State Laws on Gender-Affirming Care

This article explains what gender-affirming care is, which states have restricted access, and how the Supreme Court’s decision in United States v. Skrmetti impacted access to care.

Laws on gender-affirming care are constantly evolving and vary by state. For up-to-date legal guidance, contact a health care attorney near you.

What is Gender-Affirming Care?

“Gender-affirming care” (GAC) refers to many types of treatment related to gender transition 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)
• Physical 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.

For many, gender-affirming care is a life-saving course of treatment. However, 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, GAC often focuses on social transition. However, in some cases, transgender children will be prescribed puberty blockers. These medications temporarily halt the secondary sex changes young people experience during puberty. This pause gives the child and their parents time to explore their transition and determine if it is the correct course. 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 as early as six or seven years old. Precocious puberty is a medical condition and may be due to benign tumors or genetic factors.

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 “medical best practice” for treating the psychological issues that may arise. Medical best practice means relying on scientific research, expert consensus, and patient preference to determine the best treatment plan for a patient. State bans against such treatment undermine evidence-based transgender health care.

It is important to note that even states that support the use of gender-affirming care for minors generally do not allow sexual reassignment surgery for minors.

United States v. Skrmetti

In 2023, the state of Tennessee passed a law prohibiting gender-affirming care for minor children. Several other states passed similar laws in 2023. Three families of transgender children and a doctor sued the state, claiming civil rights violations under the Fourteenth Amendment. The federal district court issued a statewide injunction until the matter could be heard on its merits. Other state laws were suspended pending the outcome of the case.

The U.S. Supreme Court heard the matter, United States v. Skrmetti, in 2025. The appellants argued that the state law discriminated against transgender youth on the basis of gender, and thus deserved heightened scrutiny. At this level of judicial scrutiny, the burden is on the government to prove why the law is constitutional. By comparison, race, religion, or national origin trigger “strict scrutiny,” and the government must show that the law is constitutional and serves an important government interest.

The Supreme Court held that there was no discrimination under the Equal Protection Clause because the Tennessee law applied equally to male and female transgender youth. The basis for the law is age and medical condition, which trigger the rational basis standard of review. This judicial scrutiny requires the claimant to show that the law is unconstitutional.

The holding in Skirmetti reasoned that since the law applied to males and females alike, there was no discrimination. Since the law allows hormone treatment and surgical intervention in other circumstances, it did not unduly burden the public.

The Court allowed the Tennessee law to stand. Other state laws pending during the Skirmetti review also went into effect.

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
• Kansas
• Kentucky
• Louisiana
• Mississippi
• Montana
• Nebraska
• New Hampshire
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• West Virginia
• Wyoming

There are six states with criminal penalties for providing gender-affirming care to a minor. They are:

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

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
• Maine
• Maryland
• Nevada
• Oregon
• Pennsylvania
• Rhode Island
• Virginia
• Wisconsin

Sanctuary and Shield States

Sanctuary states protect access to gender-affirming care for residents. Shield states prevent insurance companies from denying coverage to transgender individuals. These states will not cooperate with law enforcement or respond to subpoenas from out-of-state investigators.

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

Sanctuary Cities

A number of cities within both sanctuary states and other states have declared themselves as “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 conflict with state law. However, these cities aim to offer some protection to transgender individuals and youth within their jurisdiction.

Access to Gender-Affirming Care by State

Note: The status of state gender-affirming care laws changes rapidly. While we aim to provide the most up-to-date information on this topic, it’s best to check your state legislature’s website and speak with local medical and legal professionals.

Alabama

Alabama banned prescribing or administering hormones or puberty blockers or performing any surgical gender affirming care for minors under 19. Counselors, teachers, and school officials must inform parents and guardians if a child discloses they believe their gender identity differs from their assigned birth sex.

Violations are a Class C felony, with possible sentences of up to 10 years in prison.

Alaska

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

Arizona

Arizona prohibits physicians from performing “irreversible” gender-affirming surgery on minors under 18. Exceptions for those with “ambiguous” external genitalia.

