Supreme Court Upholds Curbs on Care for Transgender Minors (3)

A divided US Supreme Court upheld a Tennessee law that outlaws certain controversial medical treatments for transgender children, preserving similar measures in two dozen states and dealing a fresh blow to LGBTQ rights.

Voting 6-3 along ideological lines, the justices ruled that the Tennessee law comports with the Constitution’s equal protection guarantee, rejecting arguments by families and former President Joe Biden’s administration.

“Our role is not to judge the wisdom, fairness, or logic of the law before us,” Chief Justice John Roberts wrote for the court, “but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment.”

The ruling comes at what is already an especially fraught time for transgender Americans. Since taking office Jan. 20, President Donald Trump has declared that gender is immutable, called for banning transgender women from female sports and – with the Supreme Court’s backing – moved to expel transgender servicemembers from the military. His administration supported the Tennessee law.

Tennessee bans puberty blockers, hormone therapy and surgery for those under 18. Opponents say the law flies in the face of clinical guidelines for treating gender dysphoria, the condition characterized by distress over the incongruence between one’s gender identity and birth-assigned sex. Supporters say the law protects vulnerable children from risky and dangerous medical procedures.

The ruling “authorizes, without second thought, untold harm to transgender children and the parents and families who love them,” Justice Sonia Sotomayor wrote in dissent. She took the unusual step of reading a summary of her opinion from the bench to give it emphasis.

The private challengers included Samantha and Brian Williams, whose 15-year-old daughter said in a court statement that she had felt like she was “trapped” and “drowning” in her body before beginning treatments. The girl, represented by the American Civil Liberties Union, is known in court papers only as “L.W.”

“Today’s ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution,” said Chase Strangio, an ACLU lawyer who argued the case, becoming the first openly trans person to do so at the Supreme Court.

The decision “is a punch in the gut for the transgender community,” said Maeve DuVally, a transgender-rights activist who previously worked as a spokeswoman for Goldman Sachs Group Inc. “Right now there’s a lot of anxiety amongst transgender children and their parents about whether they will have access to transgender medical care.” DuVally described such care as “life-saving.”

Tennessee Attorney General Jonathan Skrmetti, who led the defense of the law, hailed the ruling as a “historic Supreme Court win,” saying “the common sense of Tennessee voters prevailed over judicial activism.”

Gender Debate

The central question was whether the measure violated the Constitution by making treatments illegal when used for gender transition but not when used for other purposes.

Roberts said the measure didn’t discriminate on the basis of sex, as the challengers had contended. That would have required Tennessee to justify the measure under a demanding legal test known as “heightened scrutiny.”

Roberts said Tennessee cleared a lower bar known as “rational basis review.” The state “concluded that there is an ongoing debate among medical experts regarding the risks and benefits associated with administering puberty blockers and hormones to treat gender dysphoria, gender identity disorder, and gender incongruence,” he wrote.

The court’s other Republican appointees — Justices Clarence Thomas, Samuel Alito, Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett — joined Roberts in the majority.

Sotomayor countered that the law “expressly classifies on the basis of sex and transgender status.”

“By retreating from meaningful judicial review exactly where it matters most, the court abandons transgender children and their families to political whims,” she wrote. Her fellow Democratic appointees, Justices Elena Kagan and Ketanji Brown Jackson, joined her in dissent.

Tennessee says it enacted the law in 2023 amid a sharp rise in the number of diagnoses of gender dysphoria among minors. Of Americans 13 to 17 years old, about 1.4% identify as transgender, according to a 2022 study by the Williams Institute.

LGBTQ rights have been on the decline at the Supreme Court since 2020, when the court ruled that federal law protects gay and transgender workers from job discrimination. The justices in May let the Trump administration start discharging thousands of transgender servicemembers, including people who have served openly for years.

The justices are still considering a separate case testing whether a Maryland school district is violating the Constitution by using LGBTQ-friendly books in the classroom without giving parents the right to opt out. And in the term that starts in October, the court will consider whether scores of state and local governments are violating the Constitution by barring licensed counselors from trying to change a child’s sexual orientation or gender identity.

The case is United States v. Skrmetti, 23-477.

(Updates with reaction starting in eighth paragraph.)

--With assistance from Emily Flitter and Simone Foxman.

To contact the reporter on this story:
Greg Stohr in Washington at gstohr@bloomberg.net

To contact the editors responsible for this story:
Elizabeth Wasserman at ewasserman2@bloomberg.net

Steve Stroth

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