The Supreme Court announced on Monday that it will decide if states can prohibit gender-affirming care for minors. This decision, expected next term, will affect laws in over two dozen states that restrict or criminalize transgender minors’ access to healthcare. The ruling will also determine if laws targeting transgender individuals are constitutionally questionable.

There is a chance the Supreme Court could surprise by mandating equality for trans Americans and their families. However, it seems more likely that the court will uphold bans on gender-affirming care for minors, potentially stripping constitutional protections from all transgender people across the country. This significant case marks the next civil rights showdown, coinciding with the second anniversary of Dobbs.

The case, U.S. v. Skrmetti, challenges a Tennessee law that prevents healthcare professionals from providing puberty blockers and hormone therapy to minors based on sex. These treatments, endorsed by leading medical associations, are essential for children with gender dysphoria. Tennessee’s ban is part of a wave of legislation by Republicans to enforce a narrow definition of gender, accompanied by laws banning drag performances and penalizing those who assist minors in obtaining gender-affirming care out of state.

Last year, transgender minors and their parents sued to block Tennessee’s healthcare ban, arguing it violates their 14th Amendment rights. The plaintiffs claimed the state ban infringes on parents’ right to make medical decisions for their children and discriminates against minors based on sex. The U.S. Court of Appeals for the 6th Circuit rejected these claims by a 2–1 vote, stating the due process clause does not protect the right to gender-affirming care and the equal protection clause is not violated as the law does not constitute sex discrimination.

The U.S. Department of Justice (DOJ) and the ACLU litigated this case, with the Supreme Court granting only the DOJ’s petition. The DOJ argued that Tennessee’s ban discriminates based on sex. The Supreme Court’s decision will address whether anti-trans discrimination constitutes sex discrimination under the 14th Amendment, requiring stringent justification for such laws.

A broad decision could affect not just gender-affirming care but also other laws limiting transgender rights in sports, public bathrooms, housing, education, and more. If the court rules that anti-trans laws trigger heightened scrutiny, these measures will be constitutionally suspect. A decision otherwise could uphold most discriminatory laws, erasing constitutional protections for transgender people.

There is cautious optimism based on the 2020 Bostock v. Clayton County ruling, where the Supreme Court found that discrimination against transgender individuals is based on sex. However, this case involved a statute, not the Constitution. While there is a possibility the court could extend Bostock’s reasoning, the current conservative majority may be reluctant to expand LGBTQ+ rights.

Both the DOJ and the ACLU urged the Supreme Court to take up Skrmetti as the last hope against the proliferation of restrictive laws. Despite the risks, they hope the court will recognize Tennessee’s law as sex-based discrimination. However, given the court’s conservative leanings, it is uncertain if they will protect the rights of transgender individuals.