Arkansas

Arkansas prohibits health care professionals from providing or referring minors for hormones or puberty blockers. Bans surgical gender affirming care for minors. Medicaid, public funding, and private health insurance plans may not cover minor care that is not covered for adults.

California

California is a sanctuary state. 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. The state’s laws ensure that all such care is covered by insurance if the doctor feels the treatment is medically necessary.

Connecticut

Connecticut is a sanctuary state. The state protects individuals against out-of-state judgments based on care received in Connecticut.

Delaware

Delaware has no ban on gender-affirming care for minors or adults. Executive Order #11 establishes Delaware as a “shield state” and prepares the way for the state to become a sanctuary state by law.

District of Columbia

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

Florida

Florida has extremely strict gender-affirming care bans. New prescriptions for hormones and puberty blockers are banned. Existing treatment can continue under much tighter requirements. Public funds, including Medicaid, cannot be used for any treatment, including adults.

Georgia

Georgia bans hospitals from providing surgical gender-affirming care for minors. Hormones and puberty blockers are prohibited for minors. For adults, state funds, including Medicaid, cannot be used for any transgender services.

Hawai’i

Hawai’i is a shield state. It provides strong laws protecting transgender individuals’ rights, including out-of-state legal actions against state residents, protection for healthcare providers, and access to gender affirming care. A recent law passed ensuring parental support for a child’s transition cannot be used against them in a custody hearing.

Idaho

Idaho law prohibits all gender affirming care for minors including hormones and puberty blockers. Idaho is one of six states that make it a criminal offense for medical professionals to provide such care to minors.

Illinois

Illinois is a sanctuary state. The state provides strong access for all individuals for gender-affirming healthcare and is currently working to get such healthcare provided to incarcerated individuals.

Indiana

Indiana prohibited minors from accessing gender-affirming care as of 2023. The law includes an “aiding and abetting” clause prohibiting doctors from referring patients to out-of-state facilities for care. The law permits mental health treatment, but prohibits the use of any public funds, including Medicaid, for payment.

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

Iowa

Iowa bans medical professionals from providing any gender-affirming care to minors. This includes any hormones, puberty blockers, and surgical treatment. Medical professionals cannot refer patients to out-of-state providers, although such referrals are not unlawful.

Kansas

Kansas enacted the “Help Not Harm” Act in 2025. The law bans all gender-affirming care for minors, restricts public funds and referrals, and criminalizes providing care to minors. Kansas is one of six states that makes providing gender-affirming care to minors a felony. The state may intervene in custody cases if one parent intends to provide the minor with such care.

Kentucky

Kentucky law prevents minors from accessing any gender affirming care, requires all medical professionals to terminate such care, and loosens bans on conversion therapy. Adults are not banned from seeking care, but the state legislature has banned all public funding, including Medicaid. Doctors and medical facilities may face civil and professional penalties for providing care.

Louisiana

Louisiana prohibits all gender-affirming care for minors, including hormones, puberty blockers, and any type of surgery. Physicians may not provide any treatment or referrals, although there are no bans on mental health treatment. Penalties include civil liability and suspension of professional licenses.

Maine

Maine is a shield state, with laws protecting the state’s healthcare providers and access to gender affirming care for all citizens. Maine’s hospitals are vulnerable to recent proposed changes in federal rules that would ban Medicaid payments to any facility that permits doctors to provide transgender health care.

Maryland

Maryland’s Trans Health Equity Act ensures equal access to healthcare for all transgender individuals. The act defines health care as “age-appropriate treatment” for all individuals with gender dysphoria, including hormone therapy, surgery, and mental health treatment. Maryland is a shield state.

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. State law ensures gender-affirming care to all individuals, and prohibits out-of-state actors from obtaining information about patients and providers. The state provides custody protection for parents or guardians who assist minor children in accessing care.

