State Laws on Gender-Affirming Care

Gender-affirming medical care helps nonbinary or transgender people with their physical transition. However, many states have restricted access to this type of medical care for minors. Some states have even criminalized providing minors with gender-affirming care. Almost half of the state legislatures in the country have passed laws restricting or banning gender-affirming care.

This article provides an overview of what gender-affirming care is and which states have restricted access.

What is Gender-Affirming Care?

"Gender-affirming care" refers to many types of treatment related to gender transitions and gender dysphoria. It can focus on psychiatric care, physical medical care, or multidisciplinary treatment. 

Gender dysphoria is the feeling of distress or discomfort a person feels when their gender identity does not align with the sex they were assigned at birth. It negatively impacts a person's mental health, often leading to depression and other issues. 

Gender transitions can involve:

• Social transition (dressing according to gender identity, using a different name or pronouns)
• Medical transition (any combination of hormone therapy, surgical medical procedures, and nonsurgical medical procedures)
• Legal transition (legally changing name and gender marker)

Gender-affirming medical care helps nonbinary or transgender people with their physical transition. It can include hormone replacement therapy, gender-affirming surgery, or both. Gender-affirming surgery might involve:

• “Top" surgery (reconstructive surgery for the chest area)
• “Bottom" surgery (reconstructive surgery for the genital area, also known as gender confirmation, sex reassignment, or gender reassignment surgery)
• Facial feminization or masculinization procedures
• Voice surgery procedures

For many, gender-affirming care is a life-saving course of treatment. A transgender or nonbinary person's gender identity is still valid even if they have not pursued this type of care.

Gender-Affirming Care for Transgender Minors

For children and adolescents, gender-affirming care often focuses on social transition. However, in some cases, transgender children will be prescribed puberty blockers. These medications temporarily halt the changes young people experience during puberty. 

For someone identified as male at birth, puberty blockers can prevent the deepening of their voice and the growth of facial and body hair. For those identified at birth as female, puberty blockers stop menstruation and breast development. But, once the person stops taking the medication, puberty resumes, and they will go through the expected physical changes.

Puberty blockers are also used to treat precocious puberty. This condition, unrelated to gender dysphoria, causes a child to go through puberty too early.

Many major medical organizations support gender-affirming health care for minors, including:

• American Academy of Pediatrics
• American Medical Association
• American Academy of Child and Adolescent Psychiatry
• American Psychological Association
• American Psychiatric Association
• Endocrine Society

These organizations view gender-affirming care as appropriate “evidence-based" transgender health care. This describes an approach where doctors and medical providers rely on the best available scientific evidence from clinical research to decide what is best for their patients. Still, lawmakers in some states have passed laws in recent legislative sessions that limit or even ban gender-affirming care.

Types of Laws on Gender-Affirming Care

The map above depicts the level of restrictions on gender-affirming care in different states (as of the date of this article). States that appear in light blue currently restrict access to gender-affirming care for minors. Those states are:

• Alabama
• Arizona
• Arkansas
• Florida
• Georgia
• Idaho
• Indiana
• Iowa
• Kentucky
• Louisiana*
• Mississippi
• Montana*
• Nebraska
• New Hampshire**
• North Carolina
• North Dakota*
• Ohio
• Oklahoma*
• South Carolina*
• South Dakota
• Tennessee*
• Texas
• Utah
• West Virginia
• Wyoming

In several states, providing gender-affirming care to a minor is a felony. Those states are:

• Alabama
• Florida
• Idaho
• North Dakota
• Oklahoma
• South Carolina

* Lawsuits challenging laws in these states are pending, awaiting the U.S. Supreme Court ruling on the case of U.S. v. Skrmetti out of Tennessee. The Court will rule on this case during the 2025 session.

**New Hampshire’s Governor Sununu signed a law banning surgery for transgender minors in 2024. However, the law does not ban non-surgical treatments such as puberty blockers.

