In a wave of recent legislative efforts, several states are moving to restrict access to gender-affirming care, igniting heated debates on rights, healthcare, and identity. This article showcases the complexity of these measures across states and their profound implications for transgender individuals and society at large.
Alabama
Alabama prohibits any “person” (with a broad definition) from engaging in or causing practices to be performed upon a minor in an attempt to alter the appearance or affirm a minor’s perception of their gender.
This includes prescribing, administering medication, or performing surgeries to delay or transition gender for individuals under 18 years of age.
The law includes exemptions for individuals born with a medically verifiable disorder of sex development.
Arizona
Arizona legislation forbids doctors from performing permanent gender reassignment surgery on individuals who are under 18 years old. However, there are exceptions for those who have a medically confirmed disorder of sex development at birth, need treatment for injuries caused by a gender transition procedure, or have other physical injuries or illnesses that could lead to imminent danger of death or impairment.
Arkansas
In Arkansas, a law signed by Governor Sarah Huckabee Sanders in March holds health care providers liable for civil action for up to 15 years after a minor turns 18 if they performed a gender transition procedure on that minor. This law has been described as effectively making it easier to file malpractice lawsuits in these situations.
Experts suggest that the law acts as a de facto ban on gender-affirming care for children because it makes it nearly impossible for providers to obtain malpractice insurance.
In 2021, state lawmakers passed the nation’s first ban on gender-affirming care for minors, which was temporarily blocked shortly after. However, on June 20, 2023, a federal judge issued a permanent injunction against it, ruling the ban unconstitutional.
Although this marked the first time such a state ban was overturned, the more recent law signed by Sanders was still set to go into effect.
Florida
The Florida Department of Health’s Board of Medicine implemented a new regulation in March that prohibits certain treatments and procedures, such as sex reassignment surgeries and puberty blockers, for minors with gender dysphoria.
Following this, Governor DeSantis signed a similar ban into law on May 17, 2023. This law not only restricts these procedures for minors but also gives Florida courts temporary emergency jurisdiction over a child if they have been subjected to or threatened with such treatments. The law also requires transgender adults to obtain written consent before undergoing these procedures, using a specific form approved by the Board of Medicine and Board of Osteopathic Medicine.
However, on June 6, 2023, a district court judge in Florida issued a preliminary injunction that temporarily halted the enforcement of some parts of the law for several young plaintiffs.
Subsequently, the same judge ruled that the sections of the law pertaining to transgender adults can still be enforced while they are under legal challenge.
Georgia
Georgia’s Senate Bill 140, signed into law by Governor Brian Kemp, prohibits certain surgical procedures for the treatment of gender dysphoria in minors from being performed in hospitals and other licensed healthcare facilities.
The legislation, advanced by the Republican majority in the state’s General Assembly, includes exceptions for treatments deemed medically necessary and situations covering continued treatment for minors undergoing irreversible hormone replacement therapies prior to July 1, 2023.
A federal judge allowed Georgia to resume enforcing the portion of the law banning doctors from starting hormone therapy for transgender minors on September 5, 2023, weeks after blocking it with a preliminary injunction.
The prohibition on surgical procedures was not covered by the legal challenges.
Idaho
Idaho’s GOP Governor Brad Little approved a bill criminalizing the provision of gender-affirming care for youth. Signed on April 4, 2023 and scheduled to go into effect in January 2024, the law makes it a felony to provide hormones, puberty blockers, or other gender-affirming medical care to minors.
Little stated in a letter confirming the bill signing that policymakers should exercise great caution when considering allowing the government to interfere with loving parents and their decisions about what is best for their children.
However, in December 2023, a federal judge issued a temporary injunction blocking the law’s enforcement.
Indiana
Republican Governor Eric Holcomb signed into law a bill on April 5, 2023 that prohibits all gender-affirming care for minors, after previously expressing that there was “some vagueness to it,” according to the AP.
The governor stated in a release that “permanent gender-changing surgeries with lifelong impacts and medically prescribed preparation for such a transition should occur as an adult, not as a minor.”
However, parts of the law were blocked by a federal judge on June 16 following a request for a preliminary injunction by the American Civil Liberties Union of Indiana.
The order stops the law’s ban on puberty blockers and hormone treatments for minors from going into force on July 1, 2023, but does not impact the restriction on gender-affirming surgeries.
Iowa
Iowa’s ban, signed into law on March 22, 2023, prohibits health care professionals from “knowingly” performing certain medical practices on minors if they are “for the purpose of attempting to alter the appearance of, or affirm the minor’s perception of, the minor’s gender or sex, if that appearance or perception is inconsistent with the minor’s sex.”
