Gender-Affirming Care: What It Is and How It’s Being Restricted in 2023

A substantial majority of transgender adults residing in the United States, an impressive 78%, affirm that living in a gender distinct from their birth-assigned one has led to heightened contentment in their lives, as per a recent survey conducted by The Washington Post and Kaiser Family Foundation.

What Is Gender-Affirming Care?

Among the respondents, over three-quarters have made modifications to their clothing, hairstyle, or grooming practices to align with their preferred gender identity, while 31% have sought hormone treatments, and 16% have undergone gender-affirming surgery or related procedures to alter their physical appearance.

However, these options are becoming increasingly limited, as policymakers in multiple states have endeavored to curtail the access of transgender individuals to gender-affirming medical treatments. In some states, like Georgia and Tennessee, bans targeting minors were ratified during the first quarter of 2023.

Defining Gender-Affirming Care

The Human Rights Campaign, an advocacy organization for LGBTQ+ rights, defines gender-affirming care as “age-appropriate care that is medically indispensable for the well-being of numerous transgender and non-binary individuals who experience symptoms of gender dysphoria, a distress stemming from the incongruity between their gender identity and sex assigned at birth.” It’s worth noting that both the American Medical Association and American Academy of Pediatrics endorse “age-appropriate, gender-affirming care for transgender and non-binary individuals.”

Conservatives frequently oppose the concept of gender-affirming care, which may or may not encompass surgical or other interventions, for a variety of reasons, including religious convictions and apprehensions about child welfare. Florida Governor Ron DeSantis, a Republican, articulated, “You don’t subject 10-, 12-, or 13-year-old youngsters to gender dysphoria-based disfigurement,” during an August press conference.

Some have voiced concerns regarding the absence of extensive research on the potential long-term repercussions of gender-affirming medical treatment for minors. For instance, a Reuters investigation uncovered that “no extensive studies have tracked individuals who received gender-related medical care as children to ascertain how many remained content with their treatment as they aged and how many eventually regretted their transition.” Moreover, some have raised alarm about the absence of comprehensive evaluations for children before they receive gender-affirming medical care.

States Enforcing Bans on Gender-Affirming Care:

  • Arkansas
  • Florida
  • Georgia
  • Idaho
  • Indiana
  • Iowa
  • Kentucky
  • Louisiana
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • North Carolina
  • North Dakota
  • Oklahoma
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • West Virginia

The following states have moved to impose restrictions on some form of gender-affirming care for minors in the year 2023, primarily based on legislative tracking by the Equality Federation, an advocacy accelerator collaborating with a network of state-based LGBTQ+ organizations.

Several states, such as Arizona and Alabama, had enacted bans prior to this year and are excluded from this list. Alabama’s law was subsequently blocked by a federal judge pending a legal challenge.

Numerous bills are presently under consideration by lawmakers in other states, as reported by the federation. Additionally, officials in some states, such as Florida and Missouri, have circumvented state legislatures entirely.


Signed into law by the newly inaugurated Republican Governor Sarah Huckabee Sanders in March, Arkansas’ legislation holds healthcare providers accountable for civil litigation for up to 15 years after a minor reaches the age of 18 if they have performed a gender transition procedure on that minor. Essentially, this makes it exceedingly challenging for providers to secure malpractice insurance, experts contend, thereby rendering gender-affirming care for children nearly unfeasible, as reported by the AP.

Notably, in 2021, state lawmakers passed the nation’s inaugural ban on gender-affirming care for minors, albeit it was temporarily halted shortly thereafter. However, on June 20, 2023, a federal judge issued a permanent injunction deeming the ban unconstitutional. This marked the first instance in which such a state-level ban was overturned, though Sanders’ more recent law remained poised for implementation.


In March, the Florida Department of Health’s Board of Medicine introduced a new rule, prohibiting several types of treatments and procedures, such as sex reassignment surgeries and puberty inhibitors, for addressing gender dysphoria in minors. Subsequently, on May 17, Governor DeSantis signed a comparable ban on gender-affirming care passed by the state legislature. This legislation not only bars these procedures for minors but also endows Florida courts with

“temporary emergency jurisdiction” over minors subjected to or “threatened” with sex reassignment prescriptions or procedures. Additionally, the law mandates that transgender adults must acquire written consent, utilizing a form endorsed by the Board of Medicine and the Board of Osteopathic Medicine, before undergoing such procedures, according to Reuters.

