Who’d have guessed it would be a 6-3 ruling?

A Tennessee state law banning gender-affirming care for minors can stand, the US supreme court has ruled, a devastating loss for trans rights supporters in a case that could set a precedent for dozens of other lawsuits involving the rights of transgender children.

The case, United States v Skrmetti, was filed last year by three families of trans children and a provider of gender-affirming care. In oral arguments, the plaintiffs – as well as the US government, then helmed by Joe Biden – argued that Tennessee’s law constituted sex-based discrimination and thus violated the equal protection clause of the 14th amendment. Under Tennessee’s law, someone assigned female at birth could not be prescribed testosterone, but someone assigned male at birth could receive those drugs.

Tennessee, meanwhile, has argued that the ban is necessary to protect children from what it termed “experimental” medical treatment. During arguments, the conservative justices seemed sympathetic to that concern, although every major medical and mental health organization in the US has found that gender-affirming care can be evidence-based and medically necessary. These groups also oppose political bans on such care.