The U.S. Supreme Court upheld a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors on Wednesday in a setback for transgender rights that could bolster efforts by states to defend other measures targeting transgender people.

In United States v. Skrmetti, the Supreme Court ruled that Tennessee’s ban on gender-affirming care for minors was not unconstitutional—the first case of its kind on which the court has ruled.

The conservative Supreme Court dealt a significant blow to transgender Americans on Wednesday, issuing a sweeping decision that may have implications beyond the medical care that was at center of one of the court’s highest-profile disputes this year.