The 8-1 decision from the all-Republican court maintains a law that has been in effect since September 1, 2023.

Texas, being the largest of at least 25 states with such restrictions, now faces a growing number of legal challenges. The U.S. Supreme Court has agreed to hear an appeal from the Biden administration, which seeks to block state bans on gender-affirming care. The case utilized as precedent involves a similar law in Tennessee that limits puberty blockers and hormone therapy for transgender minors.

Under the Texas law, transgender minors are prohibited from accessing hormone therapies, puberty blockers, and transition surgeries, even though surgical procedures on children are rarely performed. Children who had previously started the now-banned medications must be gradually weaned off in a "medically appropriate" manner.

Justice Rebeca Aizpuru Huddle, writing for the court's majority, justified the ruling by stating that the legislature made a rational policy choice to limit the available medical procedures for children. However, one justice dissented, arguing that the Texas Supreme Court was allowing the state to infringe upon fundamental parental rights.

Critics of the ruling argue that it will have devastating consequences for transgender teens, depriving them of critical treatment recommended by their physicians and parents. Lawsuits brought against the Texas law claim that it is not only cruel but also unconstitutional. A lower court previously ruled the law unconstitutional but allowed it to take effect while the state Supreme Court deliberated on the case.

Texas Attorney General Ken Paxton has vowed to ensure that doctors and medical institutions comply with the law, using every tool at his disposal. Advocates, on the other hand, have expressed their disappointment, stating that the ruling will have a significant negative impact on Texas transgender youth and the families who support them.

The restrictions on gender-affirming care for transgender minors are part of a broader backlash against transgender rights, encompassing issues from bathroom access to sports participation. As more states enforce similar healthcare restrictions, families of transgender youths are increasingly forced to travel out-of-state to access the care they need, often facing long waiting lists.

According to estimates by the Williams Institute at the UCLA School of Law, there are over 300,000 transgender individuals aged 13 to 17 in the United States, with approximately 29,800 of them residing in Texas. It is worth noting that not all transgender people choose or can afford gender-affirming care.

Major medical organizations, including the American Medical Association, the American Academy of Pediatrics, the American Psychiatric Association, and the Endocrine Society, support gender-affirming care for youths. However, one justice dismissed the position of these medical groups, stating that their disagreement with the legislature's judgment is irrelevant to the constitutional question at hand.

Opponents of gender-affirming care argue that there is insufficient evidence to prove its claimed benefits, and that children should not make life-altering decisions that they may later regret. Texas officials have defended the law, citing the need to protect children and noting existing restrictions for minors on activities such as tattoos, alcohol, tobacco, and certain over-the-counter drugs.

The Texas ban on gender-affirming care was signed into law by Republican Governor Greg Abbott, who, in an unprecedented move, ordered investigations into families of transgender minors who undergo gender-affirming care.

During the legislative debate over the ban, transgender rights activists staged protests in the Texas House, leading to state police forcibly removing demonstrators from the chamber gallery.

As this controversial ruling stands, the fight for transgender rights and access to gender-affirming care continues in Texas and across the nation.