However, on June 6, a district court judge in Florida issued a preliminary injunction, temporarily halting the enforcement of certain provisions of the law on behalf of several young plaintiffs. Months later, the same judge ruled that portions of the law applicable to transgender adults could still be enforced while facing legal challenges.


In late March, Senate Bill 140 was signed into law by Georgia’s Republican Governor Brian Kemp. The legislation, advanced by the Republican majority in the state’s General Assembly, prohibits certain surgical procedures aimed at treating gender dysphoria in minors from being performed in hospitals and other licensed healthcare facilities.

Exceptions exist, including treatments deemed “medically necessary” and continued therapy for minors undergoing “irreversible hormone replacement therapies” before July 1, 2023. On September 5, a federal judge permitted Georgia to resume enforcing the part of the law that bars doctors from initiating hormone therapy for transgender minors, weeks after imposing a preliminary injunction. Notably, this prohibition doesn’t extend to surgical procedures and was not the subject of legal challenges.


Idaho’s GOP Governor Brad Little approved legislation that criminalizes the provision of gender-affirming care to youth. Signed into law on April 4 and scheduled to take effect in January 2024, this legislation deems it a felony to administer hormones, puberty blockers, or other gender-affirming medical care to minors.

Little emphasized in a letter affirming the bill’s signing that policymakers must exercise caution when considering government involvement in the decisions of loving parents regarding their children’s well-being.


Republican Governor Eric Holcomb signed a bill into law on April 5 that bans all forms of gender-affirming care for minors. He had previously expressed some reservations, citing a degree of ambiguity in the legislation. In his statement, the governor asserted that “permanent gender-altering surgeries with lifelong consequences, and medically prescribed preparations for such transitions, should occur when an individual reaches adulthood,

Not during their formative years as minors.” However, a federal judge issued a preliminary injunction on June 16, prompted by a request from the American Civil Liberties Union of Indiana. This order prevents the law from taking effect on July 1 but does not impact the restriction on gender-affirming surgeries.


Iowa’s ban, signed into law on March 22, prohibits healthcare professionals from “knowingly” engaging in specific medical practices on minors when the intent is to alter the minor’s appearance or affirm their gender identity if it doesn’t align with their sex assigned at birth. Procedures encompassed by the law include hormone therapies and surgical interventions. Like other states, there are exceptions, including instances involving a “medically verifiable disorder of sex development.”


On March 29, Kentucky joined other states in prohibiting gender-affirming medical care for minors when the Republican-led Kentucky General Assembly voted to override the veto of Democratic Governor Andy Beshear. The legislation stipulates that healthcare providers who violate the prohibition risk losing their licenses or certificates.

A federal judge temporarily blocked the portion of the law that sought to prevent transgender youth from accessing puberty blockers and hormone therapy on June 28, only to lift the injunction on July 14, allowing the restrictions to take effect. A federal appeals court panel on July 31 permitted the state to continue enforcing the law.


Following a successful veto override by the Republican supermajority legislature, Louisiana approved a ban on gender-affirming care for minors on July 18. This law, slated to take effect on January 1, 2024, encompasses procedures such as hormone therapies, puberty blockers, and gender-reassignment surgeries. The ban’s ultimate approval came after a Republican lawmaker cast a tie-breaking vote to resurrect the legislation in May, despite previous opposition.


Among the first laws enacted in 2023, Mississippi’s statute prohibits any individual from knowingly facilitating or abetting gender transition procedures on minors in the state. Additionally, it restricts the use of public funds or tax deductions for such procedures. Republican Governor Tate Reeves, upon signing the bill into law, remarked that “radical activists” were conveying the notion to children that they are “just a surgery away from happiness,” as reported by the AP.


Republican Governor Mike Parson signed a bill into law on June 7 that will curtail gender-affirming healthcare for both minors and some adults in Missouri, effective from late August onward. This law prevents the state’s Medicaid division from covering such treatments for individuals of all ages and bars providers from prescribing puberty blockers or cross-sex hormones to minors until August 28, 2027, unless the individual had already initiated treatment prior to the law’s effective date.

Missouri initially prohibited gender-affirming care in April through an emergency regulation issued by state Attorney General Andrew Bailey, extending the restrictions to both minors and adults, an unprecedented move. However, Bailey rescinded the rule on May 16, citing the imminent ban by the state legislature. On August 25, a circuit judge permitted the law to take effect.


Signed into law on April 28 by Republican Governor Greg Gianforte, Montana’s ban on gender-affirming care for minors covers both surgical procedures and medications like puberty blockers and testosterone. Similar to other state laws, this prohibition includes exceptions, particularly for individuals “diagnosed with a disorder of sexual development.