States Without Restrictions on Gender-Affirming Care

States that appear in medium blue currently have no restrictions on gender-affirming care. Those states are:

• Alaska
• Delaware
• District of Columbia
• Hawai'i
• Kansas
• Maine
• Maryland
• Nevada
• Oregon
• Pennsylvania
• Rhode Island
• Virginia***
• Wisconsin

***Virginia does not have laws prohibiting gender-affirming care for minors or adults. However, the state does have laws regarding school bathrooms and pronoun use.

The only state that appears in white is Missouri, which has restricted gender-affirming care for both minors and adults. A dark blue dot near the border of Missouri and Kansas indicates that Kansas City, Missouri, has declared itself a sanctuary city.

Sanctuary States

State legislation banning gender-affirming care for minors has caused worry for many. Families of nonbinary and transgender youth might feel displaced or unsafe. In response, a handful of states have designated themselves as safe harbors or "sanctuary states." These states appear in dark blue on the map above. 

Sanctuary states protect access to gender-affirming care for residents of that state. Plus, they are a safe haven for trans and nonbinary people from other states. These states will not enforce penalties from another state relating to gender-affirming care:

• California
• Colorado
• Connecticut
• Illinois
• Massachusetts
• Michigan
• Minnesota
• New Jersey
• New Mexico
• New York
• Vermont
• Washington

Below, we provide a detailed look at the laws currently in effect in each state.

Sanctuary Cities

A number of cities within both sanctuary states and other states have declared themselves to be “sanctuary cities,” including:

• Sacramento, California
• Kansas City, Missouri
• State College, Pennsylvania
• Olympia, Washington

It is difficult to know how much power a city has to enact laws that contradict state laws. However, these cities offer some protection to transgender individuals and youth within their jurisdiction.

Access to Gender-Affirming Care by State

Note: The laws surrounding gender-affirming care are changing quickly. While we aim to provide the most up-to-date information on this topic, it's best to check your state legislature's website for the most recent information if you or a loved one wish to pursue gender-affirming care.

Alabama

Alabama banned gender-affirming care for minors in April 2022. The law criminalizes giving puberty blockers and other gender-affirming treatments to anyone under 19.

A charge under this law could result in up to 10 years in prison. School officials must report transgender children to their parents.

Alaska

Alaska has no ban on gender-affirming care for minors or adults.

Arizona

In 2022, Arizona prohibited minors from obtaining gender-affirming care (SB 1138). The bill allows exceptions in the case of physical injury or illness that places the individual in imminent danger of death or for intersex individuals.

The state does not have any laws prohibiting adults from receiving gender-affirming care.

Arkansas

Arkansas was the first state to pass a law outlawing gender-affirming care for minors (HB 1570). In 2021, the state legislature passed a bill banning gender surgery and hormone therapy for minors.

The law was challenged in federal court and barred by a preliminary injunction. The state's appellate court upheld the injunction. This means the ban will not take effect until the district court makes its final determination. The state does not have any laws prohibiting adults from receiving gender-affirming care.

California

California is a sanctuary state. In 2023, a state law providing protections for trans youth and their families went into effect (SB 107). California will not enforce another state’s order to remove a minor based on gender-affirming care or custody.

Colorado

Colorado is a sanctuary state. In 2023, a bill defining gender-affirming care as a “legally protected health-care activity" was signed into law. Under this law, state courts will not issue subpoenas connected to another state's lawsuit against a doctor who provides gender-affirming care.

Connecticut

Connecticut is a sanctuary state. In 2022, the state passed a law protecting individuals against out-of-state judgments based on gender-affirming care they receive in Connecticut. The state has no ban on gender-affirming care for minors or adults.

Delaware

Delaware has no ban on gender-affirming care for minors or adults.

District of Columbia

The District of Columbia has no ban on gender-affirming care for minors or adults.

Florida

Florida bans minors from receiving gender-affirming care. The Florida Board of Medicine also prohibited health care providers from performing gender-affirming care for minors unless the minor has already undergone surgery. Providing such care is a felony. The law prohibits the use of state funds to cover best practices for medical care for transgender adults.

