The Supreme Court’s Anti-Transgender Ruling Is a Tortured Mess

The ruling, on its own terms, drew sharp criticism from the court’s three liberal justices. In her dissent, Justice Sonia Sotomayor castigated the majority for what she saw as a blow to sex-based discrimination protections in general—and for the impact it would have on transgender Americans across the country. “By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims,” she wrote. “In sadness, I dissent.”

The dispute centered on Tennessee Senate Bill 1, which was enacted in 2023 as part of a Republican-led legislative pushback against transgender Americans in general. The law bans doctors in Tennessee from approving prescriptions or surgeries that “ a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or “ purported discomfort or distress from a discordance between the minor’s sex and asserted identity.” Puberty blockers and hormones are specifically targeted by the statute.

Major medical associations, including the American Medical Association and the American Academy of Pediatrics, have endorsed gender-affirming treatments for young people for transgender youth, citing high rates of suicidial ideation, self-harm, and other destructive behaviors if left untreated. To that end, a group of transgender children, their families, and their medical providers sued the state shortly after the law was passed, arguing among other things that it violated the Fourteenth Amendment’s equal protection clause. (The Biden administration also sued Tennessee over S.B. 1, giving the combined case its current title.)

The constitutional argument took two forms. On one hand, the plaintiffs argued that the law amounted to sex-based discrimination because it targeted transgender youth who sought treatment for gender dysphoria. Alternatively, they argued that transgender Americans were collectively entitled to heightened protections under the clause’s modern judicial framework.