WASHINGTON — The Supreme Court on Wednesday upheld Tennessee’s ban on gender-affirming care for transgender minors, a jolting setback to transgender rights.

The justices’ 6-3 decision in a case from Tennessee effectively protects from legal challenges many efforts by President Donald Trump’s Republican administration and state governments to roll back protections for transgender people. Another 26 states have laws similar to Tennessee’s.

Chief Justice John Roberts wrote for a conservative majority that the law banning puberty blockers and hormone treatments for trans minors doesn’t violate the Constitution’s equal protection clause, which requires the government to treat similarly situated people the same.

“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,” Roberts wrote. “The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best.”

In a dissent for the court’s three liberal justices that she summarized aloud in the courtroom, Justice Sonia Sotomayor wrote, “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.”

The law also limits parents’ decision-making ability for their children’s health care, she wrote.

Efforts to regulate transgender people’s lives

The decision comes amid other federal and state efforts to regulate the lives of transgender people, including which sports competitions they can join and which bathrooms they can use. In April, Trump’s administration sued Maine for not complying with the government’s push to ban transgender athletes in girls sports.

The Republican president also has sought to block federal spending on gender-

affirming medical care for those under age 19 — instead promoting talk therapy only to treat young transgender people. And the Supreme Court has allowed him to kick transgender service members out of the military, even as court fights continue. The president signed another order to define the sexes as only male and female.

The debate even spilled into Congress when Delaware elected Democrat Sarah McBride as the first transgender member of the House. Her election prompted immediate opposition among Republicans, including House Speaker Mike Johnson of Louisiana and Rep. Nancy Mace of South Carolina, over which bathroom McBride could use.

Some have stopped treatment already

Several states where gender-affirming care remains in place have adopted laws or state executive orders seeking to protect it. But since Trump’s executive order, some providers have ceased some treatments. For instance, Penn Medicine in Philadelphia announced last month it wouldn’t provide surgeries for patients under 19.

The president of the American Academy of Pediatrics, Dr. Susan Kressly, said the organization is “unwavering” in its support of gender-affirming care and “stands with pediatricians and families making health care decisions together and free from political interference.”

Five years ago, the Supreme Court ruled LGBTQ people are protected by a landmark federal civil rights law that prohibits sex discrimination in the workplace. That decision is unaffected by Wednesday’s ruling.

But the justices declined to apply the same sort of analysis the court used in 2020 when it found “sex plays an unmistakable role” in employers’ decisions to punish transgender people for traits and behavior they otherwise tolerate. Roberts joined that opinion written by Justice Neil Gorsuch, who was part of Wednesday’s majority.