State Laws on Gender-Affirming Care
Gender-affirming medical care helps nonbinary or transgender people with their physical transition. But many states have restricted access to this type of medical care for minors. Some states have even criminalized providing minors with gender-affirming care.
Gender-affirming care is crucial for the well-being of many transgender and nonbinary people. However, access to gender-affirming care has become inconsistent across the United States. This is especially true for minors.
Almost half of the state legislatures in the country recently passed laws restricting or banning such care. Some states have even criminalized providing minors with 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 for 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 if young people stop 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:
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:
- North Carolina
- North Dakota
- South Carolina*
- South Dakota
- West Virginia
States in this list with an asterisk (*) have legislation pending that restricts access for minors.
States Without Restrictions on Gender-Affirming Care
States that appear in medium blue currently have no restrictions on gender-affirming care. Those states are:
- District of Columbia
- New Hampshire
- Rhode Island
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.
Some of these states are currently considering competing legislation. In New Hampshire, Republican-sponsored bills aim to ban gender-affirming care for minors and would even define it as child abuse. Meanwhile, Democrats in the state proposed a bill to make New Hampshire a sanctuary state (discussed below).
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:
- New Jersey
- New Mexico
- New York
Below, we provide a detailed look at the laws currently in effect in each state.
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 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.
Alaska has no ban on gender-affirming care for minors or adults.
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 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 is a sanctuary state. In 2023, a state law providing protections for trans youth and their families went into effect (SB 107). Some states are removing minors from their parent's care if they allow the child to receive gender-affirming care. But California will not enforce another state's order to remove a minor from their parent or guardian's care.
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 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 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 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.
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 does not ban gender-affirming care for minors or adults.
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 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.
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.
In 2023, Iowa passed a law prohibiting medical professionals from providing gender-affirming care to minors.
Kansas does not ban gender-affirming care for minors or adults. However, the governor recently 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 recently passed a law prohibiting minors from accessing gender-affirming care and requiring medical professionals to end any gender-affirming care for minors. Although the bill was originally vetoed by the governor, the veto was ultimately overridden by the legislature. The state does not ban adults from seeking gender-affirming care.
A bill was recently introduced in Louisiana aimed at banning gender-affirming care for minors. In addition to banning hormone replacement therapy and gender-affirming surgery, the bill would also ban minors from undergoing cosmetic procedures, such as hair transplants and liposuction, if the goal of the procedures is to “promote the development of feminizing or masculinizing features in the opposite sex." Lawmakers in Louisiana's House of Representatives passed the bill. However, it was rejected by a state Senate committee in May 2023. The state does not ban adults from accessing gender-affirming care.
Maine does not ban gender-affirming care for minors or adults.
Maryland does not ban gender-affirming care for minors or adults.
Massachusetts is a sanctuary state. It passed a law in 2022, expanding protections for individuals seeking gender-affirming care. Among other things, the law defined gender-affirming care as “legally protected health care" and protected individuals from out-of-state legal action for seeking gender-affirming care.
In October 2022, a bill was introduced in Michigan that could make it a first-degree felony of child abuse for a parent or guardian to allow minor children to access gender-affirming care. However, that measure was unsuccessful. 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 is a sanctuary state. Recently, the state governor signed a bill protecting gender-affirming care. Among other things, the law prohibits the use of subpoenas to gather information about individuals that are 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.
In April 2023, Missouri's Attorney General issued an emergency regulation to ban gender-affirming care for minors and adults. The rule was temporarily blocked by a state judge after being challenged in court.
In 2023, state lawmakers passed a bill banning gender-affirming care for minors. It also restricts access to care for adults who rely on Medicare for their health care costs. Governor Mike Parson signed the bill into law, and it will take effect on August 28, 2023.
However, officials in Kansas City declared the state's largest city as a sanctuary for gender-affirming care. 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 recently passed a law prohibiting minors from receiving gender-affirming care. It also puts health care professionals at risk of having their licenses suspended if they provide minors with access to gender-affirming care. There are currently no state laws prohibiting adults from accessing gender-affirming care.
In May 2023, Nebraska Governor Jim Pillen signed a bill restricting gender-affirming care for those under the age of 19. The bill is known as the "Let Them Grow Act" (LB 574). It bans gender transition surgeries, puberty blockers, and hormone treatments for patients under 19.
There are currently no state laws in Nevada prohibiting adults or minors from accessing gender-affirming care. But the Nevada legislature is currently considering two bills that could protect access. One bill proposes requiring health insurance companies to cover gender-affirming care. Another would protect healthcare providers from having their licenses revoked and facing other penalties for providing gender-affirming care.
Two bills involving gender-affirming care have been introduced in the New Hampshire legislature this year. One would prohibit gender-affirming care for minors. The other aims to provide sanctuary protections for the families of minors seeking gender-affirming care. There are currently no state laws prohibiting adults from accessing gender-affirming care.