The practices covered by the law include hormone therapies and surgical procedures. Similar to other states’ laws, there are some exceptions, including a “medically verifiable disorder of sex development.”
Kentucky
Kentucky joined other states in banning gender-affirming medical care for minors on March 29, 2023. The Republican-led Kentucky General Assembly voted to override Democratic Gov. Andy Beshear’s veto, making it the first state led by a Democrat to approve such a ban in 2023.
The law specifies that any health provider who violates the prohibition can have their license or certificate revoked. A federal judge temporarily blocked the portion of the law that would have banned transgender youth from accessing puberty blockers and hormone therapy on June 28, 2023.
That same judge lifted the injunction on July 14, 2023, allowing the restrictions to go into effect. Subsequently, a federal appeals court panel on July 31, 2023 allowed the state to continue enforcing the law, and another did the same in September.
Louisiana
Louisiana approved a ban on gender-affirming care for minors on July 18, 2023, following a successful override attempt of former Democratic Gov. John Bel Edwards’ veto by the state’s Republican supermajority legislature.
The law, which went into effect on Jan. 1, 2024, covers procedures such as hormone therapies, puberty blockers, and gender-reassignment surgeries.
The ban’s ultimate approval came after a Republican lawmaker cast a tie-breaking vote to kill the legislation in May. However, it was eventually resurrected and passed before Edwards’ veto.
New Gov. Jeff Landry, a Republican, has supported the ban, stating in a post in May 2023, “Pediatric sex changes should have no place in our society.”
Mississippi
Mississippi’s law, one of the first to be enacted in 2023, prohibits any person from knowingly providing or engaging in conduct that aids and abets the performance of gender transition procedures on a minor in the state. The ban also prohibits using public funds or tax deductions for such procedures.
Republican Gov. Tate Reeves, when signing the bill into law, stated that “radical activists” are telling children they are “just a surgery away from happiness,” according to the AP.
Missouri
GOP Governor Mike Parson signed a bill on June 7, 2023 that will restrict gender-affirming health care for minors and some adults in Missouri starting in late August. The law prevents the state’s Medicaid division from covering such treatment for people of any age and prohibits providers from prescribing puberty blockers or cross-sex hormones to minors until August 28, 2027, unless they were being treated prior to the bill’s effective date.
Missouri initially banned gender-affirming care in April through an emergency regulation from state Attorney General Andrew Bailey, which limited treatments for both minors and adults, the latter of which was believed to be a first in the country. However, Bailey terminated the rule on May 16, 2023, citing the state legislature’s imminent ban.
A circuit judge allowed the law to take effect on August 25, 2023.
Montana
Montana’s ban on gender-affirming care for minors was signed into law on April 28, 2023, by Republican Gov. Greg Gianforte. The ban covers both surgical procedures and medications such as puberty blockers and testosterone.
Similar to other state laws, the prohibition includes exceptions for individuals diagnosed with a disorder of sexual development. The law also allows for physicians who perform a banned procedure to be sued within 25 years following it if the after-effects result in any injury, including physical, psychological, emotional, or physiological harms.
Democratic state Rep. Zooey Zephyr, a transgender woman, was exiled from the Montana House floor after she expressed that her fellow Republican lawmakers would have “blood on their hands” if they passed the bill.
The law was set to take effect on October 1, 2023, but a state judge issued a preliminary injunction on September 27, 2023 that blocked its enforcement, according to the AP.
Nebraska
Republican Governor Jim Pillen signed into law on May 22 a bill that prohibits gender-affirming medical care for minors in Nebraska, covering individuals under the age of 19.
The law also includes a ban on abortions at 12 weeks of pregnancy, and it encompasses a prohibition on surgical procedures and limitations on prescribed drugs related to gender alteration. The rules for the latter are to be determined by the state’s chief medical officer, who is a political appointee, according to the AP.
The gender-affirming care portion of the new law is set to go into effect on October 1, 2023.
North Carolina
The Republican-dominated legislature in North Carolina successfully voted to override a veto from Democratic Gov. Roy Cooper and approve a ban on gender-affirming care for minors on August 16, 2023. The bill’s language covers both transition surgeries and puberty-blocking drugs or cross-sex hormones.
The law went into effect immediately. Similar to other state bans that have been approved, there are exceptions to the prohibition.
North Dakota
Republican Gov. Doug Burgum signed a veto-proof bill into law on April 19 that criminalizes providing gender-affirming medical care to minors in North Dakota. The law, which went into effect immediately as an “emergency measure,” makes performing sex reassignment surgery on a minor a felony and providing gender-affirming medication such as puberty blockers to minors a misdemeanor.
