The Supreme Court on Wednesday upheld Tennessee’s ban on puberty blockers and hormone treatments for transgender minors in a 6-3 decision that stands to impact similar laws passed in roughly half the country. 

Rejecting a challenge mounted by the Biden administration, the high court ruled Tennessee’s law does not amount to sex discrimination that requires a higher level of constitutional scrutiny, removing a key line of attack that LGBTQ rights advocates have used to try to topple similar laws.

“Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process,” Chief Justice Roberts wrote for the majority. 

Tennessee’s law, S.B. 1, prohibits health care providers from administering puberty blockers or hormone therapy to transgender minors when the medications are prescribed to help them transition. The law, which Tennessee Gov. Bill Lee (R) signed in 2023, also bans gender-transition surgeries for minors, though that provision was not at issue before the high court. Providers who violate the law can face $25,000 civil fines for violations. 

Three Tennessee families and a doctor originally sued, and the Biden administration joined them, asserting the law discriminated based on sex in violation of the 14th Amendment’s guarantee of equal protection. 

Tennessee insisted the law distinguishes based on a treatment’s medical purpose, not sex, and the court should defer to the legislature’s judgment about regulating medicine for children. 

The Biden administration was backed by various medical organizations and LGBTQ rights groups, Democratic attorneys general from 19 states and Washington, D.C., actor Elliot Page, roughly 160 Democratic members of Congress and the American Bar Association. 

Tennessee’s defense was supported by 24 Republican state attorneys general, various Republican governors, the U.S. Conference of Catholic Bishops, a group of “detransitioners” — individuals who once, but no longer, identified as transgender — and conservative organizations like Advancing American Freedom, founded by former Vice President Mike Pence. 

Trump’s Justice Department abandoned the Biden administration’s challenge to the state’s law upon taking office. But the new administration urged the Supreme Court to still decide the case, warning the weighty issue would otherwise quickly return to the justices. 

Wednesday’s decision comes as the White House seeks to restrict access to gender-affirming treatments more broadly. 

Trump, who signed an executive order in February to end federal support for transition-related care for minors, has also called for federal legislation to that effect, instructing Congress at a joint address in March to pass a bill “permanently banning and criminalizing sex changes on children and forever ending the lie that any child is trapped in the wrong body.” 

In May, the Department of Health and Human Services broke with major professional medical organizations, which have said gender-affirming care for trans youths and adults is medically necessary, in an unsigned report that declared such interventions lack scientific evidence.