Debates at the state legislature level on limiting gender-affirming care for minors remain incredibly contentious among policymakers, and it appears this will remain so for the foreseeable future. This blog post provides an update on recent state legislative activity aimed at transgender youth.
State Bans on Gender-Affirming Care
During the 2021–2023 period, 24 states passed bans or restrictions on gender-affirming care for minors.
The states that passed bans included Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Utah, West Virginia, and Wyoming.
State legislatures continue to be active in passing measures to restrict gender-affirming care and related legislation. So far this year, South Carolina has passed legislation barring health care providers from providing gender-affirming care to any person under the age of 18. Wyoming’s law passed last year and went into effect July 1, 2024. New Hampshire’s governor has not yet signed a bill banning gender-affirming care that passed the state’s Senate and House.
Corollary Restrictions on Transgender Individuals
In addition to outright bans on gender-affirming care, Trans Legislation Tracker has identified several states that have passed measures this year—“corollary” restrictions on transgender individuals.
Those policies fall into the following categories: education, bathroom use, participation in school athletic programs, provider incarceration, civil rights, and birth certificates.
For example, legislation in Alabama and Idaho includes provisions on bathroom use requiring that every public school or college accessible by users at the same time should be designated as males only or females only, and used only by, in the words of the legislation, the corresponding “biological sex.”
States Allowing Gender-Affirming Care
As of this writing, 25 states, five territories, and the District of Columbia do not ban best practice medical care for transgender youth. Those states include Alaska, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and Wisconsin.
As part of their laws protecting gender-affirming care, 16 of the 24 states and the District of Columbia have instituted what are known as “shield laws.” These laws have been established so if an individual from a state that bans gender-affirming care receives services in another state, the patient and the health care provider of services will be protected against civil or criminal charges from the state where gender-affirming services are banned.
Where Policymakers Go From Here
Most states have concluded their legislative sessions for the year, and it is expected that little action, if any at all, will take place in the second half of 2024. However, it is expected that states will be gearing up in the fall to introduce bills in early 2025 to restrict gender-affirming care in some form or restrict the rights of transgender youth. Just this year alone, 600 anti-transgender bills were introduced in state legislatures.
In a recent development on June 24, the U.S. Supreme Court announced that it will hear a challenge that legislation banning gender-affirming care in Tennessee is unconstitutional. It is expected the court will make a decision on Tennessee’s law constitutionality in 2025, which could impact similar laws on the books. In the meantime, many transgender individuals who reside in states that restrict gender-affirming care are forced to seek care in other states that have no restrictions. Without services, many who identify as transgender are likely to suffer from mental health disorders such as depression, anxiety, and suicidal ideation. A new national study from the Trevor Project highlighted that nearly 40% of young Americans who identify as LGBTQ+ considered suicide in 2023, and more than one in 10 attempted suicides. Additional studies have shown that gender-affirming care can improve mental health.
NBCC will continue to monitor state and federal legislative bans on gender-affirming care and corollary measures and provide updates on a regular basis.
