Supreme Court OKs Tennessee ban on gender-affirming care for kids, a setback for transgender rights

WASHINGTON (AP) — 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.

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.

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.

Justice Amy Coney Barrett also fully joined the majority but wrote separately to emphasize that laws classifying people based on transgender status should not receive any special review by courts. Barrett, also writing for justice Clarence Thomas, wrote that “courts must give legislatures flexibility to make policy in this area.”

Chase Strangio, the American Civil Liberties Union lawyer who argued the case for transgender minors and their families, called the ruling "a devastating loss for transgender people, our families, and everyone who cares about the Constitution.”

Mo Jenkins, a 26-year-old trans woman who began taking hormone therapy at 16, said she was disheartened but not surprised by the ruling. “Trans people are not going to disappear," said Jenkins, a Texas native and legislative staffer at the state capitol in Austin. Texas outlawed puberty blockers and hormone treatment for minors in 2023.

Tennessee's leading Republican elected officials all praised the outcome. Attorney General Jonathan Skrmetti on social media called the ruling a “Landmark VICTORY for Tennessee at SCOTUS in defense of America’s children!”

There are about 300,000 people between the ages of 13 and 17 and 1.3 million adults who identify as transgender in the U.S., according to the Williams Institute, a think tank at the UCLA School of Law that researches sexual orientation and gender identity demographics.

When the case was argued in December, then-President Joe Biden's Democratic administration and families of transgender adolescents called on the high court to strike down the Tennessee ban as unlawful sex discrimination and to protect the constitutional rights of vulnerable Americans.

They argued the law violates the equal protection clause of the 14th Amendment in part because the same treatments that the law prohibits for transgender minors can be used for other purposes.

Soon after Trump took office, the Justice Department told the court its position had changed.

A major issue in the case was the appropriate level of scrutiny courts should apply to such laws.

The lowest level is known as rational basis review, and almost every law looked at that way is upheld. Indeed, the federal appeals court in Cincinnati that allowed the Tennessee law to be enforced held that lawmakers acted rationally to regulate medical procedures.

The appeals court reversed a trial court that employed a higher level of review, heightened scrutiny, which applies in cases of sex discrimination. Under this more searching examination, the state must identify an important objective and show the law helps accomplish it.

Roberts' 24-page majority opinion was devoted almost entirely to explaining why the Tennessee law, called SB1, should be evaluated under the lower standard of review. The law's restrictions on treating minors for gender dysphoria turn on age and medical use, not sex, Roberts wrote.

Doctors may prescribe puberty blockers and hormone therapy to minors of any sex to treat some disorders, but not those relating to transgender status, he wrote.

But in her courtroom statement, Sotomayor asserted that similar arguments were made to defend the Virginia law prohibiting interracial marriage that the Supreme Court struck down in 1967.

“A ban on interracial marriage could be described in the same way as the majority described SB1,” she said.

Roberts rejected the comparison.

Associated Press writers Geoff Mulvihill, in Cherry Hill, N.J., and Nadia Lathan in Austin, Texas, contributed to this report.

Follow the AP's coverage of the U.S. Supreme Court at https://apnews.com/hub/us-supreme-court.

FILE - Chase Strangio, co-director of the ACLU's LGBT & HIV Project, speaks during the transgender rights rally on the National Mall, Saturday, May 17, 2025, in Washington. (AP Photo/Jose Luis Magana)

Transgender rights supporters rally at the Lutheran Church of the Reformation on Capitol Hill, Wednesday, June 18, 2025, in Washington after the Supreme Court upheld Tennessee's ban on gender-affirming care for transgender minors, in a setback to transgender rights. (AP Photo/Jose Luis Magana)

FILE - Supreme Court Associate Justice Sonia Sotomayor participates in a fireside chat in Miami, Feb. 11, 2025. (AP Photo/Lynne Sladky, File)

FILE - President Donald Trump signs an executive order barring transgender female athletes from competing in women's or girls' sporting events, in the East Room of the White House, in Washington, Feb. 5, 2025. (AP Photo/Alex Brandon, FIle)

FILE - Chief Justice of the U.S. Supreme Court John Roberts speaks during a lecture to the Georgetown Law School graduating class of 2025, in Washington, May 12, 2025. (AP Photo/Manuel Balce Ceneta, File)

FILE - People gather outside the Supreme Court in Washington, Oct. 8, 2019. (AP Photo/Susan Walsh, File)

FILE - The Supreme Court is seen on Capitol Hill in Washington, Dec. 17, 2024. (AP Photo/J. Scott Applewhite, File)

