The U.S. Supreme Court on Wednesday appeared inclined to uphold Tennessee’s controversial ban on gender-affirming care for minors, a case that could set a precedent for similar laws across 24 states. The justices grappled with the question of whether the state’s restrictions violate constitutional protections, thrusting the court into the heated debate surrounding transgender rights and youth healthcare.

The case, U.S. v. Skrmetti, challenges Tennessee’s 2023 law barring puberty blockers and hormone therapies for minors seeking to transition. The state argues it has a compelling interest in protecting adolescents from what it claims are “untested and risky” treatments with potentially irreversible consequences. Meanwhile, the Biden administration, joined by three families and a doctor, contends the law unlawfully discriminates based on sex and transgender status, violating the Equal Protection Clause.

Several conservative justices voiced skepticism about overturning Tennessee’s law. Justice Brett Kavanaugh highlighted “evolving” medical research and questioned whether courts, rather than lawmakers, should decide such issues. “If the Constitution doesn’t take sides and there’s strong policy arguments on both ends, why not leave it to the democratic process?” Kavanaugh asked.

Chief Justice John Roberts pointed to recent decisions in Europe, where countries like England and Sweden have limited access to puberty blockers amid concerns over insufficient evidence of their long-term efficacy. “If other nations are pressing pause, doesn’t that warrant caution from this court?” Roberts queried.

Justice Elena Kagan, however, pressed Tennessee Solicitor General J. Matthew Rice on the law’s alleged discriminatory nature. “The entire policy is rooted in sex,” she argued, emphasizing how treatments are permitted for non-transgender minors but banned for transgender youth. Justice Sonia Sotomayor added, “The evidence is clear: some children need this care to avoid devastating outcomes.”

The court’s liberal justices warned of the “dire mental health” impacts on transgender youth denied treatment. Advocates for gender-affirming care argue the bans disproportionately target a vulnerable population under the guise of regulation.

The decision, expected by June, could have sweeping implications for the transgender agenda and healthcare access nationwide. This marks the most significant case on transgender issues since the court’s 2020 ruling that workplace protections under Title VII extend to LGBTQ+ individuals. That decision, authored by Justice Neil Gorsuch, split 6-3; Gorsuch, notably silent on Wednesday, remains a potential wildcard in this case.

With protests outside the courthouse and sharp divides within the chamber, the case underscores the nation’s intensifying debate over LGBTQ+ issues, conservative family values, and state power.