Topline
The Republican-led North Carolina legislature voted late Wednesday to override a veto from Democratic Gov. Roy Cooper on a bill restricting access to gender-affirming care for minors, joining a growing list of states—including more than a dozen this year—with legislation targeting transgender healthcare.
Most states have issued restrictions this year.
Timeline
The North Carolina legislature approved—after overriding a veto from Gov. Roy Cooper (D)—a bill that prohibits in-state healthcare providers from providing hormone therapy, puberty blockers and gender-reassignment surgeries to anyone under 18, with exceptions for anyone with a “medically verifiable disorder of sex development.”
The Republican-led Louisiana legislature approved—after overriding Democratic Gov. John Edwards’ veto—a bill that prohibits in-state healthcare providers from providing gender-reassignment surgeries, puberty blockers and hormone therapy for anyone under 18, though it allows anyone who received gender-affirming care before January 1, 2024, to continue receiving care through the end of next year.
Missouri Gov. Mike Parson (R)—who threatened to call a special session to pass a ban—approved a bill that prohibits in-state physicians from performing gender-reassignment surgeries or from prescribing puberty blockers to minors unless they were already receiving treatment before August 28, with an added provision that restricts access to surgeries for imprisoned adults.
A new Texas law—which takes effect in September following Gov. Greg Abbott’s signature—prohibits physicians from providing surgery “for the purpose of transitioning a child’s biological sex” or surgery that “sterilizes the child,” and from prescribing puberty blockers and hormone therapies to minors, though it makes exceptions for children who are already receiving care until they “wean off” any drugs they are taking.
Nebraska Gov. Jim Pillen (R) signed a bill that prevents doctors from prescribing puberty blockers and hormone therapy or performing gender-altering procedures on people under 19 starting October 1, with some exceptions for people with “a medically verifiable disorder of sex development”—the bill also bans abortions after 12 weeks, effective immediately, in what Pillen called “the most significant win for social conservative agenda in over a generation of Nebraska.”
Florida Gov. Ron DeSantis (R) signed a bill that prohibits physicians in the state from providing gender-affirming services for minors, including “sex-reassignment prescriptions” or medication like puberty blockers, and includes a provision restricting access for adults unless they sign a consent form (the Florida Board of Medicine previously banned gender-transition surgeries and puberty blockers for most minors in November).
Oklahoma Gov. Kevin Stitt (R)—who called for a ban on gender-affirming care last year—signed a bill that prohibits physicians in the state from providing “gender transition procedures,” including gender-reassignment surgery or prescribing puberty blockers, with a provision indicating physicians can be charged with a felony and lose their medical licenses if they violate the law.
Montana Gov. Greg Gianforte (R) signed a bill that bans “Montana children from permanent, life-altering medical procedures until they are adults,” and includes a provision stating doctors could lose their medical licenses for a year if they violate the law.
A bill signed by North Dakota Gov. Doug Burgum (R) prohibits physicians in the state from performing gender-reassignment surgeries and from prescribing gender-affirming medication, like drugs that block puberty, though it makes exceptions for minors who are currently receiving gender-affirming care, or for minors with “genetic disorder[s] of sexual development” who get parental consent.
Indiana Gov. Eric Holcomb (R) signed a bill that prohibits healthcare providers from “knowingly” providing “gender transition procedures” to minors, which include gender-reassignment surgeries, hormone therapy and puberty blockers.
A bill signed by Idaho Gov. Brad Little (R) prevents healthcare providers from providing any gender-affirming care to minors if it’s meant to “affirm” a gender identity different from their gender at birth, and violators could face up to ten years in prison.
West Virginia Gov. Jim Justice (R) signed a bill that prohibits “irreversible gender reassignment surgery” and the prescription of any “gender altering medication,” with exceptions for people who are born intersex—when a person’s reproductive organs do not neatly match a specific gender.
Republican lawmakers in Kentucky passed—after overriding Democratic Gov. Andy Beshear’s veto—a bill that prohibits healthcare providers from providing gender-affirming services to minors “for the purpose of attempting to alter the appearance or perception of the minor’s sex.”
A bill signed by Georgia Gov. Brian Kemp (R) prohibits physicians from providing hormone therapy or any gender-transition surgeries to minors—though it does make exceptions for anyone born intersex.
Physicians in Iowa were granted a six-month period to cease gender-affirming care for minors after a bill signed by Republican Gov. Kim Reynolds prohibited healthcare providers from prescribing drugs that block puberty and hormone therapy.
Tennessee Gov. Bill Lee (R) signed a bill that prohibits healthcare providers in the state from performing gender-reassignment surgeries for minors, and physicians could be sued by parents or the state.
