Here Are the 21 States Trying to Ban Gender-Affirming Care

The War on Health Care for Transgender Americans

Bills seeking to restrict access to gender-affirming care have been introduced in 21 states this year, and one of those states, Utah, has passed one into law..

Much of the legislation focuses on young people, although some bills go beyond this population and beyond banning surgery (genital surgery almost never performed on minors). Most seek to ban nonsurgical procedures such as the administration of hormones and puberty blockers, in addition to surgery. Several of the bills warn of dire consequences from these procedures, but in reality, both the surgical and nonsurgical treatments are endorsed as safe and effective (when age-appropriate) by major medical groups and are certainly never undertaken lightly. The bills largely provide exceptions for procedures performed on intersex people or those who’ve had a genital injury, making it clear they’re aimed at transgender people.

States that have already taken action against gender-affirming care include Alabama and Arkansas, where bans enacted by legislators are temporarily blocked while court challenges proceed; Florida, where medical boards have banned this care for most minors; and Oklahoma, where a major hospital ceased providing the care because the state would have withheld funding otherwise.

The 59 bills introduced so far against trans health care are part of a rash of anti-LGBTQ+ legislation, 185 bills in all, according to the American Civil Liberties Union, which is tracking them on its website. Other bills deal with sports participation, education, and other issues.

“These bills represented a coordinated effort to deny transgender people our freedom, our safety, and our dignity,” Chase Strangio, deputy director for transgender justice at the ACLU’s LGBTQ & HIV Project, said in a press release. “Across the country, trans people and our families are gearing up to fight back and prevent every one of these bills from becoming law. The history of LGBTQ people in the U.S. shows we are hardly strangers to having our health care politicized or our safety threatened by misinformed and misguided politicians. Even in the face of such an unprecedented effort to deny our existence, we are only more determined to build the future we all deserve.”

Scroll down for a look at pending bills, which are coming from conservative states such as Kansas, Texas, and Tennessee as well as liberal strongholds like New Jersey and Oregon, and the just-passed one in Utah.

Lawmakers behind these bills include (from left) Sen. Edward Durr of New Jersey, Rep. Savannah Maddox of Kentucky, and Sen. Mark Steffen of Kansas.

Hawaii

Even liberal Hawaii is not immune from anti-transgender legislation. Rep. Diamond Garcia, a Republican, has introduced House Bill 891 to ban gender-confirmation procedures for minors, including not only genital surgery but top surgery, puberty blockers, and hormone treatment. Doing so would be a felony. However, the bill is unlikely to pass.

Indiana

Nine bills to restrict gender-affirming care have been introduced in Indiana. Senate Bill 480, House Bill 1118, House Bill 1220, and House Bill 1525 would ban all such care for minors. House Bill 1231 would do the same plus prohibit insurance coverage, including Medicaid. House Bill 1589 would allow a person who's undergone the treatment to bring a medical malpractice suit within 15 years after turning 21. House Bill 1569 would ban state or federal funding of gender-confirmation treatment for prison inmates. House Bill 1407 and House Bill 1232 would prevent the state from intervening if a parent doesn't consent to a child's gender-affirming care.

Iowa

Iowa's Senate File 110 would ban all gender-affirming care for minors and create a right to sue over it. It's sponsored by several Republicans.

Kansas

In Kansas, Senate Bill 12, introduced by Republican Sens. Mike Thompson and Mark Steffen, would make it illegal to provide hormones, puberty blockers, genital surgery, top surgery, or other gender-affirming treatment to people under age 21. Violators could face a felony charge as well as the loss of their medical license.

Kentucky

Kentucky’s House Bill 120, proposed by Republican Reps. Savannah Maddox and Felicia Raybourn, would ban the provision of or referral for gender-transition procedures, surgical or otherwise, for anyone under 18. It would “define a violation as unprofessional conduct and acting recklessly for purposes of tort claims” and prohibit government funding and health plan benefit coverage for this treatment, according to a summary of the legislation.

Mississippi

Five bills seeking to restrict gender-affirming care are pending in Mississippi. House Bill 1125, which has passed the House and gone to the Senate, would ban all such care for minors as well as any public funding for it. House Bill 576 and House Bill 1127 have this goal as well. House Bill 456 would define parents as child abusers if they allow their kids to receive this care. Senate Bill 2864 would ban Medicaid or other public funding for gender-confirming treatment, regardless of the patient's age.

Missouri

In Missouri, eight bills have been introduced, all by Republicans. Senate Bill 49, Senate Bill 236, and House Bill 916 would ban the provision of all gender-affirming procedures to people under 18. Senate Bill 164 would do the same and would classify “coercion” of a minor into such procedures as child abuse or neglect. House Bills 419, 463, and 540 would likewise ban gender-affirming care for minors. House Bill 489 would prohibit medical schools from using diversity, equity, and inclusion criteria, including that relating to gender-affirming care.

Montana

Montana’s Senate Bill 99, introduced by Republican Sen. John Fuller, would ban all gender-affirming procedures for those under 18. Health care professionals could be sued for providing this treatment or see their licenses suspended. It would also ban Medicaid funding for this care.

