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 justices ruled that Tennessee’s law, which prohibited some medical treatments for transgender youths, did not violate equal protection principles.

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. Since President Donald Trump returned to office this year, the federal government has been trying to restrict access.