Laws on Gender-Affirming Care for Minors

Gender-affirming healthcare for minors involves medical and psychological interventions like hormone therapy, puberty blockers, and mental health counseling. Legal considerations are critical as many states have differing laws regarding the availability and restrictions of such treatments for minors. Parents and guardians must navigate complex legal landscapes that may include bans or criminal charges in some states, while others offer protections and access to necessary healthcare.

The legal landscape surrounding transgender rights and gender-affirming care for minors remains uncertain. Parents of transgender teens who need current information should stay in touch with LGBTQ+ organizations in their state.

In recent years, more than half the states have passed laws prohibiting gender-affirming care for minors under the age of 18. Some state bans include criminal charges for providing some types of care, such as gender-affirming surgeries for minors.

Twelve states are considered “sanctuary states” for transgender medical treatment. These states have laws protecting the rights of transgender individuals and their parents to receive medical treatment and will not enforce out-of-state investigations or prosecutions.

What Is Gender-Affirming Healthcare?

Transgender individuals are those whose gender identity differs from their sex assigned at birth.

When the person feels distress or depression caused by the difference in their identity and assigned sex, they may experience gender dysphoria. However, not all transgender individuals experience gender dysphoria. And not all those with gender dysphoria are transgender.

Most serious cases of gender dysphoria occur during puberty. According to leading medical associations like the American Medical Association (AMA), current best practices for adolescent gender transition and gender dysphoria include:

  • Hormone therapy and puberty blockers to delay the development of secondary sex characteristics
  • Gender therapy or counseling

The AMA and the World Professional Association for Transgender Health (WPATH) both recommend therapy to address the anxiety and other emotional issues of gender dysphoria.

Surgical intervention is extremely rare for transgender youth.

Most medical providers follow WPATH best practices and will not perform complete gender confirmation surgery (GCS) on any individual under 18.

Hormone treatments are preferable treatments for trans youth because the effects are not permanent. Once the hormone therapy is halted, the child’s regular development resumes as before. In cases where a juvenile is uncertain or has other unresolved issues, waiting can be a better option.

Medical organizations, including the American Academy of Pediatrics and the American Medical Association, agree that properly managed hormone therapy is a preferable and reversible option to surgery.

The American Psychiatric Association recommends using puberty blockers to give trans youth and their parents more time to decide if other care is needed or desired.

White House Executive Orders

On January 28, 2025, President Trump issued an executive order limiting federal coverage for pediatric gender-affirming care.

The order applies to all individuals 19 years of age or under and requires, among other things:

  • That agencies cease reliance on WPATH best practices and rescind or amend all policies that contain “WPATH Standards of Care Version 8”
  • Institutions receiving federal research or educational grants must cease all gender-affirming care for minors
  • All gender-affirming actions, programs, and language must be removed from Medicare, Medicaid, and Section 1557 of the Affordable Care Act (ACA)
  • Tricare will no longer cover any gender-affirming care for any transgender minors previously covered

The order contains additional language regarding federal insurance and a timeline for updating Department of Health and Human Services policies. 

However, state laws provide varying levels of protection or restriction related to gender-affirming care. 

Shield Law and Sanctuary States

In 2022, following a wave of state bans on gender-affirming care, California became the first state to declare itself a “sanctuary state” for transgender youth.

Currently, 12 states have “shield laws” protecting transgender young people’s access to gender-affirming care, health insurance coverage, and out-of-state protection.

Several other states protect the right to gender-affirming medical care but may not protect insurance coverage or out-of-state legal challenges.

The chart below summarizes how states that protect access to gender-affirming care differ in their approach.

State

Gender-affirming care

Insurance and health plans

Out-of-state protection

Arizona

Protects access to gender-affirming care

Does not include state health insurance protection

Will not enforce out-of-state orders

California (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Colorado (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Connecticut (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Delaware

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Illinois (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Maine (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Maryland (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Massachusetts (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Minnesota (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Nevada

Protects access to gender-affirming care

Does not include state health insurance protection

Will not enforce out-of-state orders

New Jersey

Protects access to gender-affirming care

Does not include state health insurance protection

Will not enforce out-of-state orders

New Mexico (Shield Laws)

Protects access to gender-affirming care

Does not include state health insurance protection

Will not enforce out-of-state orders

New York (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Oregon (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Rhode Island (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Vermont (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

Washington (Shield Laws)

Protects access to gender-affirming care

Protects state insurance coverage and health care

Will not enforce out-of-state orders

State Bans on Gender-Affirming Healthcare

Twenty-six states have enacted statutes that limit or prohibit gender-affirming care (GAC) for minors.

Six states—Alabama, Florida, Idaho, North Dakota, Oklahoma, and South Carolina—have made it a felony to provide some kinds of GAC to minors.

One state (Nebraska) prohibits GAC for anyone under 19, meaning some people who are legally adults still cannot access gender-affirming care.

The table below summarizes state laws that restrict gender-affirming care.

State

Who restricted

What limited

Civil penalty?

Criminal penalty?

