US state ban on transgender care wins Supreme Court backing

LONDON - The Supreme Court has ruled in favour of Tennessee's ban on gender-affirming care for minors, in a case that could bolster efforts by other U.S. states to restrict transgender rights.

Tennessee's law denies hormone treatment and puberty blockers to under-18s for the purpose of changing gender or treating gender dysphoria, but allows them for other uses.

The court ruled on Wednesday the law does not discriminate against trans youth in the state.

Experts say the ruling could have far-reaching implications for trans healthcare and reproductive rights, be it birth control or abortion, and comes as Republican lawmakers seek to roll back LGBTQ+ rights in a rising number of U.S. states. 

Here's what you need to know. 

What is the case of United States v. Skrmetti?

Tennessee passed Senate Bill 0001 in March 2023, banning medical procedures such as hormone therapy, puberty blockers or surgery from being performed "for the purpose of enabling a minor to identify with, or live as, a purported identity inconsistent with the minor's sex". 

It does allow the same treatments for minors who do not identify as trans and for those with unrelated conditions, such as early-onset or delayed puberty.

The law says the state has a "compelling interest" in "encouraging minors to appreciate their sex" and protect their ability to become "adults who can create children of their own".

Three trans teenagers and their families filed a lawsuit against state officials in 2023, arguing that the law violates their constitutional right to equal protection and discriminates against trans youth on the basis of sex.

Their case was backed by the Biden administration, and an injunction on the ban was initially granted, but was overturned by a federal appeals court in 2023.

The Trump administration withdrew the Department of Justice's support for the plaintiffs.

Tennessee's attorney general, Jonathan Skrmetti, argued in defence of the law.

The case was referred to the Supreme Court in November 2023, specifically concerning the ban on hormone therapy and puberty blockers, and oral arguments were heard in December 2024.

The Supreme Court ruled on June 18 that the law was not discriminatory based on sex and could remain in effect.

What are the implications of the case?

The court's decision opens the door for other states to deny certain groups of people access to treatment based on their gender identity, experts say.

"This ruling creates a class of people who politicians believe deserve healthcare, and a class of people who do not," said Lucas Cameron-Vaughn from the American Civil Liberties Union (ACLU) of Tennessee, in a statement. 

Chase Strangio, who became the first trans person to make oral arguments before the Supreme Court when he argued for the ACLU, called the decision a "devastating loss".

Rights groups also worry the ruling could encourage other state interventions on bodily autonomy.

"It's an increasing encroachment of the government in these incredibly intimate decisions," said Leila Abolfazli, a director at the National Women's Law Center.

"You can see how it then comes up in other areas like birth control access, fertility care or wherever the government wants to put its thumb on the scale of enforcing gender roles."

What's the state of the law elsewhere in the U.S.?

The United States is home to more than 1.6 million trans people, around 300,000 of whom are aged between 13 and 17, a 2022 report from the Williams Institute, a think tank at the University of California-Los Angeles, showed.

The majority of the trans population live in Republican-led states.

Since 2021, 25 states have passed laws banning gender-affirming care for minors, while Arizona and New Hampshire prohibit gender-affirming surgery.

Seventeen states are facing lawsuits challenging laws and policies, said Swaminathan.

A Montana law was blocked in May.

Federal judges struck down legislation in Arkansas in 2023, but a law making it easier to sue providers of gender-affirming for malpractice was passed the same year.

President Donald Trump has signed an executive order saying the federal government will not "fund, sponsor, promote, assist or support" gender-affirming care for anyone under 19, which is being challenged in the states of Washington and Maryland.

This article was updated on June 19, 2025 to include the outcome of the Supreme Court ruling.

(Reporting by Lucy Middleton; Editing by Ayla Jean Yackley and Lyndsay Griffiths.)