Nebraska

In Nebraska, Legislative Bill 574 (the state legislature has only one chamber), the so-called Let Them Grow Act, would prohibit both surgical and nonsurgical gender-confirming care for anyone under 19. Civil suits could be brought against care providers.

New Hampshire

New Hampshire’s House Bill 619, sponsored by several Republicans, would ban all gender-affirming procedures for people under 18, along with Medicaid coverage for them, and make health care providers subject to lawsuits. It would also prohibit public schools from teaching “that gender is a choice, optional or fluid and that there are more than 2 genders: male and female,” with limited exceptions; make schools refer to students by the names and pronouns under which they were enrolled; and require students to use the restrooms for the sex they were assigned at birth. It further would create an exemption from the state law banning conversion therapy for minors. “Counseling of a child enrolled in therapy at the request of their parent for the evaluation of, and treatment for, gender dysphoria” would not meet the definition of prohibited conversion therapy, the bill says.

New Jersey

New Jersey Sen. Edward Durr, a Republican, is seeking to criminalize the provision of gender-affirming care, surgical or otherwise, for those under 18. Violation of his Child Protection and Anti-Mutilation Act would be a “crime of the third degree, which is punishable by imprisonment for three to five years, a fine of up to $15,000, or both,” the bill states.

North Dakota

North Dakota’s House Bill 1254, which has several Republican sponsors, would make it a felony to provide any gender-affirming care to a person under 18. This would be punishable by up to 10 years in prison and a $20,000 fine. The bill’s sponsors call it “an emergency measure.”

Oklahoma

Oklahoma, not content with withholding funds for care, has 14 new bills pending. House Bill 1011 would make it a felony to provide gender-affirming care to anyone under 21; it would be punishable by a fine of up to $100,000, a prison term of up to 10 years, or both. Senate Bill 129 would take the age limit up to 26 and likewise make violation a felony. Senate Bill 252 would ban this care for people under 18 and provide for professional discipline, such as loss of license, rather than criminal penalties, as would Senate Bill 613, House Bill 2177, and House Bill 1377. Senate Bill 614, Senate Bill 878, House Bill 1466, and House Bill 786 would ban the treatment for people under 18 and make it a cause for civil action. Senate Bill 787 would ban surgical procedures for people under 18 and make it a cause for lawsuits. Senate Bill 788 and Senate Bill 789 would allow people who received gender-affirming care as minors to sue their parents or guardians who consented to the care. Senate Bill 345 would prohibit care for people under 21 and make violation a felony punishable by imprisonment of three years to life and a fine of up to $20,000. Senate Bill 250 would ban Medicaid or other public funding.

Oregon

Oregon’s Senate Bill 452 would ban genital surgery (as mentioned, almost never performed on minors) and top surgery for people under 18. The bill doesn’t specify penalties.

South Carolina

Three bills against gender-affirming care are pending in South Carolina. Senate Bill 243 would ban both surgical and nonsurgical care for minors (under 18). So would House Bill 3551. Senate Bill 274 would ban it for anyone under 21 and require school personnel to out trans students to their parents or guardians.

South Dakota

South Dakota's House Bill 1080 would ban all gender-affirming care for minors and make it a cause for professional discipline and civil action.

Tennessee

In Tennessee, companion bills House Bill 1 and Senate Bill 1 would ban gender-affirming procedures, surgical and otherwise, for people under 18. Violators could be sued.

Texas

Texas has nine bills pending against gender-affirming care — this in a state where the governor and attorney general have been trying to have parents investigated for child abuse if they allow their kids to receive this care (most of the investigations are blocked by court action while a lawsuit proceeds). House Bill 42 and House Bill 436 would define the provision of gender-affirming care as child abuse (lawmakers have tried and failed to pass such legislation previously). Senate Bill 249 would classify genital surgery for those under 18 as “mutilation,” subject to prosecution. House Bill 1686 would ban all gender-affirming care for minors and use of public funds for it. House Bill 1752 would ban this care and make it a cause for lawsuits. Senate Bill 250, House Bill 41, and House Bill 122 would not allow medical professionals’ liability insurance to include coverage for damages incurred when providing this care. House Bill 1532 would ban that coverage and ban the care in general, making health care providers subject to professional discipline for doing so.

Utah

Utah’s Senate Bill 16 would prohibit gender-affirming surgery for minors and set restrictions for hormonal treatment. It has passed the Senate and House — despite Democratic Sen. Nate Blouin reading a moving statement from his trans intern, Ari Webb — and Gov. Spencer Cox has signed it into law. House Bill 132 would ban all gender-affirming procedures for minors, with professional discipline for violation, but it's pretty well moot now.

Virginia

In Virginia, Senate Bill 791 and Senate Bill 1203 would ban all gender-affirming care for minors, prohibit insurance coverage, and make violators subject to lawsuits. Senate Bill 960 would likewise ban this care and bar any government employee, except law enforcement personnel, from withholding information about a child’s “gender dysphoria or gender nonconformity” from parents or guardians. House Bill 2432 would require public school employees to give this information to parents.

Wyoming

Senate File 111 would classify gender-affirming treatment for minors as child abuse, with health care workers who provide this treatment subject to a prison sentence of up to 10 years.