A Times examination shows how a landmark case about gender-affirming care for minors was built on flawed politics and uncertain science.

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.

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.