Georgia

Georgia bans minors from receiving gender-affirming care. In 2023, a bill prohibiting medical professionals from providing gender-affirming care to minors was signed into law. The law provides exceptions for:

• Intersex individuals
• Situations where the treatment is deemed medically necessary
• Cases where minors are being treated with irreversible hormone replacement therapy

Hawai’i

Hawai'i does not ban gender-affirming care for minors or adults.

Idaho

Idaho passed a law in 2023 that makes it a felony for a medical professional to provide gender-affirming care to minors. The law includes exceptions for intersex individuals and the treatment of any infection or injury caused by prior gender-affirming care. The state does not have any laws prohibiting adults from receiving gender-affirming care.

Illinois

Illinois is a sanctuary state and passed a law in 2023 that increased protections for medical professionals providing and individuals receiving gender-affirming care. The law defines gender-affirming care as “lawful health care." It prohibits the enforcement of subpoenas related to the enforcement of another state's gender-affirming care laws.

Indiana

An Indiana law restricted minors from accessing gender-affirming care in 2023 and mandated any minors currently taking gender-affirming medications to cease doing so by the end of 2023. 

The law provides exceptions for intersex minors, procedures necessary to treat an injury or illness caused by prior gender-affirming care, and the imminent threat of death. 

The state does not have any laws prohibiting adults from receiving gender-affirming care.

Iowa

In 2023, Iowa passed a law prohibiting medical professionals from providing gender-affirming care to minors. The law also prohibits medical professionals from “aiding or abetting” the provision of medical best practices for transgender youth.

Kansas

Kansas does not ban gender-affirming care for minors or adults. However, in 2023 the governor vetoed a proposed state law that would have required the state's medical board to revoke the medical licenses of physicians providing gender-affirming care to minors.

Kentucky

In 2023, the Kentucky legislature passed a law prohibiting minors from accessing gender-affirming care and requiring medical professionals to end any such care for minors.

Although the governor originally vetoed the bill, the legislature ultimately overrode it. The state does not ban adults from seeking gender-affirming care.

Louisiana

Louisiana House Bill 648 took effect over the governor’s veto in 2024. It prohibits best-practice medical care for transgender youth, including surgery and medication. Lambda Legal filed a lawsuit challenging the law in January 2024. That case is pending.

Maine

Maine does not ban gender-affirming care for minors or adults.

Maryland

Maryland does not ban gender-affirming care for minors or adults.

Massachusetts

Massachusetts is a sanctuary state. In 2022, the state passed a law expanding protections for individuals seeking gender-affirming care. The law defined gender-affirming care as “legally protected health care" and protected individuals from out-of-state legal action for seeking it.

Michigan

In March 2023, the state's House of Representatives passed an amendment to the Eliot-Larsen Civil Rights Act. This bill expands the state's protections against discrimination to include gender identity and sexual orientation. Governor Gretchen Whitmer signed the bill into law on March 16, 2023.

Minnesota

Minnesota is a sanctuary state. The state governor signed a bill protecting gender-affirming care in 2023. The law prohibits the use of subpoenas to gather information about individuals related to out-of-state laws banning gender-affirming care. It also provides custody protections to parents or guardians who assist their minor children in accessing gender-affirming care.

Mississippi

Mississippi banned health care professionals from providing gender-affirming care to minors in 2023. The law also prohibits anyone from “aiding or abetting” minors in receiving medical care for a gender transition.

Missouri

Missouri bans best practices medical care for transgender minors. The state prohibits the use of state funds, specifically Medicare, for all transgender individuals, and bans gender-affirming care for anyone incarcerated in the Missouri prison system.

In 2023, Kansas City, Missouri, officially declared itself a sanctuary city for gender-affirming care, defying state law. For more details on how this affects access to care, it's best to consult with a local civil rights or health care attorney.