FILE - Protesters for and against gender-affirming care for transgender minors demonstrate outside the Supreme Court on Dec. 4, 2024, in Washington. (AP Photo/Jose Luis Magana, File)

FILE - Transgenders rights supporters rally outside of the Supreme Court, Dec. 4, 2024, in Washington. (AP Photo/Jose Luis Magana, File)

FILE - Transgender rights supporters rally outside of the Supreme Court, Wednesday, Dec. 4, 2024, in Washington. (AP Photo/Jose Luis Magana, File)

FILE - The Supreme Court is seen in Washington, Nov. 2, 2024. (AP Photo/J. Scott Applewhite, File)

FILE - The Supreme Court is seen on Capitol Hill in Washington, Dec. 17, 2024. (AP Photo/J. Scott Applewhite, File)

Iran eased some restrictions on its people and, for the first time in days, allowed them to make phone calls abroad via their mobile phones on Tuesday. It did not ease restrictions on the internet or permit texting services to be restored as the death toll from days of bloody protests against the state rose to at least 2,000 people, according to activists.

Although Iranians were able to call abroad, people outside the country could not call them, several people in the capital told The Associated Press.

The witnesses, who spoke on condition of anonymity for fear of reprisal, said SMS text messaging still was down and internet users inside Iran could not access anything abroad, although there were local connections to government-approved websites.

It was unclear if restrictions would ease further after authorities cut off all communications inside the country and to the outside world late Thursday.

Here is the latest:

A senior Iranian official responded Tuesday to Trump’s latest threat to intervene in deadly protests, saying that the U.S. and Israel will be the ones responsible for the death of Iranian civilians.

Shortly after Trump’s social media post urging Iranians to “take over” government institutions, Ali Larijani, a former parliament speaker who serves as the secretary of Iran’s Supreme National Security Council, posted on X: “We declare the names of the main killers of the people of Iran: 1- Trump 2- Netanyahu.”

Russia’s Foreign Ministry called on Tuesday the threats “categorically unacceptable.”

The ministry warned in a statement that any such strikes would have “disastrous consequences” for the situation in the Middle East and global security. It also criticized what it called “brazen attempts to blackmail Iran’s foreign partners by raising trade tariffs.”

The statement noted that the protests in Iran had been triggered by social and economic problems resulting from Western sanctions. It also denounced “hostile external forces” for trying to “exploit the resulting growing social tension to destabilize and destroy the Iranian state” and charged that “specially trained and armed provocateurs acting on instructions from abroad” sought to provoke violence.

The ministry voiced hope that the situation in Iran will gradually stabilize and advised Russian citizens in the Islamic Republic not to visit crowded places.

The TV report said the country had ‘a lot of martyrs’ in the nationwide protests and quoted Ahmad Mousavi, the head of the Martyrs Foundation.

The anchor read a statement that laid blame on “armed and terrorist groups, which led the country to present a lot of martyrs to God.”

The acknowledgment came after activists put the death toll at at least 2,003 people killed.

Germany’s Foreign Ministry says it summoned the Iranian ambassador in Berlin on Tuesday to protest the crackdown against demonstrators.

The ministry wrote in a social media post that “the Iranian regime’s brutal action against its own population is shocking.” It called on Iran to end the use of violence against its own people and “respect their rights.”

French Foreign Minister Jean-Noel Barrot summoned the Iranian ambassador Tuesday to denounce Iran’s repression of protesters, which Barrot called “intolerable, unbearable, and inhumane.″

Addressing lawmakers at France’s National Assembly, Barrot said that France “condemned the repression in the strongest possible terms, denouncing this state violence that was unleashed blindly upon peaceful protesters.”

“I have conveyed this condemnation to the Iranian foreign minister and it will be reiterated to the Iranian ambassador to France, whom I summoned today to the Foreign Ministry,” he added.

U.K. Foreign Secretary Yvette Cooper has announced plans for “full and further sanctions” against Iran that target finance, energy, transport and other significant industries after the Foreign Office summoned the Islamic Republic’s ambassador to explain the nation’s response to recent protests.

Cooper told the House of Commons on Tuesday that a “desperate regime,’’ must not be allowed to undermine a “genuine grassroots movement’’ which has spread through many regions and all parts of society.

“And that is why we and other governments across the world are determined not to play into the hands of the regime or to allow our words or actions to be twisted to support their lies and propaganda,’’ she said.

