WASHINGTON (Reuters) -The U.S. Supreme Court backed a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors on Wednesday in a setback for transgender rights that could bolster efforts by states to defend other measures targeting transgender people.

The court, in a 6-3 ruling powered by its conservative justices, decided that the ban does not violate the U.S. Constitution’s 14th Amendment promise of equal protection. They upheld a lower court’s decision upholding Tennessee’s law barring medical treatments such as puberty blockers and hormones for people under age 18 experiencing gender dysphoria. The Supreme Court’s three liberal justices dissented.

“Tennessee 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. (The law’s) ban on such treatments responds directly to that uncertainty,” conservative Chief Justice John Roberts wrote for the majority.

Gender Dysphoria Is the Clinical Diagnosis

Gender dysphoria is the clinical diagnosis for significant distress that can result from an incongruence between a person’s gender identity and the sex assigned at birth.

The Justice Department under Democratic former President Joe Biden’s administration had challenged the law.

The dispute over transgender rights and Tennessee’s ban – one of two dozen such policies enacted by conservative state lawmakers around the country – required the Supreme Court to confront a major flashpoint in the U.S. culture wars. Since returning to office in January, Republican President Donald Trump has taken a hardline stance against transgender rights.

Trump’s administration told the Supreme Court in February that Tennessee’s ban was not unlawful, reversing the position taken by the government under Biden. The Trump administration, however, suggested that the court press forward and decide the case despite the shift.

Tennessee’s law, passed in 2023, aims to encourage minors to “appreciate their sex” by prohibiting healthcare workers from prescribing puberty blockers and hormones to help them live as “a purported identity inconsistent with the minor’s sex.”

Providers can be sued and face fines and professional discipline under the law for any violations. The law allows these medications to be used for any other purpose, including to address congenital defects, early-onset puberty or other conditions.

Several plaintiffs – three transgender minors and their parents, as well as a doctor who provides the type of care at issue – sued to challenge the Tennessee law’s legality. They were represented by the American Civil Liberties Union and LGBT rights group Lambda Legal. Biden’s Justice Department subsequently intervened in the lawsuit, opposing Tennessee’s law.

Challengers Argue Law Discriminates

The challengers argued that the law discriminates against these adolescents based on sex and transgender status, violating the 14th Amendment.

Tennessee has said it is banning “risky, unproven gender-transition interventions,” pointing to “scientific uncertainty,” tightened restrictions in some European countries and “firsthand accounts of regret and harm” from people who discontinue or reverse treatments.

Medical associations, noting that gender dysphoria is associated with higher rates of suicide, have said gender-affirming care can be life-saving, and that long-term studies show its effectiveness.

A federal judge blocked the law as likely violating the 14th Amendment but the Cincinnati-based 6th U.S. Circuit Court of Appeals later reversed the judge’s preliminary injunction.

The Supreme Court on May 6 permitted Trump’s administration to implement his ban on transgender people in the military, allowing the armed forces to discharge the thousands of current transgender troops and reject new recruits while legal challenges play out.

Trump since returning to office has taken actions targeting “gender ideology” and declaring that the U.S. government will recognize two sexes: male and female. Trump issued executive orders curtailing gender-affirming medical treatments for youth under 19 and excluding transgender girls and women from female sports, while rescinding orders by Biden combating discrimination against gay and transgender people.

The Supreme Court has a 6-3 conservative majority. In a previous major case involving transgender rights, it ruled in 2020 that a landmark federal law forbidding workplace discrimination protects gay and transgender employees.

During arguments in the Tennessee case in December, some of the conservative justices cited an ongoing debate among experts and policy makers over the potential benefits and drawbacks associated with the treatments at issue, suggesting that those decisions should be left to legislatures instead of courts.

A broader set of state restrictions have been enacted in recent years targeting transgender people, from bathroom use to sports participation, some limited to minors but others extending to adults.

ACLU lawyer Chase Strangio, representing the original plaintiffs, made history in the case as the first openly transgender attorney to argue before the Supreme Court.

—

(Reporting by Andrew Chung; Editing by Will Dunham)