Gender affirming care (GAC) includes medical, psychological, and social supports that help people live in alignment with their gender identity. As of 2025, more than 20 states have passed laws restricting or banning this care, often under the claim of “protecting children.”1 2 3 However, there is no credible medical evidence that gender-affirming care harms children, despite claims that these laws are necessary to prevent harm.4 Extensive research shows that access to age-appropriate gender-affirming care is associated with improved mental health outcomes, while denial of care is linked to higher rates of depression, anxiety, and suicidality among transgender youths.5 6 7 8 9 This Fact Checked explains what gender-affirming care bans actually do and how they harm public health and civil rights.
Do gender-affirming care bans only ban surgery?
No, most bans go far beyond surgery. Gender-affirming surgeries on minors are extremely rare, and when they occur, they require extensive evaluation, parental consent, and medical approval.10 11 12 Despite this, many state laws prohibit reversible and safe treatments such as puberty blockers and hormone therapy. Some laws even restrict counseling that supports a young person’s gender identity.13 14 15 Such counseling focuses on helping young people explore, understand, and articulate their feelings about gender in a developmentally appropriate way, not on directing or pressuring them toward any particular identity or medical decision. In states like Arkansas, Tennessee, and Florida, these bans penalize providers, threaten their licenses, and undermine parents’ ability to make medical decisions for their children.16 17 18 Rather than protecting children, these laws block age-appropriate care that major medical organizations consider safe, effective, and essential for well-being.19 20 21 22 23
Do these laws only affect children?
No, for any adult receiving care for any issue (such as hormones for irregular periods, menopause, or chronic conditions), these restrictions create barriers that extend well beyond pediatric care.24 25 Several states have expanded restrictions through insurance exclusions, Medicaid bans, or limits on telehealth and cross-state care. In states like Florida and Missouri, providers who offer gender-affirming care to adults risk losing their licenses or facing lawsuits, which has led hospitals and clinics to restrict care and pharmacies to refuse to fill related prescriptions out of fear of legal liability.26 27 28 29
For adults, these restrictions result in interrupted treatment, loss of trusted providers, delayed care, and increased mental health risk, particularly for those who rely on insurance, Medicaid, or rural and telehealth services.30 These laws create confusion, fear, and gaps in care that endanger transgender adults as well as youth. Beyond their effects on youth, these laws also raise serious concerns about bodily autonomy and the right of transgender adults to make private medical decisions free from political interference.
Do these laws actually protect children from harm?
No, major medical organizations oppose these bans. Every major medical association in the United States, including the American Medical Association (AMA), American Academy of Pediatrics (AAP), American Psychological Association (APA), and Endocrine Society, recognizes age-appropriate gender-affirming care as safe, evidence-based, and medically necessary.31 32 33 34 35 36 Supporters of these bans claim to prevent harm, but there is no credible evidence that gender-affirming care endangers youth.37 38 39 40 41 42 These laws replace evidence-based medical judgment with political rhetoric, harming the very children they claim to protect.43 44
Are gender-affirming care bans narrowly enforced?
No, gender-affirming care bans vary widely across states, but most use similar enforcement tools. These laws can impose criminal penalties on providers, expose families or clinicians to civil lawsuits, revoke or suspend medical licenses, and block insurance or Medicaid coverage for gender-affirming care.45 46 Some states go even further: in Texas, for example, parents who support their transgender children risk being investigated by child welfare agencies.47 Since 2021, more than 20 states have enacted or proposed such restrictions—many using nearly identical legislative templates—and several, including Arkansas, Alabama, and Florida, are currently being challenged in court.48 49
These states do not operate in isolation; they are a part of a broader pattern of legislation that frames transgender people as threats in order to justify expanded state control over healthcare and family decision-making.50 51 Recognizing these patterns helps clarify how legislative attacks on gender-affirming care fit into a larger strategy of restricting bodily autonomy, human, and civil rights.52
Policy Recommendations
- Reject the criminalization of healthcare. Legislatures should not impose criminal penalties, civil liability, or professional discipline on clinicians for providing care consistent with established clinical standards. Instead, states should allow medical licensing boards to establish and oversee standards of care, just as they do for other areas of healthcare.
