will issue its ruling in the case, or if attorneys on either side will ask to hold new arguments in light of the SCOTUS decision.

Attorney General James Uthmeier said on social media that the court decision was “a big win for common sense and an even bigger win for children.”

Simone Chriss, an attorney with Southern Legal Counsel challenging Florida’s law, said the court’s decision is “profoundly disappointing.”

She noted that because attorneys were able to establish that Florida’s law was motivated by anti-transgender animosity, the cases are different.

“While my heart is broken for the families impacted by this cruel order, rest assured that we will continue to litigate the cases challenging Florida’s trans healthcare bans and restrictions,” Chriss said in a statement.

On June 18, the Supreme Court issued its ruling in U.S. v. Skrmetti, affirming that anti-trans legislation banning gender-affirming care for minors is constitutional. The ruling allows laws banning this kind of evidence-based and medically necessary care in states like Tennessee (the state at the heart of the case) and Missouri to continue, meaning trans youth in these places cannot access gender-affirming treatments like puberty blockers and hormone therapy from in-state providers, depending on the details of their state’s ban. According to the Movement Advancement Project, 25 states currently have laws banning gender-affirming care for trans youth, and two more states specifically ban gender-affirming surgeries for trans youth. The ruling also comes after President Trump attempted to effectively ban gender-affirming care for trans people under age 19 via Executive Order, which was later blocked by a federal judge.

According to the Williams Institute at UCLA School of Law, more than 100,000 trans youth live in states with gender-affirming care bans. For them, this ruling could mean an end to or a significant barrier to care that they, their parents, and their doctors have deemed medically necessary. This, Dallas Ducar, a registered nurse and nurse practitioner, currently the executive vice president for Donor Engagement and External Relations at Fenway Health, who served as the founding President and CEO of Transhealth, says, violates the “fundamental right” of bodily autonomy.

“There are core healthcare principals that we as clinicians really adhere to, and also clear values that many people across the country agree with. We want to be trusted with our own healthcare decisions,” Ducar tells Teen Vogue. “That is a fundamental right. Politicians and judges should not interfere with healthcare decisions that belong between patients and doctors.”

Ducar stresses that gender-affirming treatments like puberty blockers and hormone therapy are safe and effective, and have been long used as treatment for both trans and cisgender children. Major medical associations agree that gender-affirming care is both appropriate and necessary for trans youth.

US v. Skrmetti: Teen at Heart of the Supreme Court’s Trans Health Care Case Calls It “Body Horror” What trans teens fear about U.S. v. Skrmetti, reported from the steps of the Supreme Court.

In an interview with Teen Vogue politics editor Lex McMenamin in late 2024, L.W., the trans teen who brought the Skrmetti case, called the idea that the state could regulate her medical care “body horror.”

“It’s a very terrifying thought that I could have to go off this medical care, because my dysphoria was horrible before [I started]. I was really isolated because of it, which tended to hurt my mental health,” she said. “Obviously, you’re not yourself. It’s real-life body horror, essentially: Body horror is a genre of horror that’s particularly terrifying because it’s about the lack of autonomy over your own body.”

If you’re a trans teen and you’re wondering exactly what this case may mean for you, Teen Vogue spoke to medical professionals to give you as much information as we can to navigate the days ahead.

What does this ruling mean for me?

If you live in a state where gender-affirming care is banned for trans youth (you can find a map here), you may face new challenges or continue to endure existing challenges in accessing the medical help you need. If you live in a state where a ban exists but has been blocked by a judge, those bans may now go into effect.

WASHINGTON – And now we wait.

The Supreme Court on May 15 heard its final case before adjourning for the summer, debating how hard it should be to challenge President Donald Trump’s policy initiatives, particularly his executive order ending the guarantee of birthright citizenship to virtually everyone born in the United States.

Their upcoming decision is one of nearly three dozen left for the court to hand down in the coming weeks.

Those opinions may not rise to the level of blockbusters from recent terms such as presidential immunity, overturning the constitutional right to an abortion, new tests for gun restrictions or upending affirmative action.

But some will have a major impact, particularly three big religious rights cases.

A freedom of religion term

“I think this is a big freedom of religion term,” said Jessica Levinson, a professor at Loyola Law School in Los Angeles.

The court’s 6-3 conservative majority is likely to continue its trend of siding with people who say their freedom of religion is being infringed upon over those who say there’s too much entanglement between the government and religion.

“This term, in many ways, is going to be the culmination of a number of cases that began eight to 10 years ago,” Levinson said.

While another major decision to come – whether states can ban gender affirming care for minors – is not about the free exercise of religion, it came to the court as part of the same cultural upheaval driving the religious rights case, said Michael Dorf, a professor at Cornell Law School.

“Certainly for the people who are involved in these cases, they see it as part of the same broader clash,” he said.

Moving in a more conservative direction, not charting a new legal course

Dorf agreed the coming decisions will likely be more of a continuation of past rulings, mostly in a very conservative direction, rather than the court charting a new course.

But there is a difference: the Trump administration.

“We’re living in pretty unprecedented circumstances given all of the ways in which the Trump administration is, at the very least, testing the boundaries of what is lawful,” he said.

That means the court’s decision on whether to limit the ability of judges to block Trump’s policies will be one of its most consequential, according to Dorf.

“If you think about any area where there’s an executive order,” Levinson said, “if federal judges don’t have the ability to stop that order from being implemented nationwide, that could significantly change the legal landscape.”

Here’s a look at what to expect.

