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Gender-affirming care is emerging as a hot-button legal issue that pits patients and doctors against politicians and lawmakers in some states. The battle over gender-affirming care raises constitutional questions about who deserves equal protection and freedom of speech in the medical setting. People seeking gender-affirming care often face a confusing patchwork of state laws and policies that vary widely from state to state.

In This Article

What Is Gender-Affirming Care?

According to the World Health Organization, gender-affirming care refers to a range of social, psychological, behavioral, and medical interventions designed to support and affirm an individual's gender identity when it conflicts with the gender they were assigned at birth.

The goal of gender-affirming care is to help people match their physical presentation with their gender identity.

Transition is a personal process that looks different for different people. Some individuals need hormone therapy and surgery to treat their gender dysphoria; others don’t. Health professionals help transgender and nonbinary people explore different ways to express gender identity and medical treatment options for gender dysphoria.

Doctors and therapists can help people with their psychological and medical transition, including through:

  • hormone therapy
  • hair removal
  • speech therapy
  • counseling (individual, couple, family, group)
  • reproductive care (like sperm or egg storage), and
  • gender confirmation surgeries.

Behavioral health providers can guide and support people with their social transition, including when it comes to:

  • changing wardrobe or hairstyle
  • packing (using padding or a phallic object to give the appearance of a penis)
  • tucking (hiding the bulge of a penis and scrotum to create a more feminine appearance)
  • binding (using tight garments to flatten breasts)
  • prostheses (inserts in clothing or bras to change breast, hip, or butt size)
  • coming out to partners, children, family, friends, coworkers, and
  • changing identity documents to update name, gender identity, and pronoun use.

How Federal and State Laws Govern Gender-Affirming Care

Every major medical association in the United States, including the American Medical Association (AMA), recognizes that gender-affirming care is medically necessary to improve the physical and mental health of transgender and gender-diverse people. However, the AMA signaled in February 2026 that surgical interventions should generally be deferred until adulthood pending more robust evidence.

Not all insurance companies agree. Some health insurance plans cover both surgical and nonsurgical gender-affirming care. Others exclude gender-affirming services, like hair removal, viewing it as cosmetic and not medically necessary.

Lawmakers are also mixed in their response to gender-affirming care. At the federal level, protections that once barred health care discrimination based on gender identity have largely been dismantled by the Trump administration. At the state level, some states have passed anti-discrimination laws to protect people from being denied health insurance coverage or care based on gender identity. Other states allow health insurance plans, including Medicaid and state employee benefits, to exclude gender-affirming health care from coverage. Still other states have no explicit laws or policies either way.

Federal Law on Gender-Affirming Care

The Affordable Care Act (Section 1557) includes broad civil rights protections in health care, barring discrimination based on race, color, national origin, sex, age, or disability in all health care programs or activities that receive federal funding. (42 U.S. Code § 18116 (2026).)

The Obama administration interpreted Section 1557’s ban on sex discrimination to include discrimination based on gender identity. The Trump administration erased those protections in 2020. Then the Biden administration restored the protections in 2021, bolstered by the U.S. Supreme Court's landmark ruling that gender identity discrimination in the workplace is illegal. (Bostock v. Clayton County, Georgia, 140 S. Ct. 1731 (2020).)

But those protections are no longer in effect. When President Trump returned to office in January 2025, he signed executive orders removing federal policies that had protected transgender and nonbinary people from health care discrimination. In February 2025, the Department of Health and Human Services withdrew its guidance to treat gender identity discrimination as sex discrimination under Section 1557. Then, in October 2025, a federal court struck down regulations that had been written to make those same protections the law.

State Laws on Gender-Affirming Care

People seeking gender-affirming care often face a confusing patchwork of state laws and policies. Access to gender-affirming care varies widely from state to state. Some private employers and insurers offer gender-affirming health benefits; others don’t. Some state employee health benefits cover gender-affirming care; others don't.

Most state laws about gender-affirming health care and insurance fall into three categories:

  1. Some allow coverage for gender-affirming care and ban health insurance discrimination based on gender identity.
  2. Some have no explicit policy on gender-affirming care and health coverage.
  3. Some explicitly exclude gender-affirming health care and coverage.

The Movement Advancement Project (MAP) has put together a map of gender-affirming healthcare laws and policies across the country that looks strikingly similar to the 2024 electoral map, with “blue states” tending to offer the most access to gender-affirming care and insurance coverage and “red states” offering less or none.

Bans on Gender-Affirming Care for Transgender Minors

Laws concerning transgender youth take many forms. Some are aimed at preventing kids and teens from playing sports consistent with their gender identity. Others restrict the bathrooms transgender and nonbinary people can use at school. And a growing number of state laws seek to ban gender-affirming care for young people.

Arkansas was the first state to pass a gender-affirming care ban for minors in 2021, though courts blocked it from taking effect for several years. Utah became the first state in which such a ban took effect in January 2023. Republican lawmakers are pushing for similar bans in states across the country.

Which States Currently Have Gender-Affirming Care Bans?

According to MAP, as of February 2026, states that have passed total or partial gender-affirming care bans include:

  • Alabama
  • Arizona
  • Arkansas
  • Florida
  • Georgia
  • Idaho
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • New Hampshire
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • West Virginia, and
  • Wyoming.

Not all bans have gone into effect yet and some bans are facing legal challenges.

