The Supreme Court has ruled that Tennessee did not offend the Constitution by banning minors from being given puberty blockers and hormone therapy to change how they identify their gender. Wednesday’s 6–3 decision in United States v. Skrmetti, in an opinion delivered by Chief Justice John Roberts, is a victory for basic reality and a defeat for judicial adventurism.

If all the justices followed the original meaning of the Constitution in this case, it would have been 9–0. But the Court did not even need to get that far. The esoteric theory of sex discrimination advanced against the Tennessee law was that it discriminated by allowing the same hormones to be used for entirely different treatments, such as “to treat a minor’s congenital defect, precocious (or early) puberty, disease, or physical injury.” But as Roberts noted, this theory ignored “a key aspect of any medical treatment: the underlying medical concern the treatment is intended to address.” Because “different drugs can be used to treat the same thing . . . for the term ‘medical treatment’ to make sense . . . it must necessarily encompass both a given drug and the specific indication for which it is being administered.” At that, the theory once backed by Joe Biden’s Justice Department evaporated.

Hard cases make bad law; easy cases make bad dissents. Justice Sonia Sotomayor, joined by the other two liberals, brought the melodrama: “The Court abandons transgender children and their families to political whims. In sadness, I dissent.” Democracy is not a political whim. As Justice Clarence Thomas rejoined to Sotomayor’s effort to muster a medical consensus on her side, “the American people and their representatives are entitled to disagree with those who hold themselves out as experts,” especially on questions of ethics. Even if the current elite American fad for transgender treatments were not built on shifting scientific sands, it would still be the right of the people to decide that irreversible medical treatments on minors are unethical because they are not old enough to give their own informed consent.

Those sands are indeed shifting, as the Court noticed in its references to the 2024 Cass Report. Thomas added to that picture the evidence that the American medical decisionmakers were pressured politically by the Biden administration with an eye firmly on how the “science” would play in this and other court cases. Sotomayor complained that Tennessee’s law is not exactly the same as those in European countries, but this is America. Our Constitution has not surrendered the right of the people to make different decisions any more than their rights to make moral judgments or to reevaluate changing circumstances.

Under the dissent’s contorted standard, any regulation of medicine is a constitutionally suspect sex classification if the regulation or the medical practice takes any account of sex at all: “As long as sex is one of the law’s distinguishing features . . . the law classifies on the basis of sex.” But as the majority noted, medical practice has never been blind to sex differences, and the Food and Drug Administration sometimes approves treatments in areas such as breast cancer and HIV only for use with one sex. Only yesterday, feminists would have cheered the Court’s observation that the FDA “recognizes that research has shown that biological differences between men and women (differences due to sex chromosome or sex hormones) may contribute to variations seen in the safety and efficacy of drugs, biologics, and medical devices.” Vive la différence!

There remain other disputes, such as those involving sports and bathrooms, that will press again upon the Court whether transgenderism is a distinct class protected by the 14th Amendment at all. Three of the justices — Amy Coney Barrett, Samuel Alito, and Thomas — urged the Court to conclude that it is not. While Skrmetti was an easy enough case without reaching that question, they are right on the constitutional question, which would have been obvious at the time the 14th Amendment was ratified. Barrett got to the nub of the issue: There is no discrete and immutable class of transgender individuals. Gender dysphoria and confusion arise at different points of life, manifest in what even activists consider a fluid spectrum of ways, and have been abandoned by detransitioners. It’s a moving target defined by progressive ideology, which is anything but immutable.

That question will doubtless be back at the Court soon. The majority got it right this time because it didn’t need to do more than recognize reality.