What to Know About the Gender-Affirming-Care Bans Spreading Across the Country

Only six states in the U.S. have not introduced a bill restricting LGBTQ rights during this legislative session, including Delaware and Illinois. Bathroom bills, measures that would limit the ability to update identity and gender information on records and IDs, sports bans, and bans on gender-affirming care are all up for consideration in states across America.

That last category of bills is growing. On Thursday, Iowa prohibited gender-reassignment procedures and prescriptions, and two of Florida’s State Senate committees passed Senate Bill 254, which would add onto the existing gender-affirming-care restrictions by prohibiting entities from using state funds to cover gender-affirming care, among other things.

Just this year, five states—Mississippi, Utah, South Dakota, Iowa, and Tennessee—have passed bans on gender-affirming care for minors, and nearly 90 other bills targeting access to gender-affirming health care, including Florida’s, are being considered in the U.S.

Proponents of these measures often claim these laws will protect young Americans from what they portray as risky medical experimentation. “We need to let kids be kids, and our laws need to set appropriate boundaries that respect the rights and responsibilities of parents, while protecting children from the serious health, safety, and welfare consequences of social agendas that are totally inconsistent with how the overwhelming majority of parents want to raise their children,” says Florida State Sen. Yarborough, the sponsor of a gender-affirming-care ban in the state, in a press release.

But every major medical organization—including the American Medical Association, American Academy of Pediatrics, American Psychiatric Association, and more— agrees that gender-affirming care for transgender patients, which can range from social interventions, to hormonal treatments, to surgery, is both safe and medically appropriate. For transgender people, who face unemployment at twice the rate of the general population and have a suicide rate nearly nine times that of the broader U.S. population, the prospect of losing access to such care is harrowing.

“Many adolescents with gender dysphoria have severe negative psychological reactions to their bodies developing in ways that do not align with who they are, and [hormonal treatments] can temporarily put these changes on pause,” Dr. Jack Turban, Assistant Professor of Child & Adolescent Psychiatry at The University of California, San Francisco, tells TIME.

Here’s what to know about some of the gender-affirming-care bans being considered across the U.S.

Where have bans been passed already?

Eight states already have gender-affirming-care bans in place for people under the age of 18, and states like Tennessee and Iowa, which both passed legislation this year, are part of the rise in anti-trans legislation being considered more broadly.

They join states like Arkansas, which passed similar legislation two years ago. (Ongoing lawsuits in Arkansas have delayed the program from rolling out, though legislators passed a measure that would criminalize medical practitioners for providing gender- affirming care for minors in March 2023.) Arizona and Alabama also passed gender-care bans in 2022, though the latter’s law is temporarily blocked by legal challenges.

Most laws in this category, like that of Tennessee, would ban puberty blockers and hormone treatment from being used to treat gender dysphoria. Patients would also be unable to undergo surgery.

Healthcare providers who violate the Tennessee law can be sued in civil court within 30 years of the violation. They could also face a fine of up to $25,000 and have their license restricted.

The Tennessee law, which could face lawsuits, is set to go into effect in the summer, though minors who are currently undergoing treatment have until March 31, 2024 to stop treatment.

Where are gender-affirming-care bans being considered?

While the many restrictions on gender-affirming care being considered in state houses across the country do share some similarities, state lawmakers are trying a range of tactics to control access to such medical treatment.

In Oklahoma, for example, state senators are advancing Senate Bill 613, which would revoke doctors’, nurse practitioners’, or advanced practice nurses’ licenses if they offer gender-transition services to people under the age of 18. (Legislators did add a measure that says the bill would not prevent mental health counseling, depression and anxiety medication or “medications prescribed, dispensed, or administered specifically for the purpose of treating precocious puberty or delayed puberty in that patient.”)

Another bill being considered in the state, Senate Bill 129, adds onto the restrictions by banning transgender medical care at hospitals that indirectly receive public funding. This includes hospitals that are on land that is owned by a state or local government, according to the Oklahoman. House Bill 2177, meanwhile, would prohibit insurance from covering some gender-affirming care, including puberty blockers for minors, is also being considered.

“[People said] we need to protect sports…and then [legislators] didn’t and we knew it wasn’t going to stop there,” Eddie Hefner, a 22-year-old trans, nonbinary Oklahoma resident says. “That’s not what this is about. This is trans-affirming care across the board. And trans health care is essential for saving [lives] because, [for] a lot of the people that I know, to them it is just normal health care.”

Hefner, who plans on getting one gender-affirming surgery in the future, fears that legislators will make age restrictions increasingly strict—and, they say, 18 is already too late for some care. Under previous medical guidelines, UC San Francisco’s Turban tells TIME, most doctors did not allow patients to use gender-affirming hormones until age 16. (Doctors and mental health providers now work with parents to assess the best time frame for a patient to start estrogen or testosterone, which in some cases may be before 16.) But puberty blockers, which stop processes like voice changes or breast growth, are often used in the earlier stages of puberty.“Forcing [patients] to undergo a puberty that doesn’t align with who they are,” he says, “can be horrifying and traumatic.”

In Florida, a ban took effect on March 16 after the Florida Board of Medicine voted in favor of banning gender-affirming care including puberty blockers, cross-sex hormones, and surgery for minors in November.

Doctors who violate the law could face fines and the potential to have their licenses revoked. Legislators are attempting to make that ban law through Senate Bill 254, which would also mean that any healthcare paid for by the state, like Medicaid or state-employee plans, would not cover gender-affirming care.

Devon Ojeda, the Senior National Organizer at the National Center for Transgender Equality, notes that despite the rhetoric used to attack this form of healthcare, cisgender people could also be affected by these types of bans. “Cancer survivors who get breast implants, regardless if they’re cisgender or not, [are getting surgeries that are] affirming their gender,” Ojeda says. “Gender affirming care is for everyone.”

The bill would also allow Florida courts “to enter, modify, or stay a child custody determination relating to a child present in this state to the extent necessary to protect the child from being subjected to sex-reassignment prescriptions or procedures in another state.”

Two Senate committees have passed the bill. It will now head to the Senate floor for a vote.

In Missouri, the State Senate voted to advance their gender-affirming ban after a series of back-door negotiations in which Republican lawmakers agreed they would not prohibit people who are already transitioning from doing so, according to the Associated Press. (Florida’s medical rule has a similar provision.) Missouri’s Attorney General Andrew Bailey also announced on Monday that he would pass an emergency rule that would limit gender-affirming care for minors.

Bailey’s plan would require minors endure 15 hour-long therapy sessions and get a full psychiatric evaluation over the course of 18 months before accessing gender-affirming care.

“I am dedicated to using every legal tool at my disposal to stand in the gap and protect children from being subject to inhumane science experiments,” Bailey tweeted.

Organizations like the ACLU, however, contend that these bills will not protect kids, but are instead “harmful and exploitative.”

“There’s nothing extraordinary about this care except that it saves lives,” Harper Seldin, Staff Attorney for the ACLU’s LGBTQ and HIV Project, tells TIME. “I think it’s important to realize that this is not just an attack on this small group of people but is in fact, part of an ongoing attack on the bodily autonomy of people in every state.”

Correction, April 3

The original version of this story misstated when patients may start gender-affirming hormones. Previous medical guidelines instructed doctors not to begin these treatments before patients turned 16, but those guidelines have been updated.