In a major development with far-reaching implications for transgender rights in the United States, the U.S. Supreme Court on Monday threw out several lower court rulings that had favored transgender individuals, signaling a decisive legal shift. The move follows the Court’s landmark June 18 decision upholding Tennessee’s ban on gender-affirming care for minors.

The latest Supreme Court action affects cases in North Carolina, West Virginia, Idaho, and Oklahoma. In each, plaintiffs had challenged state policies that denied transgender people access to medical care or legal recognition based on their gender identity. These rulings were previously in favor of the plaintiffs — until now.

FILE PHOTO: People hold flags and signs at a demonstration as the U.S. Supreme Court hears arguments over an appeal by U.S. President Joe Biden’s administration of a lower court’s decision upholding a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors, outside the court in Washington, U.S., December 4, 2024. REUTERS/Benoit Tessier/File Photo

Lower Court Rulings Overturned or Sent Back

Among the cases impacted is one from North Carolina, where the state employee health plan excludes coverage for medical and surgical treatments related to gender transition. In West Virginia, the issue centers on Medicaid, which has barred coverage for “transsexual surgery” since 2004. Both states had lost in lower courts, but those victories for transgender claimants have now been nullified, pending reconsideration under the new legal precedent set by the Tennessee ruling.

Similarly, the Court sent back a decision from Idaho that had allowed a lawsuit to proceed against a state official accused of denying surgical care to transgender Medicaid recipients. Also under reconsideration is a case from Oklahoma involving a policy that prohibits transgender individuals from updating their birth certificates to reflect their gender identity.

Tennessee State Republican Senate Majority Leader Jack Johnson speaks during a press conference as Tennessee State Republican House Majority Leader William Lamberth and Tennessee Attorney General Jonathan Skrmetti look on following the U.S. Supreme Court decision to back a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors at the Tennessee State Capitol building in Nashville, Tennessee, U.S., June 18, 2025. REUTERS/Seth Herald

These moves by the Court do not represent final rulings against the transgender plaintiffs but rather instruct the lower courts to re-evaluate the cases using the legal framework established in the Tennessee decision.

The Tennessee Precedent

In its June 18 ruling, the Supreme Court upheld a Tennessee law banning gender-affirming treatments — such as puberty blockers and hormone therapy — for minors experiencing gender dysphoria, a condition characterized by psychological distress related to one’s gender identity and assigned sex at birth.

FILE PHOTO: Family members and advocates gather inside the Lutheran Church of the Reformation near the U.S. Supreme Court after justices?supported a?Republican-backed ban?in Tennessee on gender-affirming medical care for transgender minors, during a rally in Washington, D.C., U.S., June 18, 2025. REUTERS/Annabelle Gordon/File Photo

The Court’s 6-3 decision found that the ban did not violate the U.S. Constitution’s 14th Amendment, which guarantees equal protection under the law. The ruling, authored by Chief Justice John Roberts, emphasized the ongoing debate among medical experts about the risks and benefits of such treatments, suggesting that states have the authority to act amid scientific uncertainty.

While the decision upheld Tennessee’s restrictions, it left open the door for future legal challenges that could impose stricter scrutiny on similar laws in other states.

A Broader Shift Under Trump’s Leadership

Since returning to the presidency in January 2025, Donald Trump has taken a strong stance against expanding transgender rights. As part of his campaign and executive agenda, he has pledged to roll back gender-affirming care, restrict participation of transgender athletes in sports, and limit federal recognition of gender identity beyond the male-female binary.

FILE PHOTO: Derek Torstenson uses a megaphone while holding a sign at a demonstration, as the U.S. Supreme Court hears arguments over an appeal by U.S. President Joe Biden’s administration of a lower court’s decision upholding a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors, outside the court in Washington, U.S., December 4, 2024. REUTERS/Benoit Tessier/File Photo

Trump has already signed an executive order eliminating policies introduced by former President Joe Biden aimed at combating discrimination against LGBTQ+ individuals. In May, the Supreme Court allowed Trump’s administration to enforce a ban on transgender service members in the U.S. military.

More Legal Battles on the Horizon

People gather in Union Square after the U.S. Supreme Court upheld a Tennessee law banning some medical care for transgender youths in New York City, U.S., June 18, 2025. REUTERS/Kylie Cooper

The Supreme Court has not yet acted on three additional appeals involving state laws that ban transgender athletes from participating in female sports teams at public schools in West Virginia, Idaho, and Arizona. These cases remain pending, with the Court expected to decide soon whether it will hear them.