Updated 4:40 p.m.
The Supreme Court has upheld a Tennessee law that bans gender affirming care for minors.
The Tennessee law, SB1, prohibits healthcare providers from prescribing, administering or dispensing puberty blockers and hormone therapy for the purpose of transgender healthcare—care that allows a youth to identify with a gender that differs from their biological sex.
The medications are allowed to be prescribed for other medical conditions like congenital defects, precocious puberty, disease or physical injury.
The law was challenged by Tennessean transgender youth, their parents and a doctor for violating the Equal Protection Clause of the 14th amendment, claiming it discriminated on the basis of sex and transgender status in the case United States v. Skrmetti.
SCOTUS, in a 6-3 ruling, held that SB1 is not subject to heightened scrutiny under the Equal Protection Clause. The high court writes that the law relies on classifications of minors and medical uses, not sex.
On the question of sex discrimination, SCOTUS reasoned that the law does not exclude any one sex from medical treatment but bans a set of diagnoses—gender dysphoria, gender identity disorder and gender incongruence—from those that a healthcare provider can treat for minors.
The law does not discriminate based on transgender status because transgender youth could also be in the category of minors seeking puberty blockers and hormone therapy for the allowable conditions, like congenital defects or physical injury, the court writes.
“The Court has never suggested that mere reference to sex is sufficient to trigger heightened scrutiny,” the opinion says.
"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. The voices in these debates raise sincere concerns; the implications for all are profound. The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best," Chief Justice John Roberts wrote for the majority.
SCOTUS' role is "only to ensure that [the law] does not violate the equal protection guarantee of the Fourteenth Amendment."
"Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process," Roberts wrote.
Debra Hauser, president of the national youth activism and reproductive health organization Advocates for Youth, denounced the ruling in a statement.
“It should be common sense: every young person must have access to health care that allows them to thrive and grow up happy and healthy,” Hauser wrote. “Today, the Supreme Court has chosen to endanger the lives of transgender young people by ignoring decades of medical research in support of gender-affirming care.”
“Today’s ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution,” Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Project, said in a statement. “Though this is a painful setback, it does not mean that transgender people and our allies are left with no options to defend our freedom, our health care, or our lives. The Court left undisturbed Supreme Court and lower court precedent that other examples of discrimination against transgender people are unlawful. We are as determined as ever to fight for the dignity and equality of every transgender person and we will continue to do so with defiant strength, a restless resolve, and a lasting commitment to our families, our communities, and the freedom we all deserve.”
Gender-affirming care services comprise a range of social, behavioral and medical interventions that affirm an individual’s gender identity when it conflicts with the gender they were assigned at birth.
The services are supported by major medical groups such as the American Academy of Pediatrics, the American Medical Association, the American Psychological Association and numerous others that warn of transgender individuals’ elevated risk for self-harm when denied affirming treatments.
“The American Medical Association is disappointed in today’s decision that opens the door to further intrusion into patient care and harmful government interference into the practice of medicine," Bobby Mukkamala, M.D., president of the AMA, said in a statement. “All patients deserve access to high-quality, evidence-based medical care. Decisions about medical treatment must be made through a shared decision-making process between the patient and their physician, based on individual patient needs and in accordance with medical evidence and the standards of good medical practice. The AMA opposes efforts by the government to insert itself into the patient-physician relationship and interfere in clinical decision-making with no regard for the clinical standards of care.”