Mississippi

Mississippi bans medical professionals from providing any gender-affirming care to minors. Penalties include a 30-year private right of action and loss of medical license. The law does not affect adults, but public funds cannot be used for this care.

Missouri

Missouri laws are very restrictive and ban all gender-affirming care for minors. Adults may access care, but public funds, including Medicaid, cannot be used for surgical or hormonal treatment. Providers may face civil action and loss of license.

Kansas City, Missouri, is a sanctuary city for minors seeking gender-affirming care within the city limits. 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. The law was blocked by permanent injunction in 2025. The state has not yet appealed.

Nebraska

Nebraska bans gender-affirming medical care for patients under 19, including gender transition surgeries, puberty blockers, and hormone treatments. Doctors may not make out-of-state referrals for such care, with penalties including license suspension. The law prohibits use of public funds, including Medicaid, for such procedures. The law does not affect mental health treatment or adults over 19.

Nevada

Nevada’s shield law was vetoed by the governor, but the state has no laws banning minors from accessing gender-affirming care or limits on use of public or private insurance for such care.

New Hampshire

New Hampshire laws HB610, HB1205 and HB377 are currently in effect. Together they prevent transgender minors from accessing any gender-affirming care, including surgery, puberty blockers, and hormone treatment. Physicians cannot refer patients for out-of-state surgery. The laws do not bar mental health treatment or care for adults.

New Jersey

New Jersey is a sanctuary state. Under Executive Order No. 326, the state protects its own transgender youth and adults, and protects healthcare professionals who provide that care. Out-of-state residents may come to New Jersey to seek health care without repercussion.

New Mexico

New Mexico is a sanctuary state. State law protects gender-affirming care as “a protected health care activity.” The law prohibits release of gender-affirming care to out-of-state investigators. The state law also ensures that municipal governments cannot pass city laws blocking access to treatment.

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. New York’s Gender Expression Non-Discrimination Act (GENDA) has been on the books since 2019.

North Carolina

North Carolina bans all gender-affirming care for transgender minors. Doctors and hospitals cannot be required to perform transition surgeries for any individual, even adults. No public funds may be used for any such care. North Carolina passed a law that went into effect in January 2026 officially recognizing only two genders, male and female.

North Dakota

North Dakota bans all gender-affirming care for minors. North Dakota is one of six states that makes providing care a criminal offense for medical professionals. Providing hormones or puberty blockers is a misdemeanor and surgical treatment is a felony. At present, adults may still access such care. The ban was upheld by the U.S. Supreme Court.

Ohio

Ohio law specifically bans minors from receiving medical and surgical gender-affirming care and prohibits transgender females from competing in scholastic women’s sports. It does not prohibit transgender males from competing in scholastic men’s sports. The law also prohibits mental health practitioners from treating minors for gender dysphoria without first screening for other “psychopathologies” and physical or emotional abuse.

A legal case challenging the ban, Moe v. Yost, is currently on appeal. The ban is in place pending appeal.

Oklahoma

Oklahoma is one of six states that make it a felony for doctors and medical professionals to provide gender-affirming care to minors. The law also prohibits all gender-affirming treatment for minors under 18. Prohibits the use of any public funds, including Medicaid, for minors and adults.

Oregon

Oregon is a shield state. Its laws require insurance companies to cover all medically necessary treatment, including gender-affirming care. Gender-affirming care is considered “medically essential care.” The Oregon Health Plan is mandated to cover treatment for consenting individuals over 15 years of age.

Pennsylvania

Pennsylvania has no state bans against gender-affirming care. Pittsburgh has passed an affirmative sanctuary law protecting access within the city.

Rhode Island

Rhode Island is a shield state and protects patients from insurance denials and interference from out-of-state investigators. Rhode Island’s attorney general has joined a state lawsuit challenging the Department of Health and Human Services (HHS) recent attempt to deny Medicaid funding to states that permit minors’ access to gender-affirming care.