New Jersey is a sanctuary state, and its governor recently signed Executive Order No. 326, which provided protections for healthcare professionals giving gender-affirming care to out-of-state residents seeking gender-affirming care.
New Mexico is a sanctuary state. It recently 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 gender-affirming care.
New York is a sanctuary state and is currently seeking to pass a bill that would provide various protections for:
- Minors seeking gender-affirming care
- Families permitting gender-affirming care to minors
- Health care providers giving gender-affirming care to minors
Among other things, the bill would prohibit:
- Law enforcement agencies from providing information regarding gender-affirming care to out-of-state agencies
- The issuance of subpoenas in connection with out-of-state proceedings involving people traveling to New York to receive gender-affirming care
- The arrest of a person for performing or assisting in gender-affirming care
- Insurers from taking action against health care providers who provide gender-affirming care
The North Carolina House of Representatives recently passed a bill that would ban minors from getting gender-affirming surgery. It would also prevent state funds (such as Medicaid) from being used for any gender-affirming procedures provided to a person under 18. If the bill passes in the Senate and is signed by the governor, it will take effect on October 1, 2023.
North Dakota has banned gender-affirming care for minors. There are currently no state laws prohibiting adults from accessing gender-affirming care.
The Ohio legislature is currently reviewing a bill that would prohibit gender-affirming care for minors and ban health care providers from giving gender-affirming care to minors.
Oklahoma Governor Kevin Stitt recently 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.
There are currently no state laws in Oregon prohibiting minors or adults from accessing gender-affirming care. Lawmakers are currently considering a bill that would:
- Provide protections to out-of-state individuals seeking gender-affirming care in Oregon
- Provide protections for health care professionals giving gender-affirming care to patients
- Expand the definition of “medically necessary" gender-affirming care, such as cosmetic procedures.
There are currently no state laws in Pennsylvania prohibiting minors or adults from accessing gender-affirming care.
There are currently no state laws in Rhode Island prohibiting minors or adults from accessing gender-affirming care.
There are three bills regarding gender-affirming care circulating in the South Carolina legislature. If passed, S0274 could ban transgender or nonbinary people under 21 years old from receiving gender-affirming care. This bill would also require school employees to notify a minor's parents or guardians if the minor identifies as transgender or struggles with their gender identity. S0243 seeks to block physicians from providing gender-affirming care to minors. S0276 would amend the state constitution to define “gender" as one's sex assigned at birth.
South Dakota passed a law banning gender-affirming care for minors. Health care providers risk losing their medical licenses and could face civil action if they do not comply. There are currently no state laws prohibiting adults from accessing gender-affirming care.
Tennessee recently passed a law that prohibits health care providers from giving gender-affirming care to minors.
In June 2023, Texas Governor Greg Abbott signed a bill banning gender-affirming care for most minors. The law will take effect September 1, 2023, and prohibits access to hormone treatments and puberty blockers for those under 18.
Two other bills have been introduced in the Texas legislature regarding gender-affirming care. HB42 would criminalize gender-affirming care for minors by defining it as child abuse. HB41 would take away liability insurance from providers that provide gender-affirming care to minors.
Utah recently signed a bill that bans gender-affirming care for minors and prohibits health care providers from giving gender-affirming care to minors.
In May 2023, Vermont Governor Phil Scott signed two bills into law protecting gender-affirming health care. House Bill 89 states that gender-affirming health care is now protected by state law. It also shields out-of-state patients (and their doctors) from penalties against gender-affirming care in their home state. Senate Bill 37 requires health insurance companies in Vermont to cover gender-affirming care.
A bill introduced in the Virginia legislature would prohibit health care providers from providing gender-affirming care to minors if passed.
A bill signed in May 2023 will provide shelter to minors seeking gender-affirming care. Until now, licensed youth shelters were required to notify a minor's parents within 72 hours of their arrival. Under the new law, these facilities can instead contact Washington's Department of Children, Youth and Families. These minors will also be able to stay with volunteer host families without parental consent.
West Virginia recently banned gender-affirming care for minors. There are currently no state laws prohibiting adults from accessing gender-affirming care.
There are currently no state laws in Wisconsin prohibiting adults or minors from accessing gender-affirming care. In 2022, Representative Scott Allen introduced legislation that would have prohibited doctors from performing gender-confirming surgery on patients under 18. However, the bill did not pass.
In 2023, Dane County, Wisconsin (which includes the city of Madison) is considering a resolution making the county a sanctuary for gender-affirming care.
There are currently no state laws in Wyoming prohibiting adults from accessing gender-affirming care. Two bills were introduced by GOP senators but ultimately did not pass in the House. One bill would have made providing minors with gender-affirming care a felony of child abuse. The other bill would have revoked the licenses of health care professionals if they gave minors gender-affirming care as well as prohibited coverage of gender-affirming care under insurance.
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.