Who Is Affected by State Bans on Transgender Health Care?

According to the Williams Institute, a research center at the UCLA School of Law, an estimated 724,000 youth ages 13-17 identify as transgender in the United States. More than half of all transgender youth now live in a state with at least one anti-trans law.

Proponents of state bans on gender-affirming care say that the laws are necessary to protect kids from harmful, permanent medical procedures. Critics of the laws say that cutting off or denying minors gender-affirming care is what causes harm to minors, including an increased risk of suicide, heightened gender dysphoria, and depression.

Despite the intensity of the debate, the medical interventions most often targeted by bans are rarely used. A 2024 study by the researchers at the Harvard T.H. Chan School of Public Health found that among insured minors, no gender-affirming surgeries were performed on youth ages 12 and younger, and only 2.1 per 100,000 teens ages 15-17 received surgery. A separate study published in JAMA Pediatrics in January 2025 found that gender-affirming medications, such as puberty blockers and hormones, were also rare, with fewer than 1 in 1,000 insured adolescents receiving any gender-related medication.

Most bans target gender-affirming care for trans adolescents, but many states are trying to restrict care for people 18 years old and over. In April 2023, Missouri became the first state to restrict some gender treatments for people of all ages. Other states, including Florida, have tried to prohibit Medicaid from covering some kinds of gender care for transgender people of all ages.

Is It Legal for States to Ban Gender-Affirming Care?

In June 2025, the U.S. Supreme Court upheld Tennessee's ban on gender-affirming medical care for minors. The case, United States v. Skrmetti, is the first time the high court has weighed in on the constitutionality of this type of ban, and it's a major setback for transgender rights nationwide. The law, known as SB 1, prohibits medical professionals from treating minors experiencing gender dysphoria with puberty blockers, hormone therapy, and gender-transition surgery. Health care providers who knowingly violate the ban face a civil penalty of $25,000 per violation, as well as other consequences, including potential professional discipline and civil lawsuits.

The Court ruled that SB 1 didn't violate the equal protection clause because it didn't classify based on sex and Tennessee had a rational basis for the law. A majority of Supreme Court Justices reasoned that the law is constitutional and addresses the type of "fierce scientific and policy debates" that state lawmakers should resolve. The ruling is expected to bolster similar laws passed by dozens of other states since 2023.

The decision aligns with President Trump's executive order—"Protecting Children From Chemical and Surgical Mutilation"—banning federal funding from medical providers who offer gender-affirming care to transgender youth.

Legal challenges, however, aren't over. Some lawsuits continue to argue that the bans violate parents' due process rights under the 14th Amendment. Specifically, people and organizations suing over the bans argue that the laws violate parents' due process right to manage their children's medical care. Those cases are still working through the lower courts.

Gender-Affirming Care Shield Laws: Which States Protect Access to Care?

Not all states are trying to limit or ban gender-affirming health care for young people. In September 2022, Governor Newsom signed Senate Bill 107. The law (often described as a "shield" or "refuge" law) establishes California as a sanctuary for gender-affirming care.

As of early 2025, 14 states and the District of Columbia have passed similar shield laws protecting healthcare providers, transgender youth, and their families.

Is It Legal to Travel for Gender-Affirming Care?

In states where gender-affirming care is now banned, transgender kids and their families have difficult decisions to make. Some families are moving to transgender "refuge" or "sanctuary" states, like California, where access to care is protected. Others have been forced to pause care or travel out of state for treatment, often at great cost. In states where care is still allowed, wait lists for appointments are increasingly lengthy.

Like patients who travel to seek abortion care after Roe v. Wade was overturned, transgender kids and their families typically aren't legally prohibited from traveling to another state to receive gender-affirming care. But the legal risks are growing. Parents who facilitate gender-affirming care may risk running afoul of child welfare laws in states with bans. For example, in 2022, the governor of Texas directed the state's child welfare agency to investigate families of transgender children receiving transition-related care for child abuse. Courts have blocked those investigations, but the case illustrates the legal risks families in ban states may face.

If you have questions about your right to access gender-affirming care for you or your child, talk to a health care professional or a lawyer.

Where to Get Legal Help for Gender-Affirming Care

If you believe you’ve experienced discrimination in health care, your options at the federal level are currently limited. As of early 2025, the U.S. Department of Health and Human Services, Office for Civil Rights (OCR), is no longer investigating gender identity discrimination complaints under Section 1557. You may still file a complaint if you believe you've experienced other forms of health care discrimination, but for gender identity claims, talk with a lawyer or your state's civil rights enforcement agency.

You might also want to file a complaint about insurance-related discrimination with your state’s Department of Insurance (DOI). The department will investigate the complaint and try to get the insurer to fix the problem if the insurer has mishandled your claim or broken a law or regulation.

If you would like to file a civil lawsuit in court, talk to a lawyer. You can typically file a lawsuit instead of, or in addition to, a civil rights complaint or a complaint with your state’s DOI.

If your health insurance company refuses to pay a claim or ends your coverage, you might have the right to appeal the decision and have it reviewed by an independent third party.

The American Bar Association has put together a list of transgender resources, including organizations that offer legal and support services.

Trans Lifeline is a trans-led organization that connects trans people to community support and resources. Call (877) 565-8860 to speak with a trans/nonbinary peer operator.