- Protect provider discretion and patient privacy. Medical decisions should be made between patients, families, and healthcare professionals. This includes prohibiting laws that require clinicians to report families to child welfare agencies, mandate disclosure of private medical information to state officials, or restrict providers from discussing lawful treatment options with patients.
- Support evidence-based, age-appropriate care. Gender-affirming care should be governed by the same ethical and medical standards applied to all healthcare, grounded in scientific research and established clinical guidelines, without legislative interference that disrupts treatment.
References
1. Dai, D., Charlton, B. M., Boskey, E. R., Hughes, L. D., Hughto, J. M., Orav, E. J., & Figueroa, J. F. (2024). Prevalence of Gender-Affirming surgical procedures among minors and adults in the US. JAMA Network Open, 7(6), e2418814. https://doi.org/10.1001/jamanetworkopen.2024.18814
2. Dawson, L., & Kates, J. (2025, August 20). Policy Tracker: Youth access to gender affirming care and state policy restrictions. KFF. https://www.kff.org/lgbtq/gender-affirming-care-policy-tracker/
3. Movement Advancement Project | Healthcare Laws and Policies. (n.d.). https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
4. Georges, E., Brown, E. C., & Cohen, R. S. (2024). Prohibition of gender-affirming care as a form of child maltreatment: reframing the discussion. Pediatrics, 153(1), e2023064292.
5. Dai, D., Charlton, B. M., Boskey, E. R., Hughes, L. D., Hughto, J. M., Orav, E. J., & Figueroa, J. F. (2024). Prevalence of Gender-Affirming surgical procedures among minors and adults in the US. JAMA Network Open, 7(6), e2418814. https://doi.org/10.1001/jamanetworkopen.2024.18814
6. Dawson, L., & Kates, J. (2025, August 20). Policy Tracker: Youth access to gender affirming care and state policy restrictions. KFF. https://www.kff.org/lgbtq/gender-affirming-care-policy-tracker/
7. Movement Advancement Project | Healthcare Laws and Policies. (n.d.). https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
8. Restar A. J. (2023). Gender-affirming care is preventative care. Lancet regional health. Americas, 24, 100544. https://doi.org/10.1016/j.lana.2023.100544
9. Schweikart, S. J. (2023). What’s wrong with criminalizing Gender-Affirming care of transgender adolescents? The AMA Journal of Ethic, 25(6), E414-420. https://doi.org/10.1001/amajethics.2023.414
10. Brownstein, M. (2025, May 29). Gender-affirming surgeries rarely performed on transgender youth | Harvard T.H. Chan School of Public Health. Harvard T.H. Chan School of Public Health. https://hsph.harvard.edu/news/gender-affirming-surgeries-rarely-performed-on-transgender-youth/
11. Dai, D., Charlton, B. M., Boskey, E. R., Hughes, L. D., Hughto, J. M., Orav, E. J., & Figueroa, J. F. (2024). Prevalence of Gender-Affirming surgical procedures among minors and adults in the US. JAMA Network Open, 7(6), e2418814. https://doi.org/10.1001/jamanetworkopen.2024.18814
12. Rafferty, J., Yogman, M., Baum, R., Gambon, T. B., Lavin, A., Mattson, G., Wissow, L. S., Breuner, C., Alderman, E. M., Grubb, L. K., Powers, M. E., Upadhya, K., Wallace, S. B., Hunt, L., Gearhart, A. T., Harris, C., Lowe, K. M., Rodgers, C. T., & Sherer, I. M. (2018). Ensuring comprehensive care and support for transgender and Gender-Diverse children and adolescents. PEDIATRICS, 142(4). https://doi.org/10.1542/peds.2018-2162
13. Dai, D., Charlton, B. M., Boskey, E. R., Hughes, L. D., Hughto, J. M., Orav, E. J., & Figueroa, J. F. (2024). Prevalence of Gender-Affirming surgical procedures among minors and adults in the US. JAMA Network Open, 7(6), e2418814. https://doi.org/10.1001/jamanetworkopen.2024.18814
14. Dawson, L., & Kates, J. (2025, August 20). Policy Tracker: Youth access to gender affirming care and state policy restrictions. KFF. https://www.kff.org/lgbtq/gender-affirming-care-policy-tracker/
15. Movement Advancement Project | Healthcare Laws and Policies. (n.d.). https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
