27 states now ban gender-affirming care for minors
As of spring 2026, 27 states have enacted laws prohibiting gender-affirming medical care for transgender youth. Seven states also restrict adult access in some form: Alabama, Arkansas, Florida, Missouri, Mississippi, North Carolina, and Nebraska.
| What is banned | Where |
|---|---|
| Puberty blockers and hormone therapy for minors | 27 states |
| Some restrictions on adult care | AL, AR, FL, MO, MS, NC, NE |
| Medicaid coverage for minors' gender-affirming care | 17 states |
As of spring 2026. Source: KFF Gender-Affirming Care Policy Tracker.
KFF →A few court injunctions remain. Montana’s ban is blocked after the state supreme court ruled that transgender discrimination is sex discrimination under the state constitution. A Kansas state court blocked SB 63, so 25 of the 27 bans are in effect. Arkansas’s injunction was reversed by the Eighth Circuit, and that ban is now in effect.
These injunctions are fragile. Montana’s relies on the state constitution. Kansas’s is a preliminary order. Neither has the force of the federal precedent that Skrmetti took away.
The Supreme Court opened the floodgates
On June 18, 2025, the Supreme Court ruled 6-3 in United States v. Skrmetti that Tennessee’s ban on gender-affirming care for minors did not violate the Fourteenth Amendment’s equal protection clause. Chief Justice Roberts wrote for the majority that the law was subject only to rational basis review, the lowest level of constitutional scrutiny.
”By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent.”
Justice Sonia Sotomayor, dissenting opinion, United States v. SkrmettiThe ruling did not require any state to ban care. It removed the constitutional barrier that had been the strongest legal argument against bans. Within months, the Tenth Circuit used Skrmetti to reject a challenge to Oklahoma’s ban. Other courts followed.
Before Skrmetti, federal courts had blocked or struck down several bans. Afterward, those arguments lost their foundation. More than 55 medical groups, including the American Academy of Pediatrics and the Endocrine Society, support this care. The court disagreed that banning it for one group of patients amounted to sex discrimination.
The federal government is trying to ban care nationwide
The Trump administration has pursued a national ban through executive action and rulemaking, even in states that have not passed their own restrictions.
January 2025: Trump signed executive orders directing federal agencies to withhold funds from providers offering gender-affirming care to anyone under 19. One order targeted research and education grants. The other went after direct federal funding.
February 2025: Federal judges in Baltimore and Seattle blocked the orders, calling them likely violations of equal protection, separation of powers, and states’ rights.
December 2025: CMS proposed two rules that would cut Medicaid and Medicare funding for any hospital that provides gender-affirming care to minors. The first bars Medicaid reimbursement for the care itself. The second strips all federal funding from hospitals that offer it at all.
The second rule is the weapon. It does not just defund gender-affirming care. It threatens a hospital’s entire Medicaid and Medicare revenue. For most hospitals, that is a majority of their income. No hospital administrator will risk losing all federal funding over a single program.
The chilling effect is already visible. NPR reported in April 2026 that hospitals in California, Colorado, Pennsylvania, Massachusetts, and Montana have shut down gender-affirming care programs for minors even though it remains legal in those states. California’s largest children’s hospital system ended the care in February 2026.
The American Academy of Pediatrics told NPR that every pediatrician they approached was too afraid of retaliation to comment publicly on the closures.
The 988 Lifeline’s LGBTQ+ youth service was defunded
The 988 Suicide and Crisis Lifeline’s “press 3” option for LGBTQ+ young people launched in 2022. It was the only federally funded crisis service staffed by counselors trained specifically to work with LGBTQ+ youth. Since launch, it handled an estimated 1.3 million crisis contacts, averaging about 60,000 per month.
April 2025: A leaked draft budget proposed eliminating the funding.
June 2025: HHS confirmed the cut in its Fiscal Year 2026 budget.
June 18, 2025: SAMHSA ordered the program closed within 30 days.
July 17, 2025: The LGBTQ+ youth subnetwork was officially defunded.
Congress had directed at least $34.1 million to this program in FY2025. The program had received up to $50 million in restricted federal funds. The administration eliminated it without a congressional vote.
The Trevor Project’s 2024 national survey found that 39% of LGBTQ+ young people seriously considered attempting suicide in the past year. Among transgender and nonbinary youth, the number was 46%. The Trevor Project estimates that at least one LGBTQ+ young person attempts suicide every 45 seconds in the United States.
The defunding happened while state legislatures were passing a record number of anti-trans bills and call volume was at its highest point ever. Tell Congress to restore funding for the 988 LGBTQ+ youth lifeline.
If Congress Restores 988 Funding
The LGBTQ+ youth subnetwork handled 60,000 crisis contacts per month before it was shut down. Restoring $34 million in annual funding reconnects those callers to trained counselors at the moment of highest risk. The Trevor Project's 2024 survey found 39% of LGBTQ+ young people seriously considered suicide in the past year.