Limiting challenges to Trump’s executive authority

Trump’s executive order limiting birthright citizenship has been put on hold by judges across the country who ruled it’s probably unconstitutional.

During the May 15 oral arguments, none of the justices voiced support for the Trump administration’s theory that the president’s order is consistent with the 14th Amendment’s citizenship clause and past Supreme Court decisions about that provision.

But several of the justices have expressed concern about the ability of one judge to block a law or presidential order from going into effect anywhere in the country while it’s being challenged.

It was unclear from the oral arguments how the court might find a way to limit nationwide – or “universal” – court orders and what that would mean for birthright citizenship and the many other Trump policies being challenged in court.

‘Spaghetti against the wall?’ Trump tests legal strategies as judges block his policies

Religious rights versus separation of church and state

Of the three religious rights cases, the biggest is the Catholic Church’s bid to run the nation’s first religious charter school. Although the court has previously allowed the use of vouchers for religious schools and said scholarship programs can’t exclude religious schools, this case could allow governments to establish and directly fund religious schools for the first time.

“That really does go beyond anything we’ve seen before,” Dorf said.

In the other religious rights cases, the court is likely to side with Catholic Charities in a dispute over when religious groups have to pay unemployment taxes. And the court’s conservative majority sounded sympathetic to Maryland parents who raised religious objections to having their elementary school children read books with LGBTQ+ characters.

The battle over transgender rights

Transgender rights cases were already making their way to the Supreme Court from state actions and now the Trump administration policies regarding transgender people will accelerate that trend. The court has already granted the administration’s emergency request that it be allowed to enforce its ban on military service by transgender people while that restriction is being challenged.

In one of the court’s biggest pending decisions, the justices will decide whether states can ban minors from receiving puberty blockers and hormone therapy. During December’s oral arguments, a majority seemed to agree states can do that.

But how they reach that conclusion will affect how much their decision applies to other transgender rights case including those about transgender athletes, whether health plans have to cover gender affirming care, where transgender inmates must be housed and if transgender people can serve in the military.

Implications for parental rights

While the court seems likely to rule against the parents challenging Tennessee’s ban on gender affirming care for minors, they sounded poised to back the Maryland parents who want their elementary school children excused from class when books with LGBTQ+ characters are being read.

And in a case about Texas’ requirement that websites verify users are 18 or over, one justice expressed her own parental frustration over trying to control what her children see on the internet. Justice Amy Coney Barrett, who has seven children, said she knows from personal experience how difficult it is to keep up with the content blocking devices that those challenging Texas’ law offered as a better alternative.

But while the justices were sympathetic to the purpose of Texas’ law, they may decide a lower court didn’t sufficiently review whether it violates the First Amendment rights of adults so must be reconsidered.

Gun cases could bring mixed results

In one of the court’s biggest decisions so far this year, a 7-2 majority upheld the Biden administration’s regulation of untraceable “ghost guns,” ruling that the weapons can be subject to background checks and other requirements.

But the court is expected to reject Mexico’s attempt to hold U.S. gunmakers liable for violence caused by Mexican drug cartels armed with their weapons. A majority of the justices sounded likely to agree with the gunmakers that the chain of events between the manufacture of a gun and the harm it causes is too lengthy to blame the industry.

Neither case is directly about the Second Amendment’s right to bear arms. The court is still deciding whether to take up next year two cases about that right – Maryland’s ban on assault-style weapons and Rhode Island’s ban on high-capacity magazines.

Planned Parenthood, but not abortion directly, is an issue

Unlike last year when the court considered two cases about abortion access, that hot button issue is not directly before the court. But the justices are deciding whether to back South Carolina’s effort to deprive Planned Parenthood of public funding for other health services because it also provides abortions.

The issue is whether the law allows a Medicaid patient to sue South Carolina for excluding Planned Parenthood from its Medicaid program.

If the court says the patient can’t sue, other GOP-led states are expected to also kick Planned Parenthood out of Medicaid. And anti-abortion advocates are pushing for the same action nationwide.

Conservative challenges to Obamacare and internet subsidies

The court is considering conservative challenges to Obamacare and to an $8 billion federal program that subsidizes high-speed internet and phone service for millions of Americans.

The justices seemed likely to reject an argument that the telecommunications program is funded by an unconstitutional tax, a case that raised questions about how much Congress can “delegate” its legislative authority to a federal agency.

The latest challenge to the Affordable Care Act takes aim at 2010 law’s popular requirement that insurers cover without extra costs preventive care such as cancer screenings, cholesterol-lowering medication and diabetes tests.

Two Christian-owned businesses and some people in Texas argue that the volunteer group of experts that recommends the services health insurance must cover is so powerful that, under the Constitution, its members must be appointed by the president and confirmed by the Senate.

It seems unlikely that a majority of the justices were persuaded by that argument.

Multiple discrimination challenges

The court is deciding a number of cases about alleged discrimination in the workplace, at school and in drawing congressional boundaries.

The justices appeared likely to rule that a worker faced a higher hurdle to sue her employer as a straight woman than if she’d been gay, a decision that would make it easier to file “reverse discrimination” lawsuits.

The court may also side with a Minnesota teenager trying to use the Americans with Disabilities Act to sue her school for not accommodating her rare form of epilepsy that makes it difficult to attend class before noon.

It’s less clear whether the court will agree with non-Black voters in Louisiana that the state’s congressional map, which includes two majority-Black districts, discriminates against them.

Decisions in all the cases are expected by the end of June or early July.