Supreme Court to weigh state restrictions on gender-affirming care for youths


A view of the U.S. Supreme Court building in Washington, U.S., June 17, 2024. 

Evelyn Hockstein | Reuters

WASHINGTON — The Supreme Court on Monday waded into the contentious debate over gender-affirming care for transgender minors by agreeing to resolve challenges to a law in Tennessee that seeks to restrict it.

The justices will review an appeals court ruling that upheld the measure.

The case marks the first time the court will issue a ruling on issues arising from the culture war battles over transgender rights for teens, which have raged in both the health care and education contexts.

The law restricts puberty blockers, hormone therapy and surgery for minors.

Oral arguments and a ruling are expected in the court’s next term, which starts in October and ends in June 2025.

In a separate case, the court in April allowed Idaho to mostly enforce a similar law.

More than 20 states have enacted similar bans, according to the Movement Advancement Project, an LGBTQ rights think tank.

Major medical organizations say that gender-affirming treatments are an effective way of treating gender dysphoria, the clinical term given to the distress people can experience when their gender identity is in conflict with the gender assigned to them at birth.

Plaintiffs, including transgender teens and their families, say the law violates the Constitution’s 14th Amendment, which requires that the law apply equally to everyone, in part by barring medical treatments for transgender people that are available to others. They also say the law violates the right of parents to make healthcare decisions for their children.

The Biden administration joined the challenge to the Tennessee law.

Solicitor General Elizabeth Prelogar urged the Supreme Court to take up the issue, saying that the law “is part of a wave of similar bans preventing transgender adolescents from obtaining medical care that they, their parents, and their doctors have all concluded is necessary.”

A federal judge blocked the Tennessee ban on puberty blockers and hormone therapy but left in place a ban on surgeries.

In a separate Kentucky case the justices did not act on, a federal judge blocked the ban on puberty blockers and hormone therapy. The plaintiffs did not challenge the restrictions on surgery.

In a ruling addressing both laws, the Cincinnati-based 6th U.S. Circuit Court of Appeals ruled in favor of the states in September.

Judge Jeffrey Sutton wrote that no one was questioning “the existence of gender dysphoria or the distress caused by it,” but indicated the question of what treatments should be available to those 17 or under should be left to elected officials.

“This is a relatively new diagnosis with ever-shifting approaches to care over the last decade or two. Under these circumstances, it is difficult for anyone to be sure about predicting the long-term consequences of abandoning age limits of any sort for these treatments,” he wrote.

The plaintiffs then asked the Supreme Court to step in. The court has until now largely stayed out of disputes involving transgender students.

In 2021, the Supreme Court declined to take up a case about the question of whether transgender students can use school bathrooms that correspond with their gender identities as court battles have continued around the country. The court turned away a similar case in January of this year.

On a related issue, the court last year allowed a transgender girl in West Virginia to participate in girls’ sports.

The court’s biggest intervention on trans issues writ large came in a surprise 6-3 ruling in 2020 authored by conservative Justice Neil Gorsuch. He concluded that federal law that bars sex discrimination in employment protected transgender and gay people, a ruling that angered conservatives.



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