US Supreme Court throws out series of pro-trans rulings

The US Supreme Court has thrown out appellate decisions in several states which favoured trans plaintiffs, after the justices ruled that a law banning gender-affirming care for transgender youngsters can be upheld.

In a 6-3 decision handed down on 18 June, the court voted to allow Tennessee to continue banning trans healthcare for anyone under the age of 18 because, they ruled, it did not violate the 14th Amendment promise of equal protection.

The case of US vs Skrmetti was brought to the court in 2024 after a group of families with trans children, and a doctor who provided transition care, sued Tennessee over the legislation.

The decision is expected to serve as a precedent in future cases regarding gender-affirming care bans in other states.

On Monday (30 June), the court threw out cases involving North Carolina, West Virginia, Idaho and Oklahoma and ordered judges in lower courts to re-examine them.

The justices told the 4th Circuit Court of Appeals in Richmond, Virginia, to reconsider its ruling that West Virginia’s and North Carolina’s refusal to cover gender-affirming care under government-funded insurance plans was discriminatory.

And the 9th Circuit Court of Appeals in San Francisco will have to relook at a case from Idaho challenging the Gem State’s ban on specific gender-affirming surgeries for Medicaid recipients.

Elsewhere, the 10th Circuit Court of Appeals in Denver must now review its ruling which blocked Oklahoma’s ban on changing gender marker on birth certificates.

Chief justice John Roberts, writing for the majority in the landmark Tennessee case, said the ban did not violate the 14th Amendment promise of equal protection because the legislation prevented access to puberty blockers and hormones to treat gender dysphoria “regardless of the minor’s sex”.

He went on to say: “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] ban on such treatments responds directly to that uncertainty.”

The six conservative justices also ruled that legislation which specifically targeted transgender youngsters, did not discriminate against trans and non-binary people.

But one of the dissenting justices, Sonia Sotomayor, said: “This case is about whether Tennessee can forbid doctors from providing necessary medical care to transgender teenagers. The answer should be a resounding no.

“These laws intrude into the heart of the doctor-patient relationship. Transgender people deserve equal dignity in the eyes of the law. The constitution demands nothing less.”

Chase Strangio, from the American Civil Liberty Union’s (ACLU) LGBTQ+ & HIV Rights Project, said the ruling should be of concern to “everyone who cares about the constitution”.

The ban on gender-affirming care in Tennessee is just one of many anti-LGBTQ+ bills US states have tried to enact into law in the past few years, including sports bans, crackdowns on the display of Pride flags, and copies of Florida’s Don’t Say Gay legislation.

According to the ACLU, at least 598 anti-LGBTQ+ bills have been proposed in 2025, with 138 relating to healthcare restrictions.

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