"In sadness, I dissent": Sotomayor blasts conservative justices for upholding trans health care ban

The Supreme Court upheld a Tennessee law that bans gender-affirming medical care for transgender minors on Wednesday.

The 6-3 decision in United States v. Skrmetti lets stand a Tennessee law that bans gender-affirming care for transgender minors. The law would still allow puberty blockers and other hormone care for cisgender minors, meaning someone assigned female at birth couldn’t receive a prescription for testosterone, but someone assigned male at birth could. 

The three families and doctor who challenged the Tennessee law said that it violates the Equal Protection Clause of the 14th Amendment by discriminating based on sex. Tennessee argued that the law is based on age and medical purpose, not sex. 

In the majority opinion, Chief Justice John Roberts left the issue to the states: “We leave questions regarding its policy to the people, their elected representatives, and the democratic process.” The decision sets a precedent for the 25 states that have bans on pediatric gender-affirming care.

Justice Sonia Sotomayor dissented from the majority opinion, joined by Justices Ketanji Brown Jackson and Elena Kagan. 

“By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent,” Sotomayor wrote. 

Tennessee argued that the ban protects children from “experimental” medical treatment, despite major U.S. medical and mental health organizations supporting gender-affirming care, saying it’s backed by science and even medically necessary care that improves transgender youth’s health and well-being. 

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“Gender-affirming care is medically necessary for treating gender dysphoria and is backed by decades of peer-reviewed research, clinical experience, and scientific consensus,” Dr. Susan J. Kressly, president of the American Academy of Pediatrics, said in a statement.

Tyler Hack, founder of the Christopher Street Project, said: “There aren’t words strong enough to describe how shameful, cruel, and morally corrupt this ruling is. Access to gender-affirming care is life-or-death.” 

“The Supreme Court should know: this domino effect of suffering and more suffering is on their hands,” Hack said.  

The Trump administration is also eliminating the option for LGBTQ+ individuals who call the 988 Suicide Hotline to press 3 and connect with someone who specializes in LGBTQ+ mental health. Montana state Rep. Zooey Zephyr, the first transgender legislator elected in her state, addressed the ruling and 988 changes on Bluesky: “These bastards want us all dead.”