Supreme Court upholds ban on gender-affirming care for minors. Indiana among states affected
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 and the Trump administration.
The court's six conservatives voted to uphold the ban and the three liberals dissented.
The 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.
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.
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.
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.
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.
A federal court let Indiana's ban on gender-affirming care for minors take effect in February 2024. The law, signed in 2023 by Gov. Eric Holcomb, bans doctors from performing gender reassignment surgery or prescribing medication, like puberty blockers or hormone therapy, to those under 18 years old.
Physicians who provide these procedures in Indiana could face discipline by the state's medical licensing board.
Supreme Court's Indiana impact: What Supreme Court case could mean for Indiana's ban on gender-affirming care for minors
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.
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