Colorado voters ban trans youth surgeries that hospitals already don’t perform

Colorado voters have narrowly approved a measure banning gender-affirming surgery for minors, handing opponents of transgender rights a victory in a state where Democrats also swept major statewide races.

The Associated Press called Proposition 135’s passage Friday. Results reported by Decision Desk HQ showed 52.03 percent supporting the measure and 47.97 percent opposing it, with more than 95 percent of the estimated vote counted.

The measure prohibits healthcare professionals from performing surgery on people younger than 18 to alter their sex characteristics in response to their gender identity. It also bars state and federal funding, Medicaid reimbursements and private insurance coverage for the prohibited procedures.

Proposition 135 does not ban nonsurgical gender-affirming care, including puberty blockers, hormone therapy or counseling.

Related: 4 states move anti-trans ballot measures to voters for 2026 midterm election

The measure’s reach could extend beyond transgender patients. Colorado’s official voter guide says it may restrict surgeries for cisgender minors if the treatment is interpreted as responding to their perception of sex or gender. It includes exceptions for circumcision and certain treatments for differences in sex development and acquired physical or chemical abnormalities.

The vote restricts procedures that are already uncommon. Children’s Hospital Colorado, Rocky Mountain Children’s and Denver Health — the state’s three large pediatric surgical providers — reported that they do not perform gender- or sex-based surgeries on transgender patients younger than 18, according to the voter guide.

A 2024 study published in JAMA Network Open examined 2019 insurance claims covering nearly 23 million minors. Researchers identified 85 gender-affirming surgical procedures associated with transgender or gender-diverse diagnoses among patients younger than 18; 82 were chest-related procedures. They found no such surgeries among children 12 or younger.

Protect Kids Colorado, the conservative organization behind the initiative, argued that young people should wait until adulthood to undergo the surgeries. Opponents said the measure takes medical decisions away from patients, parents and doctors.

The group also backed Proposition 134, which voters approved to restrict transgender students’ participation in school and college sports. That measure requires teams to be designated male, female, or coeducational and generally limits participation according to sex assigned at birth.

Related: Colorado ballot measure could leave schools to verify students’ sex, raising fears of forced genital exams

Families Not Politics, the coalition opposing both measures, acknowledged their passage Thursday. Its members include One Colorado, Rocky Mountain Equality, the Transgender Law Center and Inside Out Youth Services. One Colorado pledged to continue organizing and help affected young people and families find resources as the measures move toward implementation.

“This outcome is painful, and it will have real consequences for young people and families across our state,” Nadine Bridges, executive director of One Colorado, said in a statement, according to the Colorado Sun.