In an outcome that had been broadly predicted in the legal and LGBTQ+ communities, the US Supreme Court ruled Wednesday that Tennessee's statewide ban on gender-affirming healthcare for minors may stand.

The Supreme Court justices decided not to ruin Pride Weekend this time by holding back its ruling in one of the highest profile and most consequential cases of its term, issuing its ruling today in US v. Skrmetti, a case which could have devastating consequences for trans youth across the country.

The legal question at the heart of the case, which was brought by the ACLU after Tennessee's legislature made trans youth healthcare its number one target in its 2023 term, was whether Tennessee's law violates the Constitution's equal protection clause — and whether a law about trans youth can be said to be discriminatory on the basis of sex. While the case has broad implications for the use of puberty-blocking drugs and hormones for those under 18 in 27 states where similar bans have been enacted, the justices did not rule on the merits of such broad-based bans on a type of healthcare that is being sought by a small minority of children and parents.

The six-member conservative majority took pains to explain in their opinions — Chief Justice John Roberts wrote the majority opinion while justices Amy Coney Barrett, Clarence Thomas, and Samuel Alito all felt the need to file concurring opinions making their own distinctions — how transgender status was not a new immuntable class like race or sex. And, like conservative lawmakers have, they cited cases of individuals choosing to de-transition later in life as proof that being trans might not be immutable.

Roberts contended that the court need only decide on whether the Tennessee law necessitated heightened scrutiny on their part, and deciding that it does not, he said that the merits of allowing or banning such healthcare treatments for minors should be left up to the "democratic process."

"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 in the majority opinion. "The Court's role is not 'to judge the wisdom, fairness, or logic' of [Tennessee's law]... Questions regarding the law's policy are thus appropriately left to the people, their elected representatives, and the democratic process."

Justice Sonia Sotomayor read her 31-page dissent from the bench Wednesday morning, in a move signaling her strong objection to the majority's opinion. She said the decision "authorizes, without second thought, untold harm to transgender children and the parents and families who love them."

She accused her colleagues of retreating from "meaningful judicial review exactly where it matters most,” and wrote that “the court abandons transgender children and their families to political whims."

Sotomayor rejected Roberts's and the majority's view that the democratic process should be allowed to play out in this case, noting that the court has intervened before in cases where states tried to use similarly contested beliefs about biology to ban, for instance, interracial marriage.

"Judicial scrutiny has long played an essential role," she said, in preventing lawmakers from "impos[ing] upon individuals the state’s views about how people of a particular sex (or race) should live or look or act."

As the New York Times notes, instead of concluding her dissent using the words, "Respectfully, I dissent," Sotomayor instead concluded with, "In sadness, I dissent."

Chase Strangio, the trans attorney for the ACLU who argued for the plaintiffs in the case before the high court, issued a statement Wednesday saying, "Today’s ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution."

Strangio added, "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."

As SFist noted last week, there is a film playing at the Frameline festival this week, on Friday, about the Supreme Court case and Strangio's role in it, titled Heightened Scrutiny.

"Today the Supreme Court told Tennessee transgender youth and their families that they cannot access healthcare that is vitally important for a successful life,” said Lucas Cameron-Vaughn, Senior Staff Attorney at the ACLU of Tennessee, in a statement. "This ruling creates a class of people who politicians believe deserve healthcare, and a class of people who do not. We will continue to stand with transgender people in Tennessee and are committed to realizing a world where all people belong, are valued, and can access the necessary healthcare they need.”

Photo by Claire Anderson