Map: Where gender-affirming care is being targeted in the US

States across the country are considering bans on transgender health care for minors.

At least 18 states -- Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Missouri, Montana, Nebraska, North Dakota, Oklahoma, South Dakota, Tennessee and Utah -- have passed laws or policies that restrict gender-affirming care for people under the age of legal majority, which is the threshold for legal adulthood.

The laws in Alabama and Arkansas are temporarily blocked, as legal challenges wend their way through the courts. Georgia's law allows trans youth to use puberty blockers, which delay puberty.

In at least 14 other states, local legislatures are considering or have introduced bills that would similarly restrict this kind of medical care for trans youth.

Critics say gender-affirming care restrictions are an infringement on the rights of families to make their own health decisions.

Supporters of the bans argue that transgender people should wait until they are legally adults before making these decisions.

The vast majority of bans target people under the age of legal majority, which for most of the United States is the age of 18. At least three of these states are targeting people up to the ages of 21 and 26.

Several of the legislative efforts criminalize gender-affirming procedures.

These bills are just some of the 321 anti-LGBTQ bills introduced or debated in 2023 reported by the ACLU, which surpasses the record 315 anti-LGBTQ bills in 2022, according to the Human Rights Campaign.

Last year, 91% of anti-LGBTQ efforts failed, the HRC reports.

In other states, like Alaska, Illinois, Minnesota, New Mexico and California, legislators have made strides in protecting access to care for transgender people. For example, in Alaska, gender-affirming care is covered under Medicaid.

What is gender-affirming care?

Gender-affirming care refers to social affirmation, puberty blockers, hormone therapy and surgical procedures, according to the U.S. Department of Health and Human Services.

Social affirmation refers to the adoption of a name, hairstyles, clothing, pronouns and restroom use that aligns with someone’s gender identity, according to the HHS.

Puberty blockers, taken during puberty, use hormones to pause pubertal development. Puberty blockers are reversible, the HHS says.

Hormone therapy refers to testosterone hormones for trans boys and estrogen for trans girls taken in early adolescence onward. These injections are partially reversible, according to the HHS.

Surgeries, according to the HHS, are typically reserved for adults and rarely for adolescents, who may be eligible on a case-by-case basis.

Studies, including research in JAMA Surgery, have shown that gender-affirming care can be life-saving for transgender and nonbinary children and adolescents, promoting positive mental and physical health and well-being.

Several major national medical associations, including the American Academy of Pediatrics and the American Public Health Association, say that gender-affirming care is safe and effective. Some, like the American Medical Association, deem it "medically necessary."

When signing the bill, Alabama Gov. Kay Ivey said, "We should especially protect our children from these radical, life-altering drugs and surgeries when they are at such a vulnerable stage in life.

She continued, "Instead, let us all focus on helping them to properly develop into the adults God intended them to be."