The justices' 6-3 decision effectively protects from legal challenges many efforts by President Donald Trump's  administration and state governments to roll back protections for transgender people. Another 26 states have laws similar to Tennessee's.
Chief Justice John Roberts wrote for a conservative majority that the law banning puberty blockers and hormone treatments for trans minors doesn't violate the Constitution's equal protection clause, which requires the government to treat similarly situated people the same.
"This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field. The voices in these debates raise sincere concerns; the implications for all are profound," Roberts wrote. "The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best."
The court's three liberal justices dissented from the ruling, among them Justice Sonia Sotomayor who wrote, "By retreating from meaningful judicial review exactly where it matters most, the court abandons transgender children and their families to political whims. In sadness, I dissent."
The law also limits parents' decision-making ability for their children's health care, she wrote.
The decision comes amid other federal and state efforts to regulate the lives of transgender people, including which sports competitions they can join and which bathrooms they can use. In April, Trump's administration sued Maine for not complying with the government's push to ban transgender athletes in girls sports.
And the Supreme Court has allowed him to kick transgender service members out of the military, even as court fights continue. The president signed another order to define the sexes as only male and female.
Several states where gender-affirming care remains in place have adopted laws or state executive orders seeking to protect it. But since Trump's executive order, some providers have ceased some treatments. For instance, Penn Medicine in Philadelphia announced last month it wouldn't provide surgeries for patients under 19.
The president of the American Academy of Pediatrics, Dr. Susan Kressly, said the organisation is "unwavering" in its support of gender-affirming care.
Chase Strangio, the American Civil Liberties Union lawyer who argued the case for transgender minors and their families, called the ruling "a devastating loss for transgender people, our families, and everyone who cares about the Constitution."
Meanwhile, the acting chair of the federal agency that enforces workers rights acknowledged on Wednesday that transgender workers are protected under civil rights laws but defended her decision to drop lawsuits on their behalf, saying her agency must comply with Donald Trump's orders.
Andrea Lucas, who was first appointed to the Equal Employment Opportunity Commission in 2020 and elevated to chair in January, spoke at her confirmation hearing at the Senate. Her nomination to serve another five-year term as an EEOC commissioner requires Senate confirmation, though whether she stays on as chair will be up to Trump.
Lucas, a strident critic of diversity and inclusion programs and proponent of the idea that there are only two immutable sexes, repeatedly declared that the EEOC is not independent and vowed to enthusiastically follow Trump's executive orders. Those include orders aimed at dismantling diversity and programs in the public and private sectors and declaring that the federal government would only recognise the male and female sexes.
with AP
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