Gender-Affirming Health Care for Transgender Youth Is Under Attack in the US

Through the first quarter of 2023, gender-affirming healthcare coverage for transgender youth has come under attack across the country. Several states have passed laws putting strict limitations or all-out bans into effect.

Texas is now the largest state to pass a bill banning gender-affirming care for those under the age of 18. More specifically, it bans puberty-blocking and hormone treatments, as well as surgery. The bill is headed to Governor Greg Abbott for his signature. The law is scheduled to go into effect on September 1.

It's all part of a wider effort across the country to limit or ban medical treatment for transgender youth. According to the Associated Press, at least 17 states have similar bans.

On February 13, Governor Kristi Noem signed South Dakota's bill into law, making the state 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. 

These laws place 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. 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.

States Banning Gender-Affirming Health Care

It is not just Texas and 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 482 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 in 2023. Here's a status check on laws across the country, in alphabetical order. The information is current at the time of publication and is being monitored for updates.

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. Governor Sarah Huckabee Sanders signed it into law on March 13.

Florida: In March, the Health Department's Board of Medicine put a new rule into place that bans sex reassignment surgeries and puberty-blocking therapy in minors. The state had already prohibited gender-affirming care for any new patients 18 and under. That's in addition to the “Don’t Say Gay or Trans” bill and the “‘Stop WOKE” bill.

Georgia: On March 23, Governor Brian Kemp signed a bill into law that bans "certain surgical procedures for the treatment of gender dysphoria in minors from being performed in hospitals and other licensed healthcare facilities."

Idaho: On April 4, Idaho's Governor signed a bill into law that would make it a felony for a health care provider to give hormones, puberty blockers, or other gender-affirming care to those under 18. Physicians could face up to 10 years in prison. This law goes into effect in January 2024.

Indiana: One day after Idaho, Indiana's Governor Eric Holcomb signed a bill that bans transgender youth from accessing medication or surgeries. The new law also says anyone currently taking medication needs to stop taking it by the end of the year.

Iowa: This state's law went onto the books on March 22. This law prohibits medical providers from giving treatment for the sole purpose of changing a minor's gender or sex if it doesn't match up with that minor's sex at birth. Providers can lose their medical licenses or be subjected to lawsuits.

Kentucky: The only Democratic-led state to have a law on the books that bans access to gender-affirming health care for minors. GOP lawmakers were able to override the Democratic Governor's veto of the bill on March 29. The law also restricts which bathrooms transgender youth can use.

Missouri: Similar to what Florida did, Missouri's Attorney General went around the legislature. He enacted a new rule that would require 18 months of therapy before a person, either a minor or an adult, could receive gender-affirming health care. That person would also have to show they've had a pattern of gender dysmorphia for three years, and be screened for mental health issues, autism, and "social media addiction." It went into effect on April 27 and is set to expire next February. The American Civil Liberties Union is suing to block this rule from taking effect.

Mississippi: On February 28, 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.

Montana: On April 28, Montana's Governor signed a bill banning gender-affirming care for transgender youth. The new law blocks hormone therapy, puberty blockers, and surgeries on those under age 18 for transitioning purposes.

North Dakota: The Governor in this state signed a bill on April 20 that makes gender-affirming care a crime. This law does sill permit medication for early onset puberty and other issues with parental consent.

Oklahoma: Perhaps no state has pushed an anti-LGBTQ+ agenda more than Oklahoma. According to PBS Newshour, lawmakers have introduced 45 bills since the start of the session in February. Two of those bills target transgender youth. 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 House passed its own version, House Bill 2177. This bill bans puberty blockers, hormone therapy, and surgery. It also prohibits insurers from covering any gender-affirming care, no matter how old a person is. The Senate bill is now being considered by the House and vice versa.

Tennessee: On March 2, Governor 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.

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.

West Virginia: Governor Jim Justice signed a bill on March 29 that bans medical professionals from prescribing hormone therapy and puberty blockers, as well as gender-affirming surgery. But the West Virginia law does provide an interesting exemption allowing doctors to prescribe medical therapy if a teen is considered at-risk for suicide or self-harm.

Both Alabama and Arizona passed laws against gender-affirming health care in 2022, although a federal judge has blocked Alabama's law from being enforced.

Why All Parents Need To Pay Attention

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.