Laws on Gender-Affirming Care for Minors

By Susan Buckner, J.D. | Legally reviewed by Laura Temme, Esq. | Last updated June 08, 2026

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Key Takeaways

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.

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.

This article summarizes how state laws regarding gender-affirming care for minors differ across the nation. Keep in mind these laws are evolving and subject to change. For the most up-to-date legal guidance, contact an attorney in your state.

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:

Agencies must 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 restrictions regarding 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, 15 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

There are 27 states with 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

In June 2025, the U.S. Supreme Court issued its decision in U.S. v Skrmetti, upholding a Tennessee law that prohibits gender‑affirming medical care for minors. The Court concluded that the statute does not amount to sex‑based discrimination and therefore does not violate the Equal Protection Clause of the Fourteenth Amendment. Following that ruling, roughly 25 state bans remain in effect.

Arkansas is an example of how Skrmetti allowed states to go ahead with a ban. In August 2025, the Eighth Circuit Court of Appeals overturned the lower court ruling that granted the injunction, based heavily on the Supreme Court’s decision in Skrmetti. It came to a similar conclusion that the Arkansas SAFE Act regulates access to medical care by “age and medical procedure, not sex” and “regulates a class of procedures, not people.”

The court of appeals stated that, in light of this, the law only needed to have a rational basis (the lowest threshold in constitutional cases). It found that the state’s legitimate interest in protecting the health and safety of children met that standard (Brandt v. Griffin).

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 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 cannot 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: Contact an Attorney

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. FindLaw’s attorney directory is free to use. Start by entering your legal issue and location (city or ZIP code) for a list of qualified legal professionals near you. Because state laws are relevant, your attorney should be licensed in your state.

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