“The world is watching Iran, and the UK will continue to confront the regime’s lies, to call out its repression and to take the steps necessary to protect the UK’s interests.”

The American president said he canceled meetings with Iranian officials, telling protesters, ‘help is on its way,’ without giving details.

Trump did not offer any details about what the help would entail, but it came after he said earlier this week Iran wants to negotiate with Washington after a threat to strike the Islamic Republic.

Trump’s latest message on social media appeared to make an abrupt shift in his willingness to engage with the Iranian government.

“Iranian Patriots, KEEP PROTESTING - TAKE OVER YOUR INSTITUTIONS!!!” Trump wrote in on Truth Social. “Save the names of the killers and abusers. They will pay a big price. I have cancelled all meetings with Iranian Officials until the senseless killing of protesters STOPS. HELP IS ON ITS WAY.”

European Commission President Ursula von der Leyen says the new sanctions will be imposed on Iranian officials over the crackdown on protestors.

“The rising number of casualties in Iran is horrifying. I unequivocally condemn the excessive use of force and continued restriction of freedom,” von der Leyen said in a post on social media.

She said that in cooperation with EU foreign policy chief Kaja Kallas “further sanctions on those responsible for the repression will be swiftly proposed. We stand with the people of Iran who are bravely marching for their liberty.”

The EU has already imposed sanctions on members of the Revolutionary Guard Corps and others over past concerns about human rights abuses in Iran.

Kaja Kallas said in Berlin Tuesday that the Iranian government might go the way of former President Bashar Assad’s government in Syria, which fell swiftly in late 2024 in a “surprise for everybody.” But she added that “very often these regimes are very, very resilient.”

Kallas said that “right now … it is not clear whether the regime is going to fall or not.” She said it would ultimately have to be up to the Iranian people to make decisions.

The U.S.-based Human Rights Activists News Agency, which has been accurate in previous unrest in recent years, gave the latest death toll on Tuesday.

It said 1,847 of the dead were protesters and 135 were government-affiliated.

This came a day after the European Parliament announced it would ban Iranian diplomats and representatives.

“Iran does not seek enmity with the EU, but will reciprocate any restriction,” Foreign Minister Abbas Araghchi wrote Tuesday on X.

He also criticized the European Parliament for not taking any significant action against Israel for the more than two-year war in Gaza that has killed more than 71,400 Palestinians, while banning Iranian diplomats after just “a few days of violent riots.”

Dutch Foreign Minister David van Weel said he summoned Iran’s ambassador to the Netherlands “to formally protest the excessive violence against peaceful protesters, large-scale arbitrary arrests, and internet shutdowns, calling for immediate restoration of internet access inside the Islamic Republic.

In a post on X, Weel also said the Dutch government supports EU sanctions against “human rights violators in Iran.”

The United Nations human rights chief is calling on Iranian authorities to immediately halt violence and repression against peaceful protesters, citing reports of hundreds killed and thousands arrested in a wave of demonstrations in recent weeks.

“The killing of peaceful demonstrators must stop, and the labelling of protesters as ‘terrorists’ to justify violence against them is unacceptable,” U.N. High Commissioner for Human Rights Volker Türk said in a statement Tuesday.

Alluding to a wave of protests in Iran in 2022, Türk said demonstrators have sought “fundamental changes” to governance in the country, “and once again, the authorities’ reaction is to inflict brutal force to repress legitimate demands for change.”

“This cycle of horrific violence cannot continue,” he added.

It was also “extremely worrying” to hear some public statements from judicial officials mentioning the prospect of the use of the death penalty against protesters through expedited judicial proceedings, Türk said.

“Iranians have the right to demonstrate peacefully. Their grievances need to be heard and addressed, and not instrumentalized by anyone,” Türk said.

Finland’s foreign minister says she is summoning the Iranian ambassador after authorities in Tehran restricted internet access.

“Iran’s regime has shut down the internet to be able to kill and oppress in silence," Elina Valtonen wrote in a social media post Tuesday, adding, “this will not be tolerated. We stand with the people of Iran — women and men alike.”

Finland is “exploring measures to help restore freedom to the Iranian people” together with the European Union, Valtonen said.

Separately, Finnish police said they believe at least two people entered the courtyard of the Iranian embassy in Helsinki without permission Monday afternoon and tore down the Iranian flag. The embassy’s outer wall was also daubed with paint.

Iranian security forces arrested what a state television report described as “terrorist groups” linked to Israel in the southeastern city of Zahedan.

