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.

The U.S. Supreme Court has upheld Tennessee’s ban on gender-affirming surgery for transgender youth in a ruling that’s likely to reverberate across the country. Most Republican-controlled states already have similar bans.

A divided US Supreme Court upheld a Tennessee law that outlaws certain controversial medical treatments for transgender children in a ruling that buttresses similar measures in two dozen states.