” Physicians who perform prohibited procedures may also face lawsuits up to 25 years after the procedure if it leads to any harm, encompassing physical, psychological, emotional, or physiological consequences. The law is set to take effect on October 1.


Republican Governor Jim Pillen signed a bill into law on May 22, banning gender-affirming medical care for minors under the age of 19 in Nebraska. This legislation also includes restrictions on “prescribed drugs related to gender alteration” and the rules governing these prescriptions will be determined by the state’s chief medical officer, a political appointee, as per the AP. The gender-affirming care section of this new law will be implemented on October 1, 2023.

North Carolina

On August 16, the Republican-dominated legislature in North Carolina successfully overrode a veto from Democratic Governor Roy Cooper to approve a ban on gender-affirming care for minors. This legislation covers both transition surgeries and the use of puberty-blocking drugs or cross-sex hormones. The law took effect immediately, albeit with exceptions similar to those in other states that have enacted such bans.

North Dakota

Republican Governor Doug Burgum signed a bill into law on April 19, which criminalizes the provision of gender-affirming medical care to minors. This law, effective immediately as an “emergency measure,” classifies performing sex reassignment surgery on a minor as a felony and providing gender-affirming medication like puberty blockers to minors as a misdemeanor. Burgum recommended in a statement that thoughtful and compassionate debate surround these complex medical policies, considering the welfare of North Dakota youth and their families.


GOP Governor Kevin Stitt signed a bill into law on May 1 that bans gender-affirming care for minors in Oklahoma. Stitt expressed enthusiasm for the law, stating he was “thrilled” to sign it and “protect our kids.” The legislation permits physicians who knowingly administer gender transition procedures to be charged with a felony. However, prosecution must occur before the minor patient turns 45. The law went into effect immediately, but on May 18, the state agreed not to enforce it while opponents sought a temporary court order to block it.

South Dakota

House Bill 1080, signed into law on February 13, bars healthcare professionals in South Dakota from performing various forms of gender-affirming procedures on minors. Violating the law results in the revocation of any license or certificate held by the provider, as mandated by the legislation. Governor Kristi Noem, a Republican, strongly supported this bill before signing it, according to the AP.


Tennessee’s legislation, signed by Governor Bill Lee in March but slated to go into effect on July 1, bans healthcare providers from performing or offering medical procedures to minors if the purpose is to enable the minor “to identify with, or live as, a purported identity inconsistent with the immutable characteristics of the reproductive system that define the minor as male or female.” It also prohibits such procedures if the purpose is to treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.

” While there are exceptions, the law establishes penalties for providers who violate it. Just days before its July 1 effective date, a federal judge temporarily blocked the portion of the law that would have prohibited transgender youth from accessing puberty blockers and hormone therapy. U.S. District Judge Eli Richardson, however, did not block the law’s ban on surgical procedures. A federal appeals court temporarily reversed Richardson’s ruling on July 8, allowing the law to take effect at least until the court conducts a full review.


Governor Greg Abbott, a Republican, signed a bill into law on June 2 that bans gender-affirming care for minors in Texas. The law contains exceptions similar to those in other states’ efforts to restrict transition care. The Texas Supreme Court, on August 31, allowed the law to go into effect on September 1, overturning a state district judge’s temporary injunction issued a week prior. It’s worth noting that the passage of this law wasn’t Texas’ first attempt to limit gender-affirming care: in 2022, Abbott ordered the investigation of families receiving such care, a move halted by a state judge.


Republican Governor Spencer Cox signed into law, on January 28, the first gender-affirming care ban of the year. Utah’s Senate Bill 16 restricts health providers from performing “sex characteristic surgical procedures on a minor for the purpose of effectuating a sex change” or hormonal transgender treatment on minors who weren’t diagnosed with gender dysphoria before July 1, 2023. Cox justified his approval of the law as an effort, at least in part, to pause “these permanent and life-altering treatments for new patients until more and better research can help determine the long-term consequences,” according to the AP.

West Virginia

A new law signed by Republican Governor Jim Justice on March 29 prohibits minors from being prescribed hormone therapy and puberty blockers or receiving gender-affirming surgery. The law, effective in January 2024, includes an exception for youth for whom “treatment with pubertal modulating and hormonal therapy is medically necessary to treat the minor’s psychiatric symptoms and limit self-harm or the possibility of self-harm.” In such cases, parental or guardian consent, along with two medical providers’ approval, is required.

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