Several states in the United States are introducing bills to restrict access to gender-affirming care for young adults, and possibly even adults. Republican-led efforts include seeking to ban or limit gender-affirming care for people into adulthood or making it harder for adults to access such care.
“It’s interesting that initially we heard that this was a thing to protect youth, but now we are seeing that it’s really about all transgender people,” Rep. Gloria Johnson
House Republicans in Oklahoma passed a bill that prohibits any institution receiving public funds from providing gender-affirming care to minors or adults, and also prohibits insurance coverage for such care. Additionally, a separate bill was introduced which would make it a felony for doctors to perform hormone treatments or surgeries related to gender transition on individuals below the age of 26.
“Let’s put children first and look out for them first and let them make those decisions as adults. I support your right to do so, when you’re an adult, not when you’re a child and you do not have the mental capacity to do so.” Republican state Sen. Jack Johnson
In Virginia, a proposed bill would ban gender-affirming surgeries for people under the age of 21, while in South Carolina, a bill identical to the original Virginia bill would ban gender-affirming procedures for people under 21 and make it harder for people to access that care when they’re over 21. Transgender activists argue that lawmakers are slowly trying to legislate trans people out of existence.
“Last year, the rhetoric was to protect kids, but now they are going after adults,” said Allison Chapman, a legislative researcher and transgender rights advocate based in Virginia.
The bills that aim to restrict gender-affirming care access for young adults have caused tensions in various states, leading to public hearings and protests. For instance, when Lindsey Spero, who is nonbinary, approached the podium at a public hearing of the Florida medical board on a gender-affirming youth trans care ban, they used their allotted time to inject testosterone in front of board members and the audience, as they believe action is necessary because historically speaking, queer freedom and liberation have never been won through words alone.
In Virginia, a proposed bill would ban gender-affirming surgeries for people under the age of 21. The legislation was amended to remove bans on hormone therapies.
The bills may also affect adults. In Florida, adults are banned from using Medicaid to receive gender-affirming care. In Virginia, the proposed bill would make it harder for someone over the age of 21 “to receive gender transition procedures” by requiring them to first obtain a referral from their primary care physician and a licensed psychiatrist. State Sen. Mark J. Peake, who is behind the Virginia bill, wants to restrict gender-affirming surgeries until patients are 21 because “juvenile brains really are not developed as a teen.” In South Carolina, Zoë Glass, an LGBTQ advocate, argued that “we have trans people who are under 21, but they’re adults. Why do they not have their own bodily autonomy?”
Transgender activists argue that gender-affirming care, which includes hormone therapy and gender-affirming surgeries, reduces the risk of mental health problems and suicidal thoughts. Contrary to claims by some lawmakers, research shows that rates of regret for gender-affirming procedures are extremely low, estimated to be around 1%. Studies show that rates of regret for knee and hip replacement surgeries are much higher than gender affirmation surgery.
Research shows that rates of regret for gender-affirming procedures are extremely low — estimates are around 1%. Rates of regret for knee and hip replacement surgeries are much higher than gender affirmation surgery, according to studies.
According to the American Civil Liberties Union, there are roughly 275 anti-LGBTQ bills that are currently in state legislatures or have been passed in the United States this year. Many of these include banning transgender care for minors and criminalizing people who provide such care, banning transgender girls from playing on girls’ sports teams, discussing or teaching about sexual orientation and gender identity in schools, and more.
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“The existence of trans people under 21 [is] being criminalized in South Carolina and it’s extremely frightening – extraordinarily frightening.”
Advocates argue that lawmakers are slowly trying to legislate trans people out of existence, and are preparing for the worst by ensuring that all of their medical documents and paperwork are in order.
“As somebody who felt acutely suicidal … who was placed through multiple rounds of conversion therapy, I can tell you that it is incredibly hard to stay alive as a young trans person. Bans will impact the lives of trans youth … will cause mental distress and will cause, unfortunately, a lot of negative effects in the lives of these youth because they’re not able to access life-affirming care.”
Policies or laws that limit transgender health care have been passed in states such as Tennessee, Arizona, Utah, Arkansas, Alabama, Mississippi, South Dakota, and Florida. Advocates of these laws argue that gender transitioning can be detrimental to the well-being of adolescents and young adults, and suggest that such decisions regarding health should be postponed until they are older.
Studies have shown that gender-affirming care can be life-saving for transgender and nonbinary children and adolescents, promoting positive mental and physical health and well-being.
Republican lawmakers in four states have currently approved laws to prohibit gender-affirming care for minors
Utah and Mississippi this year, and Arkansas and Alabama in the previous year. The definition of minors under these laws is under 18 in Utah, Mississippi, and Arkansas, while in Alabama, a minor is under 19. The laws in Arkansas and Alabama are currently being challenged in court. In Florida, the state Board of Medicine has endorsed a ban on gender-affirming care for minors, and the state no longer provides Medicaid coverage for such care for individuals of any age.
Minnesota Gov. Tim Walz signed an executive order protecting and supporting access to gender-affirming health care for LGBTQ people in the state on Wednesday.