Alabama

All people

  • Puberty blockers
  • Hormone therapy
  • GAC surgery

 N/A

Class C felony

Arkansas

(Permanently blocked)

  • Physicians
  • Healthcare providers
 
  • Providing or referring hormone therapy or puberty blockers
  • Prohibits public funds including Medicaid for GAC
  • Prohibits health insurance plans from covering GAC for minors

Private action for individuals

 N/A

Arizona

Physicians

GAC surgery for minors

 

 

Florida

  • Physicians
  • Some court orders
  • Prescription and administration of hormone therapy and puberty blockers
  • Prohibits referrals
  • Modifies custody laws and permits the state to take custody of a child “at risk of” GAC even in another state
  • Prohibits the use of public funds for GAC

Loss of physician licensing or facility license

  • Providing GAC to a minor is a felony
  • Providing referrals for GAC is a misdemeanor

Georgia

Physicians

  • GAC surgery and hormone therapy
  • Some exceptions for puberty blockers
  • Dept of Health sanctions
  • Administrative actions

 N/A

Iowa

Healthcare professionals

  • GAC hormone therapy or puberty blockers
  • GAC surgical care
  • Potential licensing revocation
  • Private right of action

 N/A

Idaho

Medical practitioners

“Administering or supplying” hormone therapy or puberty blockers or providing surgical GAC or referrals to minors

Civil action

Felony

Indiana

 Physicians and medical practitioners

  • Providing hormone treatment/ puberty blocker prescriptions and surgical GAC
  • Prohibits “Aiding and abetting” other providers
  • Bans services in state, county, or city facilities

Creates a private right of action.

N/A

Kentucky

Health care providers

Prescribing or administering hormones or puberty blockers or providing surgical GAC

  • Loss of license
  • Private right of action

N/A

Louisiana

Health care professionals

Prescribing or administering hormones or puberty blockers or providing surgical GAC

  • Minimum two-year loss of license
  • Private right of action

 N/A

Missouri

Health care professionals

  • Prescribing or administering hormones or puberty blockers or providing surgical GAC
  • Prohibits use of Medicaid funds
  • Prohibits GAC in correctional facilities
  • License revocation for “unprofessional conduct”
  • Punitive damages for loss of fertility

 N/A

Mississippi

Anyone — “A person shall not knowingly provide” GAC services to minors

  • Prescribing or administering hormone or puberty blockers or GAC surgical care
  • Public funds may not be used to provide GAC directly or indirectly
  • Medicaid shall not be used to cover or reimburse costs
  • Physicians, nurses, and other providers will have their licenses revoked
  • Private right of action

 N/A

Montana

  • Any “person”
  • Health care professionals and physicians
  • Hormone or puberty blockers or BAC surgical care
  • Public funds may not be used, including Medicaid or CHIP
  • Minors being treated for psychological conditions including gender dysphoria cannot be advised of GAC
  • One-year license suspension
  • Professional insurance may not cover malpractice charges
  • Private cause of action

 N/A

North Carolina

Medical professionals

  • Providing, prescribing, or dispensing hormones or puberty blockers or surgical GAC
  • State funds may not be used for GAC including Medicaid and CHIP
  • Providers and facilities may not be required to perform GAC
  • Loss of license
  • Private right of action

 N/A

New  Hampshire

Physicians

GAC genital surgical procedures

  • Licensing board discipline
  • Parental cause of action

 N/A

North Dakota

Health care providers

Prescribing, dispensing, administering, or supplying hormone and puberty blockers or providing surgical GAC

 N/A

  • Surgery: Felony

  • Medication: Misdemeanor

Nebraska

Health care practitioners

  • Surgical, hormone, and puberty blocker GAC for those under 19
  • Prohibits state funds from going to entities providing minors with GAC
  • Professional discipline
  • Private right of action

 N/A

Ohio

  • Physicians
  • Mental health professionals
  • Some court orders
  • Hormone therapy, puberty blockers, and surgical GAC, or “aiding and abetting” minor access to GAC
  • Mental health professionals must have parental consent and must screen for comorbidities and abuse or other traumas
  • Medicaid may not cover GAC

Professional discipline

 N/A

Oklahoma

Physicians

Hormone therapy, puberty blockers, and surgical GAC

  • Private right of action
  • Unprofessional conduct and discipline by licensing board

Felony

South Carolina

  • Physicians
  • Mental health providers
  • Health care providers
  • School staff
  • Hormone therapy, puberty blockers, surgical GAC
  • Prohibits public funds, including Medicaid, from being used “directly or indirectly” for GAC
  • Prohibits school staff from encouraging a minor to withhold their "gender inconsistency" from their parents.

