WASHINGTON — The Supreme Court ruled Wednesday that states may ban hormone treatments for transgender teens, rejecting the claim that such gender-based discrimination is unconstitutional.

In a 6-3 decision, the justices said states are generally free to decide on proper standards of medical care, particularly when health experts are divided.

Chief Justice John G. Roberts, writing for the court, said the state decides on medical regulations. “We leave questions regarding its policy to the people, their elected representatives, and the democratic process,” he said.

In dissent, Justice Sonia Sotomayor said the law “plainly discriminates on the basis of sex… 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.” Justices Elena Kagan and Ketanji Brown Jackson agreed.

The ruling upholds laws in Tennessee and 23 other Republican-led states, all of them adopted in the past four years.

Tennessee lawmakers said the number of minors being diagnosed with gender dysphoria had “exploded” in recent years, leading to a “surge in unproven and risky medical interventions for these underage patients.”

California and other Democratic-led states do not prohibit doctors from prescribing puberty blockers or hormones for those under age 18 who are diagnosed with gender dysphoria.

While the court’s ruling in the Tennessee case should not directly affect California’s law, the Trump administration seeks to prevent the use of federal funds to pay for gender affirming care.

This could affect patients who rely on Medicaid and also restrict hospitals and other medical clinics from providing hormones and other medical treatments for minors.

Wednesday’s decision highlights the sharp turn in the past year on trans rights and “gender affirming” care.

Solicitor Gen. Elizabeth Prelogar, representing the Biden administration, had appealed to the Supreme Court in November 2023, and urged the justices to strike down the red-state laws.

She spoke of a broad consensus in favor of gender affirming care. It was unconstitutional, she argued, for states to ban “evidence-based treatments supported by the overwhelming consensus of the medical community.”

But Republican lawmakers voiced doubt about the long-term effect of these hormone treatments for adolescents.

Their skepticism was reinforced by the Cass Report from Britain, which concluded there were not long-term studies or reliable evidence in support of the treatments.

Trans-rights advocates argued the court should have deferred to parents and their doctors, not state lawmakers.

“The court today failed to do its job,” said Jennifer Levi, GLAD Law senior director of transgender and queer rights. “When the political system breaks down and legislatures bow to popular hostility, the judiciary must be the Constitution’s backbone. Instead, it chose to look away, abandoning both vulnerable children and the parents who love them.”

Lawyers for Lambda Legal and the ACLU called it “a heartbreaking ruling, making it more difficult for transgender youth to escape the danger and trauma of being denied their ability to live and thrive.”

“This is a sad day, and the implications will reverberate for years and across the country, but it does not shake our resolve to continue fighting,” said Sasha Buchert, a Lambda attorney.

Upon taking office in January, President Trump targeted transgender people without specifically mentioning them.

He said his administration would “recognize two sexes, male and female. These sexes are not changeable and are grounded in fundamental and incontrovertible reality.”

His administration later said its ban on gender affirming care for minors would extend to medical facilities receiving federal funds.

President Trump signed legislation Thursday seeking to rescind California’s ambitious auto emission standards, including a landmark rule that eventually would have barred sales of new gas-only cars in California by 2035.

In a bill signing ceremony in the East Room of the White House, Trump slammed California’s planned zero-emission requirements for new car sales as “a disaster for our country.” During a meandering 50-minute speech, he argued that California’s regulations would raise car prices, hobble American car companies and place an incredible strain on electrical grids across the country.

“We officially rescue the U.S. auto industry from destruction by terminating the California electric vehicle mandate, once and for all,” Trump said to applause from a room filled with conservative legislators and business representatives.

“This horrible scheme would effectively abolish the internal combustion engine, which most people prefer,” Trump continued.

Trump boasted the legislation would “kill the California mandates forever,” declaring it would dash progressive plans to accelerate the adoption of electric vehicles.

“They can’t take us to court,” he said. “They can’t do any of the things they can do with the executive orders, and it’s permanent.”

But moments after he signed the three bills into law, California Atty. Gen. Rob Bonta led a coalition of 10 attorneys general in filing a lawsuit to challenge Trump’s laws, which had been approved by Congress in May. Bonta argued Congress unlawfully acted to upend California’s emission rules by invoking the Congressional Review Act, a law designed to allow legislators to rescind major federal rules adopted toward the end of a presidential administration. California and several congressional rules experts have said the Congressional Review Act could not be used to overturn federal waivers that enable California to enforce its auto emission standards.

“We’re doing this to ensure future generations inherit a livable planet with breathable air,” Bonta said at a news conference Thursday morning. “Meanwhile, the president’s divisive, partisan agenda is jeopardizing our lives, our economy and our environment. It’s reckless, it’s illegal, and because of it, we’ll be seeing the Trump administration in court again for the 26th time.”

By signing these three bills into law, Trump invalidated some of the most innovative regulations adopted by California environmental rule makers and undercut California’s long-standing authority to set more rigorous vehicle emission standards:

• The Advanced Clean Cars II rule would’ve required car companies to sell California dealerships an increasing percentage of new zero-emission or long-range hybrid vehicles, starting at 35% in 2026. The regulation would’ve culminated in a ban on the sale of new gas-only cars in California in 2035.
• Advanced Clean Trucks rule, which would’ve required a significant percentage of medium- and heavy-duty truck sales be zero-emission by 2035.
• The Heavy-Duty Engine and Vehicle Omnibus rule that established cleaner engine standards and required warranties for new heavy-duty vehicles.

In his second term, Trump has repeatedly attacked California’s ambitious auto emission rules, including the Advanced Clean Cars II regulation, which he has incorrectly described as an electric vehicle mandate. The rule does not block the sale of used gas-only cars or other zero-emission vehicles, like hydrogen-powered cars.

Because of its historically bad air quality, California is the only state that has been given permission to adopt auto emission standards that are stricter than federal standards. Many other Democratic states adhere to California’s auto emission rules, which has put pressure on auto companies to comply with the state’s progressive rules. That has irked a number of Republicans, including Trump, who believe there should be a unified slate of auto standards set by the federal government.

“It’s had us tied up in knots for years,” Trump said in his remarks Thursday morning. “They’d pass these crazy rules in California, and 17 states would go by them. The automakers didn’t know what to do because they’re really building cars for two countries.”

But California needs a federal waiver from the U.S. Environmental Protection Agency for its pace-setting auto emission standards to be enforceable.

Michael Regan, the U.S. EPA administrator during the Biden administration, granted several California waivers, including two in December 2024.

Prior to the Senate vote to overturn California auto emission rules, both

the Senate parliamentarian and Government Accountability Office had determined these federal waivers are not rules, they are administrative orders, not subject to the Congressional Review Act.

Despite those rulings, the Senate moved ahead with the vote and advanced the bill to Trump’s desk with a simple majority vote.