If Congress Does Nothing
Young LGBTQ+ callers to 988 reach the general queue instead of counselors trained on LGBTQ+ youth issues. Crisis contacts that were reaching trained specialists now go to generalists with no specialized protocol. This happened while state legislatures passed a record number of anti-trans bills and call volume was at its highest point ever.
Schools have become a battleground
By the end of 2025, 29 states had passed at least one law restricting the rights of transgender students. The restrictions fall into three categories.
| Type of restriction | Number of states | Transgender youth affected |
|---|---|---|
| Sports participation bans | 29 states | 382,800 |
| Bathroom and facility restrictions | 25 states | 348,400 |
| Pronoun restrictions or forced outing | 16 states | 262,700 |
Six states added new sports bans in 2025 alone. Source: Williams Institute.
Williams Institute →Six states added new sports bans in 2025 alone: Georgia, Kentucky, Montana, Nebraska, New Hampshire, and Utah. Five states added pronoun restrictions: Montana, North Dakota, Tennessee, Texas, and West Virginia.
The federal government added its own layer. A 2025 executive order directed agencies to rescind funding from schools that recognize transgender students’ identities, allow them to use bathrooms matching their gender, or use their correct names and pronouns.
In April 2026, the Supreme Court blocked a California law that had prevented schools from disclosing students’ transgender status to their parents without consent.
The Williams Institute found that 95% of transgender youth in the South and 51% in the Midwest live under at least one restrictive state policy. The concentration is not accidental. Legislative templates are shared between state legislatures and advocacy organizations, producing near-identical bills across multiple states in the same session.
The military ban is back
January 28, 2025: Trump signed an executive order directing the Pentagon to reverse its policy on transgender service members.
May 6, 2025: The Supreme Court allowed the ban to take effect while legal challenges continued.
May 2025: Defense Secretary Pete Hegseth issued a memo giving service members with a gender dysphoria diagnosis 30 days to volunteer for separation. After that window closed, involuntary separation began.
August 2025: The Air Force announced a policy denying transgender airmen hearings before discharge. Military separation boards were ordered to recommend discharge for any service member with a gender dysphoria diagnosis, removing independent judgment from the process.
A former top general called the removals a costly mistake, noting the loss of trained personnel and institutional knowledge at a time when the military already struggles to meet recruitment goals.
Texas is leading the erasure effort
Texas has moved further than most states. In the 2025 legislative session, lawmakers passed HB 229, which defines male and female based solely on reproductive organs at birth and orders all state records to reflect that definition. Texas became the 14th state with a “sex definition” law.
The practical effects go beyond symbolism. The law bolsters Attorney General Ken Paxton’s directive blocking changes to gender markers on birth certificates and driver’s licenses. Transgender Texans who previously updated their documents may be forced to revert them at renewal. Intersex Texans fear the law could increase pressure for surgeries on intersex children to fit the binary definitions.
In Kansas, SB 244, enacted in 2026, immediately invalidated the driver’s licenses of transgender people across the state by requiring all state IDs to reflect sex assigned at birth.
The longer-term effects of these laws are still unfolding. References to “man” and “woman” appear hundreds of times in Texas statute. Redefining those terms could affect family law, healthcare regulations, and employment protections.
Violence is rising alongside the rhetoric
Anti-transgender hate crime offenses reported to the FBI nearly tripled, from 184 in 2018 to 527 in 2024, rising from 2.2% to 3.9% of all hate crimes. The Williams Institute found that transgender people are victimized at a rate of 93.7 per 1,000 persons, compared with 21.1 per 1,000 among non-LGBT people. LGBT people overall are nine times more likely to experience violent hate crimes.
The Human Rights Campaign documented 27 cases of fatal violence against transgender and gender-nonconforming people in the year ending November 2025. Since 2013, HRC has tracked 399 deaths, and 70.4% of the people killed were Black.
Los Angeles County recorded 102 anti-transgender hate crimes in 2024, the highest single-year total ever documented in that county.
These numbers are widely understood to be undercounts. Many jurisdictions do not track gender identity in hate crime reporting. Many victims do not report. The FBI’s data depends on voluntary participation from local law enforcement agencies.
Protect yourself right now
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Know which laws affect your state. The KFF policy tracker maps healthcare bans by state. The Williams Institute tracks school, bathroom, sports, and pronoun restrictions. Check both.
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Support organizations doing the legal work. The ACLU is litigating in multiple states. Lambda Legal represents plaintiffs in federal challenges. The Trevor Project is fighting to save the 988 service.
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Know where to get help right now. The Trevor Project’s crisis line is still operational at 1-866-488-7386 and by text at START to 678-678. You can also reach the 988 Suicide and Crisis Lifeline by calling or texting 988, though the specialized LGBTQ+ youth option is no longer available.
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Talk to people around you. These laws pass because too many people think they do not affect anyone they know. One in five Gen Z adults identifies as LGBTQ+. The people affected by these policies are your neighbors, coworkers, students, and family members. Silence makes it easier for legislators to act without consequence.
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Show up at town halls. Your representative has to answer for these votes. Ask your elected officials what they plan to do about healthcare bans, the military ban, school restrictions, and the 988 defunding. In person. On the record.
Last updated September 23, 2026