New Hampshire became the 27th state to ban youth sex-change procedures on Aug. 1, following a Supreme Court decision upholding Tennessee’s controversial ban.

State legislatures, governors, and administrative agencies across the country have taken steps to eliminate access to procedures for people under the age of 18. This includes puberty blockers, and cross-sex hormones.

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On Jan. 28, President Donald Trump signed an executive order restricting transgender procedures for minors. Since then, efforts from states to ban or protect such procedures have escalated. 

Approximately 1.6 million U.S. individuals — about 0.6% of the population — ages 13 and older identify as transgender, and an estimated 300,100 people from the age of 13 to 17, according to the Williams Institute.

Walt Heyer, a senior fellow for the conservative Family Research Council, said the bans will benefit children in the long run.

“What we have is children who have been led to believe and have been told that they have gender dysphoria,” Heyer said to the Washington Examiner. “Your kids believe anything an adult tells them, and so if they’re encouraged along this line, being cross-dressed, then what you have is the development of this gender confusion. The clinics need to be shut down for doing the hormonal procedures to kids.”

Heyer said that these procedures do not eliminate children’s gender confusion, but rather enhance it. 

The gay and transgender rights organization Human Rights Campaign, though, said such procedures support a child’s “mental, physical, and emotional well-being.”

“Researchers and pollsters have consistently found that LGBTQ+ youth report worsening mental health, and increased anxiety and fear, as a result of anti-LGBTQ+ legislation, with effects substantially worse for transgender and non-binary youth,” the HRC said in a statement. 

Individual states have taken markedly different approaches, with some introducing extra provisions to extend the youth sex-change procedure ban.

Pending additions or threats to current bans 

New Hampshire

Gov. Kelly Ayotte (R) signed two bills on Aug. 1, making New Hampshire the first New England state to ban “gender-affirming” procedures for children. 

New Hampshire’s legislation bans puberty blockers, and cross-sex hormones for people under the age of 18, with an exception for prescribed patients to continue their treatment when the ban goes into effect on Jan. 1. 

“Medical decisions made at a young age can carry lifelong consequences, and these bills represent a balanced, bipartisan effort to protect children,” Ayotte said in a statement.

Tennessee

In Tennessee, it has been prohibited for healthcare providers to give sex-change procedures to minors since 2023.

Three transgender teens and families sued state officials to prevent the bill’s enforcement, which was disputed in a June Supreme Court case.

In a 6-3 decision, the Court found that Tennessee’s law did not violate the equal protection clause of the 14th amendment, and therefore, the bill was upheld.

Chief Justice John Roberts, who voted in the majority, said opponents of the decision misunderstood the medical context in which a particular course of treatment is used for a specific ailment.

North Carolina

In August 2023, North Carolina passed an act to prohibit gender transition procedures for minors, banning hormone therapy, puberty blockers, and other related surgeries. In the last few months, the state has made more efforts to extend this ban.

One bill extends the time limit to sue medical providers after treatment. This passed in the North Carolina House, and awaits a vote in the Senate.

Another bill has passed both the House and the Senate, stating that refusing to acknowledge or accept a child’s gender identity cannot be considered child abuse or neglect. The bill is now awaiting the governor’s signature or veto.

South Carolina

In May 2024, South Carolina enacted the “Help Not Harm” bill to ban sex-change procedures for minors. The bill also has a provision that bans public funding from directly or indirectly going toward sex-change procedures. This means no individual of any age on Medicaid or state healthcare plans is covered for such procedures.

Providing transgender procedures in South Carolina is also considered a felony. 

However, the ACLU filed a lawsuit against the state in August 2024, and was on hold waiting for Tennessee’s Supreme Court case’s decision. The ACLU plans to argue that South Carolina’s law differs from Tennessee’s, and raises challenges that were not addressed in the June lawsuit.

Ohio

In 2023, the Ohio legislature passed a house bill banning sex-change operations for minors, and prohibits biological males from competing in women’s sports at K-12 and university levels. It bans puberty blockers, hormone therapies, and gender reassignment surgeries for residents under the age of 18.

Gov. Mike DeWine (R) vetoed the bill, but the legislature voted to override it. 

However, the Tenth District Court of Appeals overturned the legislation on March 18, lifting the ban.

Arkansas

Arkansas was the first state to pass a law banning sex-change procedures for minors. In 2022, gender surgeries and hormone therapies were banned for youth. 

The law was challenged in federal court, and barred by a preliminary injunction. Arkansas’s appellate court upheld the injunction, meaning the ban will not take effect until the district court makes its final determination.

There is no law prohibiting adults from receiving sex-change surgeries or treatments.

Missouri 

Missouri banned youth sex-change procedures, prohibited using state funds—specifically Medicaid—towards such procedures for all ages, and banned sex-change procedures for anyone in the Missouri prison system in 2023.

However, Kansas City defied state law in 2023 by declaring it as a “sanctuary city,” protecting access to sex-change operations for residents in that state. 

Texas

Texas banned youth sex-change procedures in 2023, prohibiting health-care providers from prescribing puberty blockers or other hormone therapies to minors “for the purpose of transitioning a child’s biological sex.”

The Texas Court of Appeals, however, blocked a bill that would have criminalized sex-change care by calling it child abuse. The Senate also tried to cancel medical providers’ liability insurance, but the bill failed to make it out of committee.

Kansas

In February, Kansas’s legislature overrode Gov. Laura Kelly’s (D) veto of a bill that bans youth sex-change procedures.

The law took effect in February, and due to the decision from Tennessee’s SCOTUS ruling, the ban can remain in effect. 

States where youth transgender procedures are banned 

Georgia; Florida (considered a felony); Alabama (considered a felony); Mississippi; Kentucky; West Virginia; Indiana; Louisiana; Iowa; Oklahoma (considered a felony); Nebraska; South Dakota; North Dakota (considered a felony); Wyoming; Montana; Arizona; Utah; Idaho (considered a felony)

Sanctuary areas

These states consider themselves “safe harbors” to protect access to youth sex-change procedures:

California; Colorado; Connecticut; Illinois; Massachusetts; Michigan; Minnesota; New Jersey; New Mexico; New York; Vermont; Washington. 

These are the declared “sanctuary cities”: Sacramento, California; Kansas City, Missouri; State College, Pennsylvania; Olympia, Washington.

DEMOCRATS GO ALL IN ON SEX CHANGES FOR CHILDREN

States where no enforcement has taken place

Alaska; Delaware; District of Columbia; Hawaii; Maine; Maryland; Nevada; Oregon; Pennsylvania; Rhode Island; Virginia; Wisconsin.