State laws restricting transition care for minors have surged over the past few months, as part of a Republican movement to regulate the lives of transgender youth.
In a little over two years, Republican-led state legislatures have enacted restrictions on a host of L.G.B.T.Q.-related issues, including gender-affirming medical care, bathroom access, and sports participation for transgender children and teenagers.
Here’s a snapshot of where those three kinds of laws have passed.
This year alone, 16 states have enacted bans or significant new restrictions on some or all gender-affirming care for minors, most ending the use of cross-sex hormones and puberty blockers. On Friday, Gov. Greg Abbott signed his state’s bill, making Texas the largest state to ban transition care for minors. Another ban, in Missouri, is expected to be signed into law.
Before this year, three states had passed restrictions.
There are injunctions on the bans in Alabama and Arkansas, and a temporary stay on Oklahoma’s law. Not all the laws passed this year have gone into effect yet.
Several states have prohibited only certain parts of gender-affirming care. Arizona and Nebraska have banned only surgery; Nebraska’s law directs the state medical officer to create regulations on cross-sex hormones and puberty blockers. Georgia’s bill permits the use of puberty blockers, and West Virginia’s allows hormone therapy in cases of serious mental health issues.
Legislators who support the restrictions have said they are seeking to protect children from irreversible decisions.
There is continuing research on how gender-affirming care should be given and when, but the American Academy of Pediatrics and the American Medical Association support allowing adolescents to access this care. Advocates and physicians who provide the care say the bills infringe on the rights of adolescents and parents, legislate decisions that should be left to doctors and families, and will have mental health ramifications for trans teens. Advocates for trans care have sued in numerous states over these laws, and other Democratic-led states have passed laws protecting transition care for young people.
The bills restricting care have largely focused on minors, but in some areas they also have affected transgender adults. Florida’s Senate Bill 254, recently signed into law, limits which medical providers can prescribe hormones to transgender adults. The bill led some providers of gender-affirming care to temporarily suspend their services to adults. And several states have banned Medicaid from covering transition care for adults.
Lawmakers this year have also passed a series of laws prohibiting transgender students from using the restroom that matches their gender identity.
These “bathroom bills” once drew enough criticism that a 2016 North Carolina law was repealed, but they have gained traction in the last few years. More than half the bills have passed only in the last few months.
Most of the bills instruct public school districts to create policies prohibiting students from using a bathroom that does not match their sex at birth, and leave enforcement to the individual districts. Some also have the same restroom restrictions in other places, like jails and prisons. (Kansas recently passed a law stating that separating bathrooms by biological sex at birth is “substantially related” to the government’s responsibility to protect safety and privacy, but it does not contain language on enforcement and is not included here as a ban.)
Bills barring young transgender people from competing on the sports teams that match their gender identity have been a Republican priority longer than either transition care bans or restroom bills. These laws have been passed in more than 20 states, most in 2021 and 2022. (Several are blocked because of continuing legal fights.)
These bills primarily prohibit transgender girls and women — and anyone assigned male at birth — from playing on middle school and high school girls’ sports teams at public schools, or private schools that play against public schools. Most also apply to elementary schools and higher education.
Before these laws, states, districts and schools had a patchwork of rules on athletic participation.
In Utah an injunction on the state’s ban means decisions about whether transgender girls can participate go on a case-by-case basis to a panel of commissioners who decide if fairness could be compromised.
Republicans have called this issue “a battle for the very survival of women’s sports,” pointing to a debate at the most elite level of sports as well as at high schools and colleges. Critics say that these rules affect very small numbers of students and that the bills keep transgender children and adolescents from joining social activities.
Legislatures have passed other laws that reshape school and life for young L.G.B.T.Q. people. These include restrictions on teaching about sexual orientation and gender identity, and laws that require teachers to tell parents a student has changed their pronouns or name in school. They have also passed laws that restrict the lives of L.G.B.T.Q. people more broadly, including defining sex in ways that advocates say could lead to discrimination; limiting where drag shows can be performed; and regulating whether people can change their sex on their birth certificates.
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