Supreme Court Justice Sonia Sotomayor issued a bitter dissent Wednesday, reading it aloud from the bench after the Supreme Court upheld a Tennessee law that bans gender-affirming care for minors on a 6-3 vote.
“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,” said Sotomayor.
“Transgender adolescents’ access to hormones and puberty blockers (known as gender-affirming care) is not a matter of mere cosmetic preference. To the contrary, access to care can be a question of life or death.”
Transgender people already have to contend with structural discrimination, noted Sotomayor, because they’re extremely underrepresented in government and therefore unable to use political power to ward off discriminatory treatment.
The justice reserved particular scrutiny, however, for a provision of Tennessee’s law, known as SB 1, that hypocritically permits doctors to prescribe gender-affirming care to children to align their physical appearance with their sex assigned at birth ― but not the opposite.
“Physicians in Tennessee can prescribe hormones and puberty blockers to help a male child, but not a female child, look more like a boy; and to help a female child, but not a male child, look more like a girl,” she explained.
“Put in the statute’s own terms, doctors can facilitate consistency between an adolescent’s physical appearance and the ‘normal development’ of her sex identified at birth, but they may not use the same medications to facilitate ‘inconsisten[cy]’ with sex.”
Tennessee had argued that SB 1 doesn’t rise to the level of discrimination based on sex (which is illegal) because it doesn’t explicitly target trans people; instead, it prohibits medical care for minors on an age and use-related basis while encouraging “minors to appreciate their sex.”
A 2025 study in JAMA Pediatrics found that only 0.1% of transgender teens with private insurance received puberty blockers or hormone treatments.
Sotomayor called out her fellow justices for failing to “call a spade a spade” and acknowledge that SB 1 clearly contains a sex classification, which is protected under Title VII of the Civil Rights Act.
The justice said the court’s willful ignorance of that fact “does irrevocable damage to the Equal Protection Clause” and invites state legislatures to “engage in discrimination by hiding blatant sex classifications in plain sight.”
“It also authorizes, without second thought, untold harm to transgender children and the parents and families who love them,” she said in closing. “Because there is no constitutional justification for that result, I dissent.”
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