These States Have Banned Gender-Affirming Care

A total of 19 states now have restrictions on gender-affirming care, either via a legislative ban or some other policy action. While
the majority of states have enacted legislative bans, three states — Florida, Missouri, and Texas — have restricted access to gender-affirming care via other methods, including new medical board rules, an emergency rule, and an action through the state’s child welfare agency, respectively.

Below is a list of the effective dates, exemptions, and penalties to clinicians for providing gender-affirming care. This list will be updated as new information becomes available.

Alabama

In effect: May 8, 2022

Exemptions: A “medically verifiable disorder of sex development” including a chromosome disorder

Risks to Physicians: Felony offense with up to 10 years in prison and a fine up to $15,000

Arizona

In effect: