There had been cause for joy this June. There were events timed with Pride Month, when families and friends gathered with rainbow tattoos and flags for the annual celebration of L.G.B.T.Q. life. And there was an unexpected legal victory when a federal judge extended a temporary injunction on a federal policy requiring passports to reflect the sex on a person’s original birth certificate.
Then on Wednesday, the Supreme Court upheld Tennessee’s ban on transition treatment for transgender youth, dealing a bitter setback to their families and reviving fear about other limits that may come for L.G.B.T.Q. people in the state.
For many transgender people, children and their families in Tennessee, it was not necessarily an unexpected outcome given the vitriol they have faced in recent years.
The state has been at the forefront of a rollback on L.G.B.T.Q. rights as its General Assembly, with an entrenched Republican supermajority, has barred changes to gender identification on driver’s licenses, limited where drag shows can take place and prevented transgender students from using public school bathrooms that fit their identities.
“I’m not surprised” at the ruling, said Eli Givens, who at 18 had testified against the ban. “I really want to be. Ever since I started all of this in 2023, it’s been whiplash every single day. There’s just always a new decision, someone saying something about the community.”
Receiving treatment as a teenager “was a new chance at life for me,” Mx. Givens, 20, added. “I could savor things in a way I never could before. Everything kind of made sense and fell into place.”
Republicans in Tennessee said banning treatment for transgender youth shielded them from a medical decision the recipients were not old enough to understand.
“I understand a lot of people are disappointed with this ruling,” said Jonathan Skrmetti, the state attorney general. “But this is coming out of a hard look at the medical evidence and trying to figure out what the best course of action is.”
He added, “Nobody should make light of the struggles that these kids are dealing with.”
Asked about those who disagree with the state’s argument that the legislation reflected the beliefs of a majority of the state’s residents, Mr. Skrmetti said, “they are free to try to persuade everybody that their position is the right position.”
Many families and activists, however, were furious that transgender youth were now barred from medical treatment that is still available to patients who are not transgender.
“It just feels like a gut punch,” said Olivia Hill, the first openly transgender woman to be elected to the City Council that governs Nashville and surrounding Davidson County. She said that she worried that the decision would further traumatize a marginalized group of youth.
One mother in Tennessee, who spoke on the condition on anonymity to protect her transgender child’s identity, described a roller coaster of anger and sadness once the family heard the ruling. It was difficult, she said, to explain to her child why lawmakers and the court were opposed to treatment that felt so essential.
The family was one of several in Tennessee that had already been dealing with the consequences of the state’s ban on transition treatment, which took effect in July 2023. (Existing patients had until the following March to phase out care.)
Some families began making regular trips to out-of-state clinics that did not face similar restrictions. Others moved out of the state altogether. There are widespread fears about being targeted.
The Trump administration has already rolled back some transgender rights and canceled funding for some L.G.B.T.Q. groups. On Wednesday, the Trevor Project, a nonprofit, said it had received a stop-work order for its support to L.G.B.T.Q. callers who reach out to the 988 national suicide prevention hotline. And in 2023, Vanderbilt University Medical Center turned over extensive medical records of transgender patients to the attorney general’s office, because of a separate investigation into possible insurance fraud.
Some groups in Tennessee and across the South were already raising money on Wednesday to help families get treatment elsewhere. Other people were coordinating rallies, or reassuring one another that the ruling did not change their support or ability to continue living in Tennessee.
“I’m not going to go away, and I’m not going to hide,” Ms. Hill, the councilwoman, said. “I’ve done that my whole life. I won’t ever do that again.”
Emily Cochrane is a national reporter for The Times covering the American South, based in Nashville.
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