In her dissent, Justice Sotomayor said the Supreme Court “abandons transgender children and their families to political whims.”
Families speak out for transgender youth at Supreme Court
Families of transgender youth tells how their lives could change if Supreme Court bans gender-affirming care.
WASHINGTON — An ideologically divided Supreme Court on June 18 upheld Tennessee’s ban on gender-affirming care for minors, a major setback for transgender Americans who have increasingly become targets of conservative states such as Iowa and the Trump administration.
The court’s six conservative justices upheld the ban, and the three liberals dissented.
The ruling likely will have big repercussions in Iowa, which in 2023 passed laws banning Iowa doctors from providing gender-affirming care to transgender minors and barring transgender students from using school bathrooms that align with their gender identity.
The Supreme Court decision — one of the court’s biggest this year — came about five years after the court ruled that transgender people, as well as gay and lesbian people, are protected by a landmark civil rights law barring sex discrimination in the workplace.
But in this case, the court said that preventing minors from using puberty blockers and hormone therapy does not violate the equal protection clause of the 14th Amendment, which requires the government to treat similarly situated people the same.
“Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process,” Chief Justice John Roberts wrote for the majority.
In her dissent, Justice Sonia Sotomayor said the court retreated “from meaningful judicial review exactly where it matters most,” and “abandons transgender children and their families to political whims.”
Tennessee Attorney General Jonathan Skrmetti called the decision a “landmark victory … in defense of America’s children.”
The Biden administration and the Tennessee families that challenged the law argued it discriminated against transgender people because a teenager whose sex assigned at birth is male may be given testosterone to treat delayed puberty. But a teenager assigned female at birth who wants testosterone to treat gender dysphoria may not have it.
Tennessee countered that the treatments have different risks and benefits when used by transgender youth, who need to be protected from life-altering consequences.
The Supreme Court agreed, saying the law is removing one set of diagnoses − gender dysphoria − from the range of treatable conditions, not excluding people from treatment because they’re transgender.
After the case was argued in December, the Justice Department under President Donald Trump told the court it was no longer challenging Tennessee’s law.
Trump made opposition to transgender rights a central theme of his campaign.
The issue, a major flashpoint in the culture wars, gained prominence with startling speed, despite the tiny – though increasing – fraction of Americans who are transgender.
More states, including Iowa, ban gender-affirming care for kids
Since 2022, the number of states taking steps to limit access to gender-affirming care for minors grew from four to about half.
States have also taken steps to restrict the bathrooms transgender students can use, what sports teams they can join. and whether they can change the sex designation on their birth certificates.
Iowa has been among them.
In March 2023, Iowa Gov. Kim Reynolds signed bills into law prohibiting Iowa doctors from prescribing puberty blockers or cross-sex hormones to transgender minors, and also preventing transgender people from using school restrooms or locker rooms that do not align with their sex at birth.
The Iowa law forbids health care professionals from prescribing transgender minors medication to delay the onset of puberty or any cross-sex hormones, such as estrogen or testosterone.
Doctors in Iowa are also forbidden from performing surgeries on minors that sterilize or reconstruct genitalia to differ from the individual’s sex at birth. Surgeries to remove “any healthy or nondiseased body part or tissue” are prohibited, if the surgeries are meant to affirm a transgender child’s gender that differs from their sex.
Medical procedures on children’s genitalia that are unrelated to affirming a transgender child are legal in Iowa, including circumcisions.
One Iowa, a statewide group that lobbies for LGBTQ equality, issued a statement saying the Supreme Court’s upholding of laws banning gender-affirming care for children will have “devastating implications.” The ruling, it said, disregards the opinions of “leading medical experts and organizations, including the American Medical Association, American Psychiatric Association and the American Academy of Pediatrics, that understand that gender affirming care is medically necessary for transgender youth.”
One Iowa Executive Director, Max Mowitz, called it “a dark day for our country.”
“One Iowa stands in solidarity with trans and nonbinary youth everywhere who will be harmed because of this ruling. Our community deserves better,” Mowitz said in a statement.
“In our work, we know that medical care for minors is vital to transgender youths’ health and well-being. This ruling sends the message that the needs of transgender youth are irrelevant to the whims and unfounded opinions of lawmakers, not doctors, medical experts or parents. This medical care saves lives.”
Families of transgender children appeal laws
When families with transgender children challenged bans on gender-affirming care, district courts largely sided with them and blocked enforcement. But three appeals courts upheld the laws, including the Cincinnati-based 6th U.S. Circuit Court of Appeals.
Tennessee’s law was the first to reach the Supreme Court.
During the December oral arguments, several of the conservative justices voiced support for taking a similar approach to what the court did when it overturned Roe v. Wade, finding there’s no constitutional barrier to the issue at hand and leaving it up to state and federal legislatures to decide.
“My understanding is the Constitution leaves that question to the people’s representatives, rather than to nine people, none of whom is a doctor,” Chief Justice John Roberts said during December’s debate.
The court’s liberal justices had argued that the court can’t ignore constitutional protections, particularly for the vulnerable.
“That’s a question for the court,” Justice Ketanji Brown Jackson said.
Gender-affirming care for minors is supported by every major medical organization, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association.
But the court’s conservative justices focused more on the fact that some European countries have tightened restrictions on the treatments. England’s National Health Service, for example, stopped prescribing the drugs outside of clinical trials after a review concluded more data is needed to help doctors and their patients make informed decisions.
“Recent developments only underscore the need for legislative flexibility in this area,” Roberts wrote.
The case is U.S. v. Skrmetti.
The Des Moines Register contributed to this story.
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