16. Dai, D., Charlton, B. M., Boskey, E. R., Hughes, L. D., Hughto, J. M., Orav, E. J., & Figueroa, J. F. (2024). Prevalence of Gender-Affirming surgical procedures among minors and adults in the US. JAMA Network Open, 7(6), e2418814. https://doi.org/10.1001/jamanetworkopen.2024.18814
17. Dawson, L., & Kates, J. (2025, August 20). Policy Tracker: Youth access to gender affirming care and state policy restrictions. KFF. https://www.kff.org/lgbtq/gender-affirming-care-policy-tracker/
18. Movement Advancement Project | Healthcare Laws and Policies. (n.d.). https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
19. American Medical Association & American Medical Association. (2021, June 15). AMA reinforces opposition to restrictions on transgender medical care. American Medical Association. https://www.ama-assn.org/press-center/ama-press-releases/ama-reinforces-opposition-restrictions-transgender-medical-care
20. American Psychological Association. (2024). APA Policy Statement on Affirming Evidence-Based Inclusive care for transgender, gender diverse, and nonbinary Individuals, Addressing Misinformation, and the role of Psychological Practice and science. https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care.pdf
21. Rafferty, J., Yogman, M., Baum, R., Gambon, T. B., Lavin, A., Mattson, G., Wissow, L. S., Breuner, C., Alderman, E. M., Grubb, L. K., Powers, M. E., Upadhya, K., Wallace, S. B., Hunt, L., Gearhart, A. T., Harris, C., Lowe, K. M., Rodgers, C. T., & Sherer, I. M. (2018). Ensuring comprehensive care and support for transgender and Gender-Diverse children and adolescents. PEDIATRICS, 142(4). https://doi.org/10.1542/peds.2018-2162
22. Restar A. J. (2023). Gender-affirming care is preventative care. Lancet regional health. Americas, 24, 100544. https://doi.org/10.1016/j.lana.2023.100544
23. Schweikart, S. J. (2023). What’s wrong with criminalizing Gender-Affirming care of transgender adolescents? The AMA Journal of Ethic, 25(6), E414-420. https://doi.org/10.1001/amajethics.2023.414
24. Medina, C. (2021, August 25). Fact sheet: Protecting and advancing health care for transgender adult communities. Center for American Progress. https://www.americanprogress.org/article/fact-sheet-protecting-advancing-health-care-transgender-adult-communities/
25. Movement Advancement Project | Healthcare Laws and Policies. (n.d.). https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
26. Dawson, L., & Kates, J. (2025, August 20). Policy Tracker: Youth access to gender affirming care and state policy restrictions. KFF. https://www.kff.org/lgbtq/gender-affirming-care-policy-tracker/
27. IBID
28. Movement Advancement Project | Healthcare Laws and Policies. (n.d.). https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
29. The Trevor Project. (n.d.). 2024 U.S. National Survey on the Mental Health of LGBTQ+ Young People. https://www.thetrevorproject.org/survey-2024/
30. Medina, C. (2021, August 25). Fact sheet: Protecting and advancing health care for transgender adult communities. Center for American Progress. https://www.americanprogress.org/article/fact-sheet-protecting-advancing-health-care-transgender-adult-communities/
31. American Medical Association & American Medical Association. (2021, June 15). AMA reinforces opposition to restrictions on transgender medical care. American Medical Association. https://www.ama-assn.org/press-center/ama-press-releases/ama-reinforces-opposition-restrictions-transgender-medical-care
32. American Psychological Association. (2024). APA Policy Statement on Affirming Evidence-Based Inclusive care for transgender, gender diverse, and nonbinary Individuals, Addressing Misinformation, and the role of Psychological Practice and science. https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care.pdf
33. Brownstein, M. (2025, May 29). Gender-affirming surgeries rarely performed on transgender youth | Harvard T.H. Chan School of Public Health. Harvard T.H. Chan School of Public Health. https://hsph.harvard.edu/news/gender-affirming-surgeries-rarely-performed-on-transgender-youth/
34. Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., … Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644
