Tennessee Republicans are one step closer to creating a registry of transgender Americans

The Tennessee Senate on Monday passed an amended version of SB676, a bill that would require the state to collect detailed data on transgender patients. The legislation now returns to the Tennessee House of Representatives, where lawmakers must decide whether to accept the Senate’s changes before sending it to Republican Gov. Bill Lee.

The bill requires clinics and insurers to submit granular information about patients receiving gender-affirming care, including prescriptions, treatment timelines, and demographic data, which would be compiled into reports for lawmakers. The measure also ties those reporting requirements to a broader mandate that insurers cover so-called detransition care, a provision supporters say ensures continuity of treatment.

For advocates, the bill's structure, not just its stated purpose, is the concern.

“This is a bill that gathers data on trans and gender-diverse patients throughout the state, as well as providers,” Dahron Annelise Johnson, co-chair of the Tennessee Equality Project, told reporters while speaking outside the Senate chamber, according to video shared with The Advocate. “It asks for details around prescriptions, around what’s discussed in medical visits, around how long somebody has been in treatment.”

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The state has said the data would ultimately be reported in de-identified form. But Johnson and other advocates argue that the act of collecting, assembling, storing, and structuring it carries its own risks.

“The fact that that list exists at all is problematic on its face,” Johnson said.

In smaller or rural communities, where patient populations are thin and providers are few, advocates warn that even anonymized data can become legible, revealing patterns recognizable enough to identify the people behind them.

The bill’s rationale remains contested. Supporters have described SB676 in part as a way to track outcomes and ensure access to detransition care. But critics say that justification rests on hypotheticals and leaves fundamental questions unanswered.

The bill rests, in part, on assumptions about detransition that are not supported by the research. A 2021 study of more than 17,000 transgender adults found that while some respondents reported detransitioning at some point, the vast majority did so because of external pressures such as stigma, family rejection, or barriers to care, rather than a change in identity. Only a small fraction cited doubt about being transgender, and many later resumed transition.

Related: Tennessee bill could create public registry of trans residents’ medical info

“Do we collect data on everybody who’s taking hormones?” Johnson asked. “For all of the definitions in this bill, questions like that, which are key to understanding who it’s going to target, are completely murky still.”

That ambiguity, advocates say, is the point of tension: a bill that is narrow in its stated intent but potentially broad in its reach.

The amendment adopted Monday removes certain identifying elements, including geographic details, and narrows the circumstances under which provider information may be disclosed. Lawmakers backing the changes have pointed to them as evidence that the bill is responsive to privacy concerns.

But for opponents, the revisions read less like a fix than an acknowledgment.

“Any amount of risk reduction, any amount of harm reduction that we can come by, we are glad to see,” Johnson said. “But it just begs the question of why we’re doing this in the first place.”

The bill’s House companion, HB754, passed last month. The legislation now returns to the House, where lawmakers must vote on whether to concur in the Senate’s changes. If they do, the bill heads to Lee’s desk and almost certainly into court

Advocates are already preparing for both outcomes.

“We need people to contact Governor Bill Lee to tell him to veto this bill,” Johnson said. “We ask our legal partners to take a look at this bill as well.”