Bans against gender-affirming care for transgender youth in the US

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published 23 May 2023

Despite opposition from major medical groups, Republican officials across state legislatures have in recent months forged ahead with a slew of bans on gender-affirming care for transgender youth, including puberty blockers, hormone therapy and surgery. Those who support the limits argue such care is too experimental and allegedly irreversible. But critics are concerned that the restrictions stand to further harm and ostracize an already-marginalized and vulnerable population. Below, we've rounded up every state that has approved some degree of care ban.

Alabama

In April of 2022, Republican Gov. Kay Ivey signed a bill criminalizing gender-affirming care for individuals under the age of 19. "We should especially protect our children from these radical life-altering drugs and surgeries when they are at such a vulnerable stage in life," the governor said in a statement, claiming she approved the bill because "if the good Lord made you a boy, you are a boy, and if he made you a girl, you are a girl." A federal judge not long after halted portions of the law from taking effect while court challenges play out.

In the spring of 2022, former Gov. Doug Ducey (R) signed into law two bills targeting transgender youth, one of which restricts "any irreversible gender reassignment surgery until the age of 18," Ducey said. The case for the bill is "simple and common sense," the governor wrote in a letter at the time: "This is a decision that will dramatically affect the rest of an individual's life, including the ability of that individual to become a biological parent later in life." The ban does not include cross-sex hormones or puberty blockers and is currently in effect, per The New York Times.

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In March, Republican Gov. Sarah Huckabee Sanders signed a bill that makes it easier to sue medical professionals who provide gender-affirming care for kids, "a move that could effectively reinstate a blocked ban on such care," The Associated Press reported. The law takes effect in the summer of 2023 and allows "anyone who received gender-affirming care as a minor to file a malpractice lawsuit against their doctor for up to 15 years after they turn 18." The state legislature had previously passed a law restricting gender-affirming care for kids, overriding a veto from then-Gov. Asa Hutchinson, but its efforts were later temporarily blocked by U.S. District Judge Jay Moody, who's currently considering whether to strike down the law.

In early May, the Florida legislature advanced a bill that bans gender-affirming care for transgender minors, prohibits local governments and institutions that access Florida's Medicaid programs from using that money to provide such treatment, and makes it easier to sue a doctor who provided gender-affirming therapies. Gov. Ron DeSantis (R), whose "administration last year blocked state-subsidized health care from paying for treatments of transgender people," according to Politico, is expected to sign it. The bill also arrives after the state's medical boards passed rules banning gender-affirming care like puberty blockers, hormones and surgical procedures for new patients under 18. Both the administration's decision and the medical board's decision are being challenged in court.

Republican Gov. Brian Kemp in March signed a bill barring medical professionals in Georgia from providing minors with hormone therapy or gender-affirming surgery under threat of license revocation. The law ensures "we protect the health and wellbeing of Georgia's children," Kemp tweeted at the time. "As Georgians, parents and elected leaders, it is our highest responsibility to safeguard the bright, promising futures of our kids — and SB 140 takes an important step in fulfilling that mission." Minors who began hormone therapy before July 1 of this year, when the law takes effect, are permitted to continue treatment.

Republican Gov. Brad Little on April 4 approved a bill criminalizing the act of providing minors with puberty blockers, hormones or other gender-affirming care in the state of Idaho. The law doesn't go into effect until January 2024. "In signing this bill, I recognize our society plays a role in protecting minors from surgeries or treatments that can irreversibly damage their healthy bodies," the governor wrote in a signing statement. "However, as policymakers we should take great caution whenever we consider allowing the government to interfere with loving parents and their decisions about what is best for their children."

In late March, Republican Gov. Kim Reynolds approved two bills aimed at Iowa's transgender youth. The first — Senate File 538, which immediately went into effect — bans doctors from treating minors with gender-affirming care. "We need to just pause; we need to understand what these emerging therapies actually may potentially do to our kids," Reynolds said at a news conference. "This is an extremely uncomfortable position for me to be in. I don't like it. But I have to do what I believe right now is in the best interest of the kids."

At the end of March, the Republican legislature voted to override Democratic Gov. Andy Beshear's veto of a multipronged anti-trans law, which counts a ban on gender-affirming health care among its many restrictions. While once "fairly narrow," wrote The New York Times, the final law also prohibits schools from referring to students using their preferred pronouns, should those pronouns differ from the student's birth certificate, urges doctors to cease treating patients that have begun transitioning, and limits the discussion of sexuality and gender orientation in schools. It goes into effect on June 29 of this year.

Gov. Tate Reeves (R) in early 2023 signed a bill banning puberty blockers, hormone therapies and gender-related surgeries for individuals under 18 in Mississippi. The bill also blocks institutions or individuals who provide gender-affirming care to minors from accessing public funding, allows minors to sue providers for 30 years after receiving gender-affirming treatment and threatens medical professionals with the loss of their license should they violate the law. It's currently in effect.

Attorney General Andrew Bailey in mid-April issued a state directive that severely limits treatment of both transgender adults and minors. Under Bailey's rules, which he described as "substantial guardrails" around such "experimental treatments," individuals must submit to at least 18 months of therapy before receiving puberty-blocking drugs or undergoing gender-related surgeries. The directive went into effect on April 27 and expires February 2024.

Despite his nonbinary son having urged him otherwise, Republican Gov. Greg Gianforte at the end of April signed into law a bill restricting hormone treatments and surgeries for transgender youth in the state of Montana. The bill's journey to the governor's desk was quite dramatic. After she spoke out against the legislation, transgender Rep. Zooey Zephyr was blocked from the House floor for the remainder of the legislative session. The law goes into effect on Oct. 1.

GOP Gov. Bill Lee signed a gender-affirming care ban into law in Tennessee in early March. The legislation prohibits medical professionals from "performing on a minor or administering to a minor a medical procedure if the performance or administration of the procedure is for the purpose of enabling a minor to identify with, or live as, a purported identity inconsistent with the minor's sex." The new law takes effect on July 1. Minors already receiving transition and gender-affirming care can continue to do so until March 31, 2024, provided their physician can certify that ending the treatment would be harmful to the child.

Last spring, Gov. Greg Abbott (R) alerted state health agencies that providing transgender youth with gender-affirming care was, under state law, tantamount to "child abuse." His directive also stipulated that medical professionals and teachers must alert the Texas Department of Family and Protective Services should they encounter a parent helping their child to receive such care, The Washington Post summarized. The order is currently on hold as court challenges unfold.

In March, Gov. Jim Justice (R) approved a bill banning gender-affirming surgery, as well as the prescription of hormone therapy and puberty blockers, to individuals under the age of 18. The law does, however, include a "unique exemption," PBS stated, permitting "doctors to prescribe medical therapy if a teenager is considered at risk for self-harm or suicide." It takes effect in January 2024 and permits a patient to receive puberty blockers and hormone therapy if the medication is approved by a parent and comes in conjunction with a diagnosis of severe gender dysphoria from two doctors, including a mental health professional.

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Brigid Kennedy worked at The Week from 2021 to 2023 as a staff writer, junior editor and then story editor, with an interest in U.S. politics, the economy and the music industry.