Montana

Montana passed SB99 in April 2023, prohibiting minors from receiving gender-affirming care. A district court blocked the state ban on grounds of violation of privacy.

In December 2024, the state’s Supreme Court ruled in Van Garderen v. State of Montana that the law violated the state’s constitutional right to privacy and remanded the case back to the lower court to litigate on its merits.

Nebraska

Nebraska bans gender-affirming medical care for patients under 19, including gender transition surgeries, puberty blockers, and hormone treatments. A lawsuit challenging the ban was denied by the state supreme court in August 2024.

Nevada

There are currently no state laws in Nevada prohibiting adults or minors from accessing gender-affirming care.

New Hampshire

On July 22, 2024, Governor Chris Sununu signed HB 619, preventing trans minors from receiving surgery. It bars physicians from referring patients out of state for transition-related surgery. The law does not ban other gender-affirming care like puberty blockers and hormone therapy.

Governor Sununu also signed HB 1205, which requires students in grades 5-12 to compete on sports teams that “match their birth certificate gender.”

New Jersey

New Jersey became a sanctuary state in 2023 when its governor signed Executive Order No. 326. The order provided protections for healthcare professionals giving gender-affirming care to out-of-state residents seeking gender-affirming care.

New Mexico

New Mexico is a sanctuary state. In 2023, the legislature passed a law prohibiting the release of information regarding gender-affirming care for an out-of-state “investigation or proceeding that seeks to impose civil or criminal liability or professional disciplinary action." The law designates gender-affirming care as a “protected health care activity."

The state also passed a law protecting access to gender-affirming care by ensuring that local governments cannot bar access to it.

New York

New York is a sanctuary state. State law prohibits removing a child from a parent or guardian based on gender-affirming care claims, protects healthcare providers who provide such care, and protects families and minors seeking care.

North Carolina

North Carolina’s House and Senate passed a law over the governor’s veto that bans gender-affirming care for transgender minors. Lambda Legal and the National Health Law Program (NHeLP) sued the state in Voe v. Mansfield and asked the courts to block enforcement of the ban.

The request for an injunction was denied by a federal district court in December 2024.

North Dakota

North Dakota has banned gender-affirming care for minors. Providing surgical care is a felony, and medication is a misdemeanor. There are currently no state laws prohibiting adults from accessing gender-affirming care.

Three families and a medical provider from North Dakota have filed a lawsuit challenging the ban. In January 2025, a judge denied the state's motion to dismiss the case, allowing it to go to trial.

Ohio

In 2023, the Ohio legislature passed House Bill 68, which bans minors from receiving gender-affirming care. It also prohibits transgender girls and women from competing in women's sports at the K-12 and university levels.

Governor Mike DeWine vetoed the measure in December 2023, but the legislature voted to override the veto in January 2024.

The law prohibits puberty blockers and other hormone therapies for minors, as well as gender reassignment surgery.

Several groups challenged the law, asking the courts to prevent it from taking effect. In April 2024, the Franklin County Court of Common Pleas issued a temporary restraining order (TRO) blocking the ban. The TRO lasted until the case went to trial in July. Following a five-day trial, the judge in the case ruled against the plaintiffs and allowed the ban to take effect.

The case, Moe v. Yost, is ongoing. The parties presented oral arguments before a panel of Ohio appeals court judges in September 2024.

Oklahoma

In 2023, Oklahoma Governor Kevin Stitt signed a bill making it a felony for physicians to provide access to gender-affirming care to patients under 18 years old. This includes hormone treatments.

A lawsuit was filed on behalf of several transgender children and their families. The state attorney general agreed not to enforce the ban while the court considered the lawsuit.

Injunctive relief was denied in October 2023, but the lawsuit remains active. Once the injunction was denied, the attorney general declared the ban enforceable. The U.S. Court of Appeals for the Tenth Circuit put the case on hold until the U.S. Supreme Court decides U.S. v. Skrmetti.

Oregon

There are currently no state laws in Oregon prohibiting minors or adults from accessing gender-affirming care. Oregon has shield laws protecting individuals who come to Oregon for medical treatment.