Discipline by licensing agency

Surgery is considered “infliction of great bodily injury on a child,” a felony with a maximum penalty of 25 years imprisonment

South Dakota

Health care professionals

Hormone and puberty blockers and GAC surgery

Loss of license

 N/A

Tennessee

  • Health care providers
  • Any “person” who prescribes medication

Hormone and puberty blockers, and offering or performing surgical GAC, including via telehealth

  • Private right of action for parents if no consent was given
  • Wrongful death action if a minor’s death results from physical or emotional harm

 

Class B misdemeanor

Texas

Health care providers

  • Prescribing, administering, dispensing hormone or puberty blockers or GAC surgical care
  • Prohibits public funds from going to any entity providing care, including CHIP, Medicaid and the state medical assistance program
  • Loss of license
  • GAC defined as “child abuse” that can lead to investigation and possible removal of children

 

 N/A

Utah

Health care providers

Hormone and puberty blockers and surgical GAC

Malpractice cause of action

 N/A

West Virginia

Physicians

Surgical GAC prohibited

Hormone or puberty blockers are permitted if:

  • Two medical professionals attest the minor has gender dysphoria
  • The treatment is necessary to treat or limit self-harm
  • The minor and parents agree to the treatment in writing
  • The lowest possible dosage is used

N/A

 N/A

Wyoming

Physicians

Health care providers

  • Hormone and puberty blockers and GAC surgery
  • Mental health professionals may provide treatment that does not violate the terms of the law

License suspension or revocation

 N/A

(Charts based on data from KFF Policy Tracker)

What the Laws Mean for Transgender Children and Parents

Some state bans are on hold, awaiting the Supreme Court's ruling on U.S. v Skrmetti. This case challenges the Tennessee law banning GAC for minors and a similar law in Kentucky. The plaintiffs claimed that the laws violated their Constitutional rights to equal protection and due process and the right of parents to make decisions for their minor children.

The United States Department of Justice (DOJ) applied as an intervenor alongside the petitioners in 2023 and requested a Supreme Court review. The request was granted in June 2024.

On February 7, 2025, the DOJ notified the Supreme Court that it had reversed its position in the case and was now aligned with the Tennessee defendant/respondents in the matter. The Supreme Court has indicated it will issue a ruling during the June 2025 session.

Shield Laws

In the twelve sanctuary states, shield laws preserve access to transgender health care and prevent intrusion from other state actions. Specifically, shield laws:

  • Protect parents, health care professionals, and others against out-of-state prosecution, extradition, subpoenas, and arrest
  • Require insurance companies and state health insurance providers to cover GAC and prohibit exclusionary language in health insurance
  • Permit GAC access for minors and adults, prohibit release of any medical data related to gender-affirming care, and provide a cause of action for denial of service
  • Protect medical professionals against professional discipline related to GAC, such as suspension, revocation, or dismissal

Sanctuary states will not enforce subpoenas or extradition orders from other states related to the gender-affirming care laws of those states.

Gender-Affirming Care Bans

Except in the handful of states with felony charges for performing surgery on minors, gender-affirming care bans primarily:

  • Prevent physicians and other health care providers from prescribing hormone therapy and puberty-blocking drugs to minors
  • Prohibit performing gender-affirming surgery on minors
  • Ban the use of public funds for any GAC purpose, including Medicare and CHIP and, pursuant to the Executive Order, Tricare
  • In some states, providers may not discuss gender-affirming care with minors presenting with gender dysphoria as a mental health issue
  • In some states, school officials may not withhold information that a minor has disclosed a gender-related issue to them

Nebraska’s law bans transgender care for minors under the age of 19. However, the state has not banned transgender care for adults. This creates an uncertain area where adults over the age of 18 may be unable to access care.

To date, laws and case law have been silent on gender-affirming care for adults on parental health insurance, such as college students who still use their parents' health insurance. Parents concerned about such matters should consult their attorneys.

Can a Minor Obtain Gender-Affirming Care Without Parental Consent?

Generally, no. Even in a state that allows minors to access gender-affirming care.

Minors are unable to legally consent to medical care on their own. Some states allow minors to access things like contraceptives or vaccines without parental consent. But puberty blockers and other hormone therapies would not apply.

However, gender therapy and other counseling services might be an option, particularly for older teens. In some states, minors can access mental health services without parental consent.

For example, in New York, a licensed mental health provider can provide services without parental consent if they believe it is necessary for your well-being and one of the following is true:

  • Your parent or guardian is not available
  • Requiring parental involvement would be detrimental to your treatment
  • Your parent or guardian has refused consent, but a health care provider has determined mental health treatment is necessary and in your best interest

An emancipated minor can make all of their own health care decisions, including gender-affirming care. However, emancipation is not an easy process and may not be the best option for everyone.

Get Legal Advice for Transgender Issues

Families of transgender teens need legal advice while state legislatures decide what new laws will affect them. LGBTQ+ rights fall in a broad spectrum of legal practice areas, including family law, discrimination law, civil rights, and more.

To keep up with your state’s laws, the Movement Advancement Project (MAP) features interactive maps on a wide array of state and federal laws that impact transgender and other LGBTQ+ rights. KFF is a medical policy tracking site that regularly updates changes in state and federal healthcare, insurance, and research.

For legal referrals in your area, visit FindLaw’s attorney directory or contact an LGBTQ+ organization near you..

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