Gender-Affirming Healthcare Coverage for Transgender Youth Is Under Attack in the US

On February 13, 2022, South Dakota banned gender-affirming care for transgender youth. Governor Kristi Noem signed HB1080 into law, making the South Dakota bill the first legislation passed in the country that calls for forced medical detransition of trans youth currently receiving care. Taking effect on July 1, medical practitioners providing hormone therapy to minors will have to terminate care immediately or systematically reduce all care to end no later than December 31. If they don't comply, they risk getting their professional license revoked. 

This law places trans youth at risk for both self-harm, as shown by record high rates of suicide, as well as abuse or assault from others. The Trevor Project reports nearly 1 in 5 transgender and nonbinary youth attempted suicide. And according to the Human Rights Campaign, at least 34 transgender and gender non-conforming people were killed in the U.S. in 2022.

Susan Williams, the founder and executive director at The Transformation Project, says the organization has been inundated with calls and emails from panicked parents across South Dakota who fear for their child’s wellbeing. They're also questioning if they will need to move out of the state. “It’s terrifying for these kids as they feel like they have had a target on their back just living in South Dakota, as they’ve faced 8 years of anti-trans legislation,” says Willaims.

It is not just South Dakota where youth and families feel a target on their backs. To date, 97 gender-affirming care bans have been presented across the nation in a coordinated attack on transgender youth and adults. Those make up a large percentage of the 321 anti-LGBTQ bills the American Civil Liberties Union (ACLU) is tracking. 

Williams sees this sweeping movement of anti-trans bills as our newest culture war. “When the vote hit the Senate floor in South Dakota, it was party line: every Republican voted for this to pass. Unfortunately, many states will have the same outcome as South Dakota because of this culture war.”

We have seen this play out numerous times now. Here's a status check on similar bills across the country. The information is current at the time of publication.

Tennessee: On March 2, 2023, Gov. Bill Lee signed Senate Bill 1 into law. It bans those under 18 from having access to transition treatments such as puberty blockers and hormone therapies, as well as surgery. The law also allows for the attorney general to fine healthcare professionals who provide such care with a civil penalty of $25,000.

Mississippi: On February 28, 2023, Gov. Tate Reeve signed House Bill 1125, which forbids doctors from providing gender-affirming care including hormone treatments and surgical procedures to those 18 and under.

Arkansas: The State Senate moved a bill forward allowing healthcare professionals who have performed gender transition procedures to be sued, conceivably violating the equal protection clause of the Constitution. It was signed into law by the governor on March 13, 2023.

Oklahoma: The State Senate has passed Senate Bill 613, a ban on gender-affirming healthcare for those under 18. Providers could lose their licenses, be criminally prosecuted or imprisoned, and could face a $100,000 fine. The bill is now with the House.

Wyoming: Senate File (SF) 111 would criminalize any medical care provided to youth for gender transition by labeling it as child abuse. SF 144 would prohibit physicians from providing any gender transitioning or reassignment care. Both bills passed the Senate but were defeated in the House.

Utah: In January 2023, Governor Spencer Cox signed a bill that prohibits transgender surgery for youth and disallows hormone treatments for minors who have not yet been diagnosed with gender dysphoria.

Alabama: In 2022, the state passed Senate Bill 184, making it a class C felony for medical professionals to provide gender-affirming care to those 18 and under.

Florida: Prohibited gender-affirming care for any new patients 18 and under, in addition to the “Don’t Say Gay or Trans” bill and the “‘Stop WOKE” bill.

As such bills continue to make progress, we can expect to see more families asking themselves if a move is necessary, or looking for answers with interstate medical access. Currently, the fragmented status of interstate care will include many legal questions and political maneuverings. Access to gender-affirming care will soon look like the current state of reproductive care, showing just how entwined the futures of both are. The option of potentially crossing state lines to receive care for either is accessible largely to those with additional resources of time, money, and privilege. 

Trans youth need allies now more than ever, and as parents, we have to get public about our allyship. Williams teaches parents about ways to support our children and communities. “Speak with those in your circle and share education, share the stories of trans individuals and how bills like these affect them,” she says. She cites actions including writing and calling legislators regarding anti-trans legislation, showing up to town halls, protests, hearings, running for office, and even just voicing your opinion.

Parents can use this time to get involved with local citywide organizations that support the LGBTQ+ community and look into what bills are under consideration in their home state by using the ACLU's bill tracker. Then contact your local lawmaker. The Department of Health and Human Services also has a list of advocacy and support organizations for the LGBTQ+ community that you can get involved with and support.

Williams remains hopeful that we can “uplift the transgender community and empower them to share their stories.” Perhaps it is through such personal connections to trans individuals and their stories, that we can change hearts and minds and put an end to this wave of anti-trans and anti-LGBTQ+ legislation. Every person should have the right to their own life story.