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 June 18 ruling in United States v. Skrmetti marks a significant victory for Tennessee and 25 other states with similar restrictions on transgender medical interventions, such as puberty blockers,