The closely watched ruling came amid a long-running legal battle about a similar ban that Florida approved in 2023. The Campaign for Southern Equality, an LGBTQ-advocacy group, said 27 states have passed bans or restrictions on such treatment since 2021 and that the ruling means they will “remain in place.”
Wednesday’s majority opinion, written by Chief Justice John Roberts, rejected arguments that such restrictions violate equal-protection rights and pointed to the authority of legislatures to decide such issues.
“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. Our role is not ‘to judge the wisdom, fairness, or logic’ of the law before us … but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment,” Roberts wrote, partially quoting a legal precedent. “Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process.”
But Justice Sonia Sotomayor, taking issue with a legal standard used by the majority, said justices retreated from “meaningful judicial review” and abandoned “transgender children and their families to political whims.” Sotomayor wrote that she dissented in “sadness.”
“Transgender adolescents’ access to hormones and puberty blockers (known as gender-affirming care) is not a matter of mere cosmetic preference,” Sotomayor wrote. “To the contrary, access to care can be a question of life or death. Some transgender adolescents suffer from gender dysphoria, a medical condition characterized by clinically significant and persistent distress resulting from incongruence between a person’s gender identity and sex identified at birth. If left untreated, gender dysphoria can lead to severe anxiety, depression, eating disorders, substance abuse, self-harm, and suicidality.”
Along with Roberts, the majority was made up of Justices Clarence Thomas, Samuel Alito, Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett. Justices Elena Kagan and Ketanji Brown Jackson joined Sotomayor in dissent.
The ruling came about five months after a panel of the 11th U.S. Circuit Court of Appeals heard arguments in a battle about a similar Florida law and regulations that Gov. Ron DeSantis and the GOP-controlled Legislature made a priority in 2023. The case has remained pending at the Atlanta-based appeals court.
In addition to preventing minors from beginning to receive puberty blockers and hormone therapy for treatment of gender dysphoria, the Florida restrictions allowed only physicians — not nurse practitioners — to approve hormone therapy for adults and barred the use of telehealth for new prescriptions. Opponents have argued the restrictions reduced access to hormone therapy for adults.
The U.S. Supreme Court ruling dealt only with Tennessee’s restrictions on treatment for children.
In 2024, U.S. District Judge Robert Hinkle ruled that the Florida restrictions were unconstitutional, but a panel of the Atlanta-based appeals court issued a stay of Hinkle’s decision. The stay allowed the restrictions to be in effect while the underlying appeal of the decision continued,
It was clear during the January hearing that appeals-court judges were watching the U.S. Supreme Court on the Tennessee law. Judges Adalberto Jordan and Andrew Brasher raised questions during the hearing about whether the panel should put the Florida case on hold while the Supreme Court considered the similar dispute.
Florida and other Republican-led states in recent years have approved numerous laws and regulations focused on transgender people. One of the highest-profile issues has been restricting use of puberty blockers and hormone therapy for minors.
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This article appears in Jun 12-18, 2025.