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 delivered a blow to transgender rights by upholding a Tennessee ban on gender-affirming care for adolescents, but legal experts said the ruling was narrower than it could have been and left open the door for challenges to the rising number of government restrictions aimed at transgender people.

The decision to uphold the Tennessee law will most likely mean a patchwork of laws throughout the country, a map that traces current political polarization.