Here are the states that plan to limit gender-affirming care in the coming year

History at a glance

  • No fewer than 20 bills targeting transgender medical care have been pre-filed in at least nine states for 2023.

  • More than two dozen states in 2022 sought to introduce measures to severely limit or ban access to gender-affirming health care for transgender youth.

  • States with default measures for 2023 include Missouri, Montana, New Hampshire, Oklahoma, South Carolina, Tennessee, Texas, Utah and Virginia.

More than two dozen states in 2022 sought to introduce measures to severely limit or ban access to gender-affirming health care for transgender youth in one of the worst years on record for anti-LGBTQ legislation.

Ahead of next year’s legislative session, no fewer than 20 bills targeting transgender medical care have been pre-filed in at least nine states.


Three Missouri Senate bills — SB236, SB49 and SB164 — pre-introduced this month aim to enact a blanket ban on gender-affirming health care for transgender minors, with exceptions for intersex youth. Each measure would establish the “Missouri Save Adolescents from Experimentation (SAFE) Act,” which GOP lawmakers failed to pass last year.

Identical “SAFE laws” were introduced in state legislatures across the country in 2022, inspired by legislation passed in Arkansas last year that banned health care for gender-affirming youth and threatened to revoke the medical licenses of doctors who provide such care.

Last year, a federal judge blocked state officials from enforcing the law in Arkansas, which is currently being challenged in a lawsuit by the American Civil Liberties Union (ACLU).

A fourth bill in the Missouri Senate, tentatively filed this month, would similarly prohibit medical professionals from performing gender-affirming surgeries or administering puberty blockers or hormone therapy to youngsters under 18.

Doctors who “willfully and knowingly” violate the measure can have their medical licenses revoked, and parents or guardians who allow their minor child to receive gender-affirming health care will be reported to the state Department of Human Services for abuse and neglect.


Montana House Republicans this month introduced several bills targeting health care for gender-affirming transgender youth. One of the proposed measures, sponsored by Montana Rep. Keith Regier (R), would ban transgender minors from undergoing gender-affirmation surgeries.

Four others — LC3824, LC3825, LC3826 and LC3827 — seek to “protect minors from gender reassignment” and overhaul state laws related to health care for gender-affirming youth.

New Hampshire

The pre-filed legislation in New Hampshire aims to ban “gender reassignment procedures” for minors and revise the state’s definition of so-called conversion therapy, a discredited practice that seeks to change a person’s sexual orientation or gender identity.

Ann an earlier version of the bill, which seeks to ban gender-affirming health care for both youth and “young adults.”


Legislation, pre-filed earlier this month by Oklahoma Republican Rep. Jim Olsen, aims to prohibit doctors from providing or attempting to provide “gender transition procedures” to patients under 21, except for intersex youth .

Under the bill, the administration of “any medical or surgical service” intended to assist a gender reassigned individual would be made a felony punishable by a fine of $100,000 and up to ten years in prison. The bill also prohibits the use of public funds, including those from the state Medicaid program, to help pay for gender-affirming health care for transgender youth and young adults under 21.

Olsen’s proposed legislation would also limit the ability of transgender Oklahomans to socially or legally change their name or gender marker on official state-issued documents.

South Carolina

A South Carolina Senate bill tentatively filed this month would bar transgender people under the age of 21 from receiving gender-affirming health care and require transgender adults over 21 to receive a referral from both their primary care physician and and by a licensed psychiatrist certifying that they have been diagnosed with gender dysphoria in order to receive gender-affirming care.

The bill also requires school teachers and staff to notify a student’s parents or guardians if the student identifies as transgender or struggles with their gender identity.

A second South Carolina bill would prohibit doctors from providing gender-affirming health care to minors, except for intersex youth, and a third pre-filed measure would amend the state constitution to define “gender” as a person’s gender as determined under birth , meaning that gender markers on government documents such as driver’s licenses and birth certificates cannot be corrected.


In November, Tennessee House Republicans pre-filed a measure to bar transgender youth under 18 from accessing gender-affirming health care, saying the legislature has a responsibility to “protect the health and welfare of minors.” An identical bill has been pre-filed in the state Senate.


At least two bills pre-filed in Texas last month — HB42 and HB112 — seek to define gender-affirming care of minors as child abuse under state law, effectively codifying a directive from Gov. Greg Abbott (R) earlier this year to state agencies to launch abuse investigations into families who allow their minor children to receive gender-affirming medical care.

A third Texas House bill introduced last month would repeal liability insurance for providers who prescribe drugs used to treat gender dysphoria in minors.


Utah Sen. Michael Kennedy, a Republican, last week tentatively introduced legislation that seeks to ban gender-affirming surgeries — including genital surgery, tip surgery and breast reduction — on minors, except for intersex youth.

Kennedy, a family physician, argued at a state Health and Human Services Committee hearing in October that gender-affirming health care is not medically necessary for transgender people experiencing gender dysphoria — contrary to the consensus view of most major accredited medical associations.

Kennedy in 2014 sponsored a measure to ban transgender youth from playing on school sports teams or using restrooms or locker rooms consistent with their gender identity.


Legislation tentatively filed in November by Virginia Republican Sen. Amanda Chase would create a “SAFETY Act” that would bar doctors in the state from providing gender-affirming health care to transgender youth under 18.

The proposed measure would also prohibit the Virginia Department of Medical Services, which administers the state’s Medicaid program, from reimbursing or providing coverage for gender confirmation services for individuals under 18.

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