In a statement, Burgum recommended that “thoughtful debate around these complex medical policies should demonstrate compassion and understanding for all North Dakota youth and their families,” according to the AP.
Ohio
On January 5, 2024, Mike DeWine the Governor of Ohio, a member of the Republican party, issued an executive order preventing young individuals in Ohio from undergoing gender-affirming surgeries before reaching the age of 18. This order became effective immediately.
The governor’s decision to veto a bill from the state legislature aimed to impose a more comprehensive restriction on gender-affirming care for minors, including hormone therapies. However, on January 24, 2024, the state Senate successfully voted to overturn the governor’s veto.
This wider-reaching ban also includes provisions that prohibit transgender girls and women from participating in girls’ and women’s sports teams at both the K-12 and collegiate levels.
Oklahoma
On May 1, 2023, the Governor of Oklahoma, a member of the GOP, signed a law prohibiting gender-affirming care for minors in the state. He expressed his enthusiasm for the measure and stated that it was intended to “protect our kids.”
The legislation permits the charging of any physician who knowingly provides gender transition procedures with a felony. However, prosecution must take place before the minor patient reaches the age of 18.
Although the law became effective immediately, on May 18, 2023, the state agreed not to enforce it while opponents sought a temporary court order to block it. Subsequently, in October, a federal judge declined to halt the law from taking effect.
South Dakota
On February 13, 2023, House Bill 1080 was signed into law in South Dakota, prohibiting healthcare professionals in the state from performing certain types of gender-affirming procedures on minors.
The legislation mandates that if a provider violates the law, a professional or occupational licensing board must revoke any license or certificate held by the provider.
The bill received strong support from GOP Governor Kristi Noem before being signed into law, as reported by the AP.
Tennessee
In Tennessee, Governor Bill Lee signed legislation in March that was scheduled to take effect on July 1, 2023. This law prohibits healthcare providers from performing or offering to perform a medical procedure on a minor if its purpose is to enable the minor to identify with or live as a gender inconsistent with their biological reproductive characteristics.
It also prohibits such procedures if the purpose is to address discomfort or distress related to a discordance between the minor’s sex and asserted identity. The law includes exceptions and establishes penalties for providers who violate it.
Shortly before its scheduled effective date, a federal judge on June 28, 2023 temporarily blocked the portion of the law that would have prohibited transgender youth from accessing puberty blockers and hormone therapy. However, the judge did not block the law’s ban on surgical procedures.
On July 8, 2023, a federal appeals court temporarily reversed the judge’s ruling, allowing the law to take effect at least until the court conducts a full review.
Texas
On June 2, 2023, GOP Governor Greg Abbott signed a bill in Texas that prohibits gender-affirming care for minors. The law includes exceptions similar to those seen in other states’ efforts to restrict transition care.
The Texas Supreme Court permitted the law to take effect on September 1, 2023, overturning a temporary injunction issued by a state district judge a week earlier.
This legislation was not Texas’ initial endeavor to limit gender-affirming care, as in 2022, Abbott had ordered an investigation into families receiving such care, although the order was halted by a state judge.
Utah
On January 28, 2024, Republican Governor Spencer Cox signed into law the first gender-affirming care ban of the year in Utah. The legislation, Senate Bill 16, restricts health providers from performing “sex-characteristic surgical procedures on a minor for the purpose of effectuating a sex change” or providing hormonal transgender treatment to minors.
The treatment is only allowed for minors who were diagnosed with gender dysphoria before July 1, 2023. Governor Cox stated that his approval of the law was partly an effort to pause “these permanent and life-altering treatments for new patients until more and better research can help determine the long-term consequences,” as reported by the AP.
West Virginia
On March 29, 2023, GOP Governor Jim Justice signed a new law in West Virginia prohibiting minors from being prescribed hormone therapy and puberty blockers, as well as from undergoing gender-affirming surgery.
The legislation, set to take effect in January 2024, includes an exception specifically aimed at youth for whom “treatment with pubertal modulating and hormonal therapy is medically necessary to treat the minor’s psychiatric symptoms and limit self-harm, or the possibility of self-harm.”
In such instances, the minor must obtain consent from their parents or guardians along with approval from two medical providers.
What Do You Think?
As we explore the evolving legislation affecting gender-affirming care, we must ask ourselves: How will these restrictions shape the future of individual freedoms and society’s understanding of identity?
Are we moving towards inclusivity and understanding or away from it?