35. Rafferty, J., Yogman, M., Baum, R., Gambon, T. B., Lavin, A., Mattson, G., Wissow, L. S., Breuner, C., Alderman, E. M., Grubb, L. K., Powers, M. E., Upadhya, K., Wallace, S. B., Hunt, L., Gearhart, A. T., Harris, C., Lowe, K. M., Rodgers, C. T., & Sherer, I. M. (2018). Ensuring comprehensive care and support for transgender and Gender-Diverse children and adolescents. PEDIATRICS, 142(4). https://doi.org/10.1542/peds.2018-2162
36. Restar A. J. (2023). Gender-affirming care is preventative care. Lancet regional health. Americas, 24, 100544. https://doi.org/10.1016/j.lana.2023.100544
37. American Medical Association & American Medical Association. (2021, June 15). AMA reinforces opposition to restrictions on transgender medical care. American Medical Association. https://www.ama-assn.org/press-center/ama-press-releases/ama-reinforces-opposition-restrictions-transgender-medical-care
38. American Psychological Association. (2024). APA Policy Statement on Affirming Evidence-Based Inclusive care for transgender, gender diverse, and nonbinary Individuals, Addressing Misinformation, and the role of Psychological Practice and science. https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care.pdf
39. Brownstein, M. (2025, May 29). Gender-affirming surgeries rarely performed on transgender youth | Harvard T.H. Chan School of Public Health. Harvard T.H. Chan School of Public Health. https://hsph.harvard.edu/news/gender-affirming-surgeries-rarely-performed-on-transgender-youth/
40. Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., … Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644
41. Rafferty, J., Yogman, M., Baum, R., Gambon, T. B., Lavin, A., Mattson, G., Wissow, L. S., Breuner, C., Alderman, E. M., Grubb, L. K., Powers, M. E., Upadhya, K., Wallace, S. B., Hunt, L., Gearhart, A. T., Harris, C., Lowe, K. M., Rodgers, C. T., & Sherer, I. M. (2018). Ensuring comprehensive care and support for transgender and Gender-Diverse children and adolescents. PEDIATRICS, 142(4). https://doi.org/10.1542/peds.2018-2162
42. Restar A. J. (2023). Gender-affirming care is preventative care. Lancet regional health. Americas, 24, 100544. https://doi.org/10.1016/j.lana.2023.100544
43. Medina, C. (2021, August 25). Fact sheet: Protecting and advancing health care for transgender adult communities. Center for American Progress. https://www.americanprogress.org/article/fact-sheet-protecting-advancing-health-care-transgender-adult-communities/
44. Restar A. J. (2023). Gender-affirming care is preventative care. Lancet regional health. Americas, 24, 100544. https://doi.org/10.1016/j.lana.2023.100544
45. Abbott, G. (2022). Letter from Governor Greg Abbott to Commissioner Jaime Masters regarding “sex change” procedures as child abuse under Texas law. https://gov.texas.gov/uploads/files/press/O-MastersJaime202202221358.pdf
46. Brandt et al v. Rutledge et al | American Civil Liberties Union. (2025, November 7). American Civil Liberties Union. https://www.aclu.org/cases/brandt-et-al-v-rutledge-et-al
47. Abbott, G. (2022). Letter from Governor Greg Abbott to Commissioner Jaime Masters regarding “sex change” procedures as child abuse under Texas law. https://gov.texas.gov/uploads/files/press/O-MastersJaime202202221358.pdf
48. Dawson, L., & Kates, J. (2025, August 20). Policy Tracker: Youth access to gender affirming care and state policy restrictions. KFF. https://www.kff.org/lgbtq/gender-affirming-care-policy-tracker/
49. Movement Advancement Project | Healthcare Laws and Policies. (n.d.). https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
50. GLAAD. (2025, October 14). Groomer: Definition, Meaning, and origin in Anti-LGBTQ hate | GLAAD. GLAAD | GLAAD Rewrites the Script for LGBTQ Acceptance. https://glaad.org/groomer-definition-meaning-anti-lgbt-online-hate
51. King, W. M., Hughto, J. M., & Operario, D. (2020). Transgender stigma: A critical scoping review of definitions, domains, and measures used in empirical research. Social Science & Medicine, 250, 112867. https://doi.org/10.1016/j.socscimed.2020.112867
52. IBID
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