Laws on Gender-Affirming Care for Minors

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 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.

(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..