The Supreme Court will hear arguments on Wednesday over the constitutionality of state bans on transgender procedures for minors, in one of the most high-profile cases the justices will consider this term.

The closely watched case, the United States v. Skrmetti, will unfold as the Supreme Court has been relatively quiet on transgender issues so far even as a debate rages across the country. The case centers around a Tennessee law, SB1, that prevents healthcare providers from performing “gender-transitioning” procedures on minors — and the court’s decision is expected to affect more than 20 states that have enacted similar bans or restrictions.

The legislation being challenged in Tennessee notes that gender-changing procedures, such as hormone therapy or puberty blockers, “can lead to the minor becoming irreversibly sterile, having increased risk of disease and illness, or suffering from adverse and sometimes fatal psychological consequences.” It also notes that not all harmful effects are fully known yet and that many of the “treatments” are “experimental in nature and not supported by high-quality, long-term medical studies.”

The oral arguments come as President-elect Trump took hardline positions throughout the campaign on transgender issues — promising to “end left-wing gender insanity” by keeping biological males out of female sports and preventing public schools from promoting gender transitions. In the lead up to the election, Trump ran an ad against Vice President Harris for her past support of taxpayer-funded sex changes for transgender inmates: “Kamala is for they/them, President Trump is for you,” the ad said.

Tennessee, in its brief before the high court, notes that states have seen an explosion of minors receiving gender-dysphoria diagnoses and a “corresponding surge in unproven and risky medical interventions for these underage patients.” It says the surge is “unexplained,” as the percentage of youth identifying as transgender has doubled in the past few years while the percentage of transgender adults has stayed constant.

The state defends its law as a simple way to ensure that minors can’t receive a procedure with “lifelong consequences” until the science is developed enough that the state might take a “different view.” The state, referring back to the Sixth Circuit Court of Appeals decision that upheld its law, also contends that unelected federal judges should not “impose a constitutional straightjacket” on laws while questions about “medical and scientific uncertainty” are playing out.

The Biden administration, while targeting the Tennessee law, has argued that both the state’s ban and the wave of similar legislation across the country has created “profound uncertainty for transgender adolescents and their families around the Nation.” The administration contends that urgent intervention from the court is needed for the health of transgender adolescents across the country since the bans have prevented them from obtaining care that their parents and doctors have deemed necessary.

The Biden administration argued in its brief that Tennessee’s law and similar state bans discriminate openly based on “sex and transgender status” and thus constitute a violation of the 14th Amendment’s Equal Protection Clause. It argues that because the law prohibits the procedures when they are intended to treat gender dysmorphia, but “permits the exact same treatments when prescribed for any other purpose,” the laws are discriminatory.

The case has already prompted a surge of national interest in support of each side. A group of individuals who underwent the gender procedures as minors and “detransitioned” as adults filed an amicus brief, arguing that they have seen firsthand how “pediatric gender affirming care has destroyed lives.”

Without state restrictions on the procedures, “minors exploring their gender identities can easily and inevitably be pressured to transition,” they argue. The detransitioners say that when they originally transitioned “were not fully aware that they would be medically experimenting with their bodies” and that they were “ushered into the process without safeguards because medical transitioning is the ‘standard of care.’”