U.S. Supreme Court Shamefully Upholds Tennessee Ban on Gender-Affirming Medical Care for Trans Youth

The U.S. Supreme Court ruled yesterday to uphold Tennessee’s ban on gender-affirming health care for transgender youth. It’s an awful outcome that reveals the hypocrisy of conservatives’ talk about “parental rights”—but trans rights advocates are vowing to keep fighting.

The Ruling

The plaintiffs in U.S. v. Skrmetti were three families and their transgender children, plus one medical doctor. The court ruled 6 to 3 against them, saying that Tennessee’s ban on minors’ access to hormone therapies used to treat gender dysphoria is constitutional. Justice Sonia Sotomayor dissented, joined by Justices Elena Kagan and Ketanji Brown Jackson.

The ruling is legally questionable and flies in the face of every major medical association, including the American Medical Association and the American Psychological Association, which support access to gender-affirming hormone treatments. GLAD Law noted in a statement that such treatment is “backed by decades of research and relying upon the same safe and effective medications used to treat a range of other health issues for children and adults.”

That’s right. The treatments in question have been used to treat cisgender youth with various hormonal imbalances, affirming their genders, and the court says that’s fine. The only prohibition is on trans youth using them to affirm their genders. As Sotomayor pointed out in the dissent, that constitutes sex-based discrimination—but the majority failed to recognize that.

The Impact

I’ll leave further legal analysis to others (try Chris Geidner at Law Dork and Erin Reed at Erin in the Morning); let’s look here at the implications.

Samantha Williams, who was one of the plaintiffs in the case, along with her husband and their transgender teen daughter, wrote in the New York Times after the ruling:

I am beside myself. Our heartfelt plea was not enough. The compelling, expert legal arguments by our lawyers at the American Civil Liberties Union and Lambda Legal were not enough. I had to face my daughter and tell her that our last hope is gone. She’s angry, scared and hurt that the American system of democracy that we so put on a pedestal didn’t work to protect her.

They hadn’t intended to end up at the Supreme Court, she said, but:

We ended up there through parental and civic duty. My and my husband’s demands in our lawsuit against the ban felt quite basic: Let us do our job as parents. Let us love and care for our daughter in the best way we and our doctors know how. Don’t let our child’s very existence be a political wedge issue.

And she asked pointedly of the legislators who sponsored the Tennessee law, “What happened to all their rhetoric about parental rights?”

Indeed.

Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Project, who argued the case at the Supreme Court, called the ruling “a devastating loss for transgender people, our families, and everyone who cares about the Constitution.”

Andy Marra, executive director of Advocates for Trans Equality (A4TE), explained further in a statement:

This ruling will cause real harm for transgender children and families in Tennessee. Transgender youth who are denied access to evidence-based medical care will now face increased risk of depression, anxiety, and suicide.

Those harms could be multiplied as the ruling comes just a day after the Substance Abuse and Mental Health Services Administration (SAMHSA) officially began the closure of the 988 Suicide & Crisis Lifeline’s LGBTQ+ Youth Specialized Services program, effective July 17, 2025.

And Marra observed that the harm goes beyond just trans youth:

Parents and families who have done everything to provide care and support for their children are now being told by the Court that their children’s medical needs don’t matter and that their children should be treated as second-class citizens. A democratic government by and for the people should never undermine the needs of its most vulnerable—especially the needs of children and their families. It harms us all when government limits or erases children’s and families’ rights.

Some Limits

GLAD Law and the National Center for LGBTQ Rights (NCLR) remind us in a statement, however, that the decision “has no impact in states where health care for transgender youth is not currently banned.” It does not require states to ban such care. Nevertheless, 25 states do currently ban gender-affirming medical care (see the Movement Advancement Project) and more than 100,000 trans people under 18 now live in such a state, per UCLA’s Williams Institute.

Strangio observed, however:

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.

That offers a glimmer of hope—but make no mistake about how tough things are right now.

The Future and Fighting Back

The full extent of the fallout from this decision remains to be seen. What I do know is that trans people, particularly trans youth, need the support of us cis allies now more than ever. Whether that means checking in with a trans friend or friend whose kid is trans, writing to or calling your elected officials (and voting when it is time), supporting organizations working for trans rights with your time and/or money, I hope that we all do something, and keep doing something, until we have changed this blot on our nation’s history and fully embrace people of all gender identities and gender journeys.

Trans rights advocates are not giving up hope. As Strangio asserted:

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.