In a ruling that could have far-reaching consequences for transgender rights across the United States, the US Supreme Court on June 18, 2025, upheld a Tennessee law banning gender-affirming medical treatments for minors, triggering a fresh wave of debate across the political and medical spectrum.

The court voted 6-3 to sustain the Tennessee state legislation, which bars hormone therapy, puberty blockers, and gender transition surgeries for individuals under 18 years of age. The decision was split along ideological lines, with the six conservative justices forming the majority and the three liberal justices dissenting.

This marks a pivotal moment in America’s cultural and legal confrontation over transgender healthcare, placing the judiciary squarely in the middle of a deeply divisive national issue.

Majority Justifies State's Right to Regulate

Chief Justice John Roberts, writing the majority opinion, acknowledged the complex nature of the subject, referring to the ongoing scientific and policy debates over transgender health interventions for youth.

“This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field,” Roberts wrote.

He emphasised that the court’s responsibility was not to assess the wisdom of the legislation, but to determine whether it violated the Equal Protection Clause of the Constitution.

“It does not. Questions regarding the law’s policy are thus appropriately left to the people, their elected representatives, and the democratic process,” he added.

Wider Impact Across Republican-Led States

The ruling is expected to reverberate through at least 24 Republican-led states that have enacted or proposed similar restrictions on transgender medical care for minors in recent years. These laws, varying in scope, have largely mirrored each other in banning or limiting access to gender-affirming healthcare, often citing potential long-term risks and reversibility concerns.

Trump's Executive Order Adds Federal Weight

The ruling follows an executive order signed by President Donald Trump in January 2025, which imposed a nationwide restriction on federal involvement in gender transition procedures for individuals below the age of 19.

The order barred federal funding for such procedures under:

• Medicaid (health insurance for low-income families),

• Medicare (healthcare for retirees), and

• Defence Department insurance programmes, which cover around two million children in military families.

Trump’s executive order states:

“Across the country today, medical professionals are maiming and sterilising a growing number of impressionable children… This dangerous trend must end.”

The order established that it would henceforth be US policy not to fund, promote, support, or assist in gender transition procedures for minors.

AAP Slams the Ruling as ‘Dangerous Precedent’

Reacting strongly to the decision, the American Academy of Pediatrics (AAP), a leading body of paediatricians in the United States, warned that the court had set a dangerous precedent by allowing legislative interference in clinical medical practice.

“Gender-affirming care is medically necessary for treating gender dysphoria and is backed by decades of peer-reviewed research, clinical experience, and scientific consensus,” the AAP stated.

The group emphasised that denying this care would undermine the health and safety of transgender youth and strip them of basic human dignity.

ACLU: Parents and Doctors Overruled

Chase Strangio, attorney for the American Civil Liberties Union (ACLU) and first openly transgender lawyer to argue before the US Supreme Court, represented three trans adolescents, their parents, and a Memphis-based doctor in the case.

Strangio said the court’s decision overrides the expertise and judgment of families and medical professionals.

“What they’ve done is impose a blunderbuss ban, overriding the very careful judgment of parents who love and care for their children and the doctors who have recommended the treatment,” he said.

The ACLU and its allies had challenged the law on constitutional grounds, arguing that it treats transgender minors differently by denying them access to medical care otherwise available to their peers.

Supporters Say Law Protects Children

On the other side, conservative groups and lawmakers have hailed the ruling. The Alliance Defending Freedom, which supported Tennessee’s law, called the ruling a “huge win for children”, arguing that gender transitions for youth are “dangerous experiments” lacking long-term studies.

Tennessee Solicitor General Matthew Rice, who argued the state’s case before the court in December 2024, claimed the law was meant to “protect minors from risky, unproven medical interventions”, especially ones that could have irreversible consequences.

Dissenting Voices Raise Rights Concerns

In their dissenting opinion, the liberal justices warned that the law unfairly targets a marginalised group and restricts access to scientifically accepted medical treatments.

While the dissenters’ full text was not made public immediately, court watchers noted that Justice Sonia Sotomayor and Justice Ketanji Brown Jackson had questioned the scientific basis and ethical foundation of the ban during oral arguments.

Scientific Backing for Gender-Affirming Care

A broad range of medical organisations in the US and abroad—including the Endocrine Society, the American Medical Association (AMA), and the World Health Organization (WHO)—support gender-affirming care when conducted under strict medical supervision and after comprehensive psychological evaluation.

According to these bodies:

• Puberty blockers are reversible treatments often used to provide time for gender questioning minors to explore their identity.

• Hormone therapy is monitored and adjusted based on each patient’s needs and health conditions.

• Gender-affirming surgery is extremely rare for minors and usually not permitted until adulthood.

Who is Affected?

A UCLA Williams Institute study estimates that 1.6 million people aged 13 and above in the US identify as transgender, with over 300,000 of them under the age of 18. Many of these individuals rely on gender-affirming care to alleviate gender dysphoria, a condition that can lead to anxiety, depression, and increased suicide risk if untreated.

Advocates warn that bans like Tennessee’s could lead to heightened mental health issues, discrimination, and reduced access to care for already vulnerable youth.

What Comes Next?

With this ruling, the Supreme Court has effectively allowed individual states to decide whether or not minors should have access to gender-affirming care.

More legal challenges are expected in the coming months, particularly in Democrat-led states that may push back against federal efforts to curtail such treatments.

In the meantime, transgender minors and their families in conservative states face tough choices—either forego medical treatment or relocate to states with more supportive healthcare laws

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