Pennsylvania

There are currently no state laws in Pennsylvania prohibiting minors or adults from accessing gender-affirming care.

Rhode Island

There are currently no state laws in Rhode Island prohibiting minors or adults from accessing gender-affirming care.

South Carolina

In 2024, South Carolina passed a law banning gender-affirming care for minors. H4624 requires school officials to notify parents if a child tells any school employee that "their gender is inconsistent with their sex” or asks to use different pronouns.

The law also prohibits the use of public funds, including Medicaid, to treat any illness or disorder related to gender transition.

The ACLU filed legal action against the state in August 2024. The case is currently on hold, pending resolution of a case before the U.S. Supreme Court (United States v. Skrmetti), scheduled for the 2025 session.

South Dakota

South Dakota passed a law in 2023 banning gender-affirming care for minors. If health care providers do not comply, they risk losing their medical licenses and could face civil action.

There are currently no state laws prohibiting adults from accessing gender-affirming care.

Tennessee

Tennessee prohibits health care providers from giving gender-affirming care to minors. The law, known as SB1, took effect in 2023. Three transgender teens and their families sued state officials to prevent enforcement of the ban. This lawsuit, U.S. v. Skrmetti, is pending before the U.S. Supreme Court. The Supreme Court's decision could impact other states that have enacted similar bans.

Texas

In 2023, Texas passed a law prohibiting health-care providers from prescribing puberty blockers and other hormone therapies to minors "for the purpose of transitioning a child's biological sex."

The Texas Court of Appeals blocked a bill that would have criminalized gender-affirming care by calling it child abuse. A Senate bill that would have canceled medical providers’ liability insurance failed to make it out of committee.

Utah

Utah bans gender-affirming care for minors and prohibits health care providers from giving gender-affirming care to minors. Utah recently passed a law requiring individuals to use public restroom facilities, including school toilets, that correspond to their birth-assigned sex.

Vermont

Vermont is a sanctuary state. Vermont law protects gender-affirming healthcare and shields out-of-state patients, doctors, and families. Health insurance companies must cover gender-affirming care.

Virginia

Virginia does not have any laws prohibiting or protecting gender-affirming healthcare for minors or adults. Virginia does have laws requiring students to use school restrooms that correspond with their birth-assigned gender and requiring minors to be addressed by the names and pronouns on their birth certificates.

Washington

Washington is a sanctuary state. SB5599 allows licensed youth shelters to contact Washington’s Department of Children, Youth, and Families if a runaway is seeking shelter for LGBTQ+ protection.

Washington law also protects minors and adults' access to gender-affirming care and prohibits law enforcement from cooperating with out-of-state officials seeking to enjoin actions that are lawful in the state.

West Virginia

West Virginia prohibits gender-affirming care for transgender youth. The law also defines “male” and “female” in the context of reproductive capacity.

Gender-affirming care is available for adults in West Virginia. However, it is under a complex and restrictive set of conditions including requiring certification from two independent physicians.

Wisconsin

There are currently no state laws in Wisconsin prohibiting adults or minors from accessing gender-affirming care.

Wyoming

Wyoming passed a law specifically banning gender-affirming care for minors and suspending the licenses of medical professionals who provide such services. The law went into effect on July 1, 2024. As of January 2025, there are no legal challenges to Wyoming’s law.

Are There Federal Laws On Gender-Affirming Care?

There is currently no federal law protecting access to gender-affirming care. However, the Biden administration has taken steps to make health care more accessible for the LGBTQ+ community.

Furthermore, the Affordable Care Act prohibits health care discrimination based on sex. Sex discrimination includes discrimination based on gender identity. The Supreme Court's decision in Bostock v. Clayton County supports this interpretation of the ACA.

Getting Legal Help

If you need guidance in navigating these laws or your state's laws, an attorney can help. A civil rights lawyer or health care lawyer can explain the protections provided above, along with any additional protections your state may provide.