Physicians in Mississippi are prohibited from offering gender-reassignment surgeries, drugs that block puberty or hormone therapy to minors, according to a bill signed by Republican Gov. Tate Reeves.
Healthcare providers in South Dakota could lose their medical licenses and face civil action if they provide gender-affirming care “for the purpose of attempting to alter the appearance of, or to validate a minor’s perception of, the minor’s sex,” according to a bill signed by Republican Gov. Kristi Noem.
Utah Gov. Spencer Cox (R) signed a bill that prohibits healthcare providers from providing any gender-affirming services and places an indefinite ban on access to hormone therapy and puberty blockers.
Alabama Gov. Kay Ivey (R) signed a bill that prohibits healthcare providers from performing gender-reassignment surgeries and from prescribing hormone therapy and puberty blockers, with violations punishable by up to ten years in prison—though the bill was blocked by a federal judge the following month.
A bill signed by then Arizona Gov. Doug Ducey (R) prohibits physicians from providing any gender-transition procedures to anyone under 18, though it does make exceptions for anyone who is born intersex.
Arkansas became the first state to outlaw gender-affirming care for minors after the state legislature voted to override a veto by then Gov. Asa Hutchinson (R).
Big Number
300,000. That’s how many kids aged 13 to 17 identify as transgender, according to estimates from UCLA’s Williams Institute, of which nearly 27% are estimated to live in states that have banned gender-affirming care.
Chief Critic
Earlier this year, former President Donald Trump said he would assign federal agencies to “stop” healthcare providers from giving gender-affirming care—which he said was “child abuse” and “child sexual mutilation”—for minors if he was re-elected. Florida Gov. Ron DeSantis (R) has referred to gender-affirming care as “an example of woke ideology infecting medical practice.” Rep. Marjorie Taylor Greene (R-Ga.) said she wanted to introduce legislation that would block federal funding for gender-affirming services because “the Republican Party has a duty” to “be the party that protects children.” Ivey said in a statement she supported a bill prohibiting gender-affirming care in Alabama because “if the Good Lord made you a boy, you are a boy, and if he made you a girl, you are a girl.” Reynolds supported a bill because “we need to just pause” to better understand how gender-affirming care affects children. Rep. David Meade (R), speaker pro tempore of Kentucky’s House, said a ban was necessary in order to “ensure” that gender-affirming care “is not something we should be allowing until they are adults.”
Contra
Several politicians and medical organizations have pushed back against attempts to ban gender-affirming care, arguing treatment is often necessary because transgender children face higher rates of depression and suicide. The American Medical Association said, “decisions about medical care belong within the sanctity of the patient-physician relationship.” In 2018, the American Academy of Pediatrics said transgender youth experience “disproportionately high” rates of homelessness, physical violence, substance abuse and are often subjected to harassment. The Human Rights Campaign criticized Indiana lawmakers for introducing a bill banning gender-affirming care and said it was “another example of extremist politicians using their power to marginalize LGBTQ+ people, especially transgender youth.” Hutchinson, a Republican, said he vetoed a bill banning gender-affirming care because it put “a very vulnerable population in a more difficult position.” Beshear said after vetoing a bill banning gender-affirming care that the bill would “cause an increase in suicide among Kentucky’s youth” and could “endanger the children of Kentucky.” After the state legislature approved a bill that would provide state funding for gender-affirming care, Gov. Wes Moore (D-Md.) said he wanted “every person in this state to know that their authentic self is good enough.”
Tangent
Access to gender-affirming care in Europe varies from country to country, as national health services have debated whether there is a lack of evidence supporting hormonal treatment for minors. England, which previously only had one facility that provided gender-affirming services, expanded access to hormone therapy and other gender-reassignment treatments after a review by the National Health Service indicated a single provider was “not sustainable.” The review also found there to be a “lack of consensus and open discussion” about gender dysphoria and how medical services should respond. Dr. Hilary Cass, who authored the review, also questioned whether children were supported if they decided against transitioning. The Swedish National Board of Health and Welfare updated its healthcare guidelines last year to prevent minors from accessing gender-affirming care, after it noted the “evidence base for hormonal interventions” for minors is “of low quality, and that hormonal treatments may carry risks.” The Finnish Health Authority issued similar restrictions, though both Finland and Sweden made exceptions for children who show evidence of “distress” from experiencing gender dysphoria.
Further Reading
Kansas Approves Ban On Gender-Affirming Care—Likely Next State To Join Wave Of State Restrictions (Forbes)
Indiana Becomes 14th State To Ban Gender-Affirming Care—Despite GOP Governor’s Concerns About ‘Vagueness’ (Forbes)
Kentucky Becomes 12th State To Ban Gender-Affirming Care After GOP Lawmakers Override Governor’s Veto (Forbes)