South Carolina

South Carolina is one of six states that has criminal penalties for health care professionals who provide gender affirming care to minors. Performing surgery is a felony with possible penalties of up to 25 years’ imprisonment. Providers also face civil penalties and loss of their medical license.

South Carolina’s laws also:

• Require school officials to notify parents if children ask to use different pronouns, different names, or any other gender-related matters

• Bans the use of any public funds including Medicaid and state employee healthcare plans for any transition-related healthcare, including adults

South Dakota

South Dakota has banned all forms of gender-affirming care for minors, including “validating a minor’s perception” of their gender. Health care providers may not provide hormones, puberty blockers, or surgical treatment. Penalties include loss of licensing and civil action. The law does not affect mental health treatment or prevent adults from seeking care. However, it bars public funds, including Medicaid, from being used.

Tennessee

Tennessee prohibits health care providers from giving gender-affirming care to minors. The law prohibits all forms of care, including hormones, puberty blockers, and surgical treatment for anyone under the age of 18. Penalties for violation include a private right of action for minors and for non-consenting parents (as in custody cases) and loss of medical license for up to two years.

Texas

Texas law prohibits all gender-affirming care for minors under the age of 18. Any entity that provides such care loses all public funding including Medicaid, CHIP and state funds. Texas requires individuals to use restrooms and other public facilities based on one’s birth-assigned gender, and recognizes only two genders, “male” and “female”. Currently, there are no bans against adults who seek gender-affirming care.

Utah

Utah bans gender-affirming care for minors, requires those receiving care at the time of the laws passage to cease treatment, and forbids any new treatment. The ban includes “facilitating treatment.” Currently, mental health treatment is not affected, but legislation is being considered to make the moratorium permanent. Utah law requires 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. Vermont’s Attorney General has joined 17 other states challenging the HHS attempt to block Medicaid payments for states that provide gender-affirming care to minors.

Virginia

Virginia does not have strong laws protecting or prohibiting gender-affirming healthcare for minors or adults. All proposed restrictions have stalled in the legislature. Virginia prohibits insurance companies from discriminating against transgender adults.

Washington

Washington is a sanctuary state. The state’s Gender Affirming Treatment Act provides strong protections for all gender-affirming care, prohibits law enforcement and other agencies from cooperating with out-of-state officials, protects health care providers who give treatment and services, and continues to expand protection and coverage.

West Virginia

West Virginia defines “biological sex” as the biological indicators and potential reproductive capacity present at birth, and “gender” as the psychosocial aspects of being male or female. Senate Bill 299, passed in June 2025, banned all remaining options for gender-affirming care for transgender youth.

Wisconsin

Wisconsin does not have any laws banning or protecting gender-affirming care for adults or minors. Several proposed laws passed the state legislature in 2025 but were vetoed by the governor. This state remains in flux.

Wyoming

Wyoming specifically bans all forms of gender-affirming care for minors, although it excludes mental health treatment that does not violate the language of the statute. The law provides for the suspension of any medical professional, including nurses and pharmacists, who violate the law.

The law does not affect adults who seek gender-affirming care.

Federal Laws On Gender-Affirming Care

There have been a number of Executive Orders and declarations from the Department of Human Services affecting the accessibility of gender-affirming care. The majority of these are in litigation. To better understand how these orders may affect your care, you should speak to your state health department or a health care lawyer.

Get Legal Help With Gender-Affirming Care Laws

Laws on gender-affirming care are constantly in flux and vary by state. Also, the rules for adults differ from the rules for minors. It’s natural to feel overwhelmed and confused as to how these laws apply to you or your child. If you need help navigating these laws or your state’s laws, an attorney can help. A civil rights attorney or health care attorney can explain the protections provided above, along with any additional protections your state may provide.

FindLaw’s directories of health care lawyers and civil rights lawyers can get you started. Because state laws are relevant, your attorney should be licensed in your state. Enter your city or ZIP code for a list of qualified legal professionals in your area. Your search results will also show important details about prospective lawyers, including ratings and whether they offer free consultations.