According to a survey conducted by The Washington Post and the Kaiser Family Foundation, the vast majority of transgender adults in the United States – 78% – feel that living with a gender other than the one assigned to them at birth has improved their quality of life. Gender-affirming refers to medical interventions or treatments that affirm a person’s gender identity, often including hormone therapy, surgeries, or other procedures to align their physical characteristics with their gender identity.
More than three-quarters of respondents changed their clothing, hairdo, or grooming habits to match their desired gender, while 31% utilized hormone therapy and 16% underwent gender-affirming surgery or a related surgical procedure to change their look.
However, such options are becoming more limited as legislators in several states move to restrict trans-Americans’ access to gender-affirming medical treatments.
What exactly is gender-affirming care?
Conservatives, including those with religious convictions and concerns about potential abuse, typically oppose gender-affirming care for minors, which may involve surgeries or other interventions. “Children as young as ten shouldn’t be subjected to irreversible procedures because of gender dysphoria,” stated Florida Governor Ron DeSantis at a news briefing in August.
There are concerns about the long-term effects of gender-affirming treatments in minors due to a lack of extensive studies. A 2022 Reuters investigation highlighted the absence of comprehensive research tracking long-term satisfaction or regret among those who received gender-related medical care as children. Additionally, there are worries about insufficient evaluations conducted before administering gender-affirming treatments to children.
Here is a list of states that have enacted laws to restrict or ban gender-affirming care for minors, based on legislation tracking from the Equality Federation, which collaborates with state-based LGBTQ+ organizations:
Arkansas
Florida
Georgia
Idaho
Indiana
Iowa
Kentucky
Louisiana
Mississippi
Missouri
Montana
Nebraska
North Carolina
North Dakota
Ohio
Oklahoma
South Dakota
Tennessee
Texas
Utah
West Virginia
Wyoming
Several states, such as Arizona and Alabama, implemented bans before 2023 and are not included in this list. Numerous bills are still under consideration in various states, and some officials have circumvented legislative processes to impose restrictions.
Arkansas
In Arkansas, newly elected Republican Governor Sarah Huckabee Sanders signed a law in March making healthcare providers liable for civil actions up to 15 years after a minor turns 18 if they perform a gender transition procedure on them. This creates a significant challenge for providers to obtain malpractice insurance, essentially acting as an indirect ban on gender-affirming care for minors. Previously, in 2021, Arkansas was the first state to ban such care, but the ban was temporarily halted and eventually struck down as unconstitutional by a federal judge in June 2023. However, the recent law remains in effect.
Florida
In Florida, the state’s Department of Health’s Board of Medicine established a rule in March banning various treatments and surgeries for minors with gender dysphoria. Governor DeSantis later signed a law reinforcing this ban and adding provisions for court interventions in cases involving sex reassignment procedures. While some aspects of the law were temporarily blocked by a district court judge, the restrictions on adults undergoing these procedures remain enforceable.
Georgia
Georgia’s Governor Brian Kemp signed Senate Bill 140 in late March, which prohibits certain surgeries for treating gender dysphoria in minors within licensed healthcare facilities, with few exceptions. Although a federal judge initially blocked the state from enforcing new bans on hormone therapy for transgender minors, the ruling was partially overturned, allowing the state to continue implementing the ban on surgeries.
Idaho
Governor Brad Little of Idaho signed legislation on April 4, 2023, making it a felony to provide gender-affirming care to minors. Although initially set to take effect in January 2024, a federal judge issued a temporary injunction in December 2023. In April 2024, the U.S. Supreme Court ruled that the ban could be enforced, except for the plaintiffs challenging it. Additionally, Governor Little signed a law in March that prevents transgender individuals from using publicly funded programs for gender-affirming care, effective July 1, 2024.
Indiana
Governor Eric Holcomb signed a bill on April 5, 2023, banning all gender-affirming care for minors. Despite previously expressing uncertainty, Holcomb stated that irreversible surgeries should only occur in adulthood. A federal judge initially blocked parts of the law, but a federal appeals court ruling on February 27, 2024, allowed these restrictions to take effect.
Iowa
Signed into law on March 22, Iowa’s ban prohibits health professionals from performing certain medical practices on minors to alter their gender appearance or perception. The law covers hormone therapies and surgical procedures, with exceptions for medically verified disorders of sex development.
Kentucky
On March 29, Kentucky joined other states in banning gender-affirming medical care for minors. Despite Democratic Governor Andy Beshear’s veto, the Republican-led Kentucky General Assembly overrode it. A federal judge temporarily blocked a portion of the law, but later lifted the injunction, allowing the restrictions to take effect.
Louisiana
Louisiana approved a ban on gender-affirming care for minors on July 18, following a successful override of former Democratic Governor John Bel Edwards’ veto. The law, effective January 1, 2024, covers hormone therapies, puberty blockers, and gender-reassignment surgeries.
Mississippi
Mississippi’s law, enacted in 2023, prohibits providing gender transition procedures to minors and restricts the use of public funds for such procedures. Governor Tate Reeves criticized activists promoting gender transition as a solution for children’s happiness.
Missouri
Governor Mike Parson signed a bill on June 7, 2023, restricting gender-affirming health care for minors and some adults in Missouri. The law prohibits Medicaid coverage for such treatment and limits providers from prescribing puberty-blockers or cross-sex hormones to minors until August 28, 2027.
Montana
Montana’s ban on gender-affirming care for minors, signed into law on April 28, 2023, covers surgical procedures and medications like puberty blockers and testosterone. A state judge issued a preliminary injunction on September 27, 2023, blocking enforcement of the law.
Nebraska
Governor Jim Pillen signed a bill on May 22, 2023, limiting gender-affirming medical care for minors under the age of 19 in Nebraska. The law includes bans on surgical procedures and prescribed drugs related to gender alteration, with regulations approved by the state’s chief medical officer.
North Carolina
North Carolina’s ban, enacted on August 16, 2023, prohibits gender-affirming care for minors, including transition surgeries and puberty-blocking drugs or cross-sex hormones. Exceptions exist, but the law goes into effect immediately.
North Dakota
Governor Doug Burgum signed a bill into law on April 19, 2023, criminalizing gender-affirming medical care for minors. The law makes sex reassignment surgery on a minor a felony and providing gender-affirming medication a misdemeanor.
Ohio
Governor Mike DeWine signed an executive order on January 5, 2024, prohibiting gender-affirming surgeries for young Ohioans before the age of 18. Despite initially vetoing a bill from the state legislature, the state Senate overrode the veto, enacting a broader restriction on gender-affirming care for minors.