The report, without providing additional details, said the group entered through Iran’s eastern borders and carried U.S.-made guns and explosives that the group had planned to use in assassinations and acts of sabotage.

The Israeli military did not immediately comment on the allegations.

The Nobel Peace Prize laureate hailed people who have “long warned about this repression, at great personal risk.”

“The protests in Iran cannot be separated from the long-standing, state-imposed restrictions on girls’ and women’s autonomy, in all aspects of public life including education. Iranian girls, like girls everywhere, demand a life with dignity,” Yousafzai wrote on X.

“(Iran’s) future must be driven by the Iranian people, and include the leadership of Iranian women and girls — not external forces or oppressive regimes,” she added.

Yousafzai was awarded the peace prize in 2014 at the age of 17 for her fight for girls’ education in her home country, Pakistan. She is the youngest Nobel laureate.

The French Foreign Ministry said it has “reconfigured” its embassy in Tehran after reports that the facility's nonessential staff left Iran earlier this week.

The embassy's nonessential staff left the country Sunday and Monday, French news agency Agence France-Presse reported.

The ambassador remained on site and the embassy continued to function, the ministry said late Monday night.

Associated Press writer Angela Charlton contributed from Paris.

German Chancellor Friedrich Merz said he believes the Iranian government is in its “final days and weeks,” as he renewed a call for Iranian authorities to end violence against demonstrators immediately.

“If a regime can only keep itself in power by force, then it’s effectively at the end,” Merz said Tuesday during a visit to Bengaluru, India. “I believe we are now seeing the final days and weeks of this regime. In any case, it has no legitimacy through elections in the population. The population is now rising up against this regime.”

Merz said he hoped there is “a possibility to end this conflict peacefully," adding that Germany is in close contact with the U.S. and European governments.

The Israeli military said it continues to be “on alert for surprise scenarios” due to the ongoing protests in Iran, but has not made any changes to guidelines for civilians, as it does prior to a concrete threat.

“The protests in Iran are an internal matter,” Israeli military spokesperson Brig. Gen. Effie Defrin wrote on X.

Israel attacked Iran’s nuclear program over the summer, resulting in a 12-day war that killed nearly 1,200 Iranians and almost 30 Israelis. Over the past week, Iran has threatened to attack Israel if Israel or the U.S. attacks.

Mobile phones in Iran were able to call abroad Tuesday after a crackdown on nationwide protests in which the internet and international calls were cut. Several people in Tehran were able to call The Associated Press.

The AP bureau in Dubai, United Arab Emirates, was unable to call those numbers back.

Witnesses said the internet remained cut off from the outside world. Iran cut off the internet and calls on Thursday as protests intensified.

This frame grab from videos taken between Jan. 9 and Jan. 11, 2026, and circulating on social media purportedly shows images from a morgue with dozens of bodies and mourners after crackdownon the outskirts of Iran's capital, in Kahrizak, Tehran Province. (UGC via AP)

This frame grab from videos taken between Jan. 9 and Jan. 11, 2026, and circulating on social media purportedly shows images from a morgue with dozens of bodies and mourners after crackdown on the outskirts of Iran's capital, in Kahrizak, Tehran Province. (UGC via AP)

This frame grab from videos taken between Jan. 9 and Jan. 11, 2026, and circulating on social media purportedly shows images from a morgue with dozens of bodies and mourners after crackdown on the outskirts of Iran's capital, in Kahrizak, Tehran Province. (UGC via AP)

Protesters hold up placards and flags as they demonstrate outside the Iranian Embassy in London, Monday, Jan. 12, 2026. (AP Photo/Alastair Grant)

Shiite Muslims hold placards and chant slogans during a protest against the U.S. and show solidarity with Iran in Lahore, Pakistan, Sunday, Jan. 11, 2026. (AP Photo/K.M. Chaudary)

Activists carrying a photograph of Reza Pahlavi take part in a rally supporting protesters in Iran at Lafayette Park, across from the White House, in Washington, Sunday, Jan. 11, 2026. (AP Photo/Jose Luis Magana)

Protesters burn the Iranian national flag during a rally in support of the nationwide mass demonstrations in Iran against the government in Paris, Sunday, Jan. 11, 2026. (AP Photo/Michel Euler)

People attend a rally in Frankfurt, Germany, Monday, Jan. 12, 2026. (Boris Roessler/dpa via AP)

A picture of Ayatollah Ali Khamenei is set alight by protesters outside the Iranian Embassy in London, Monday, Jan. 12, 2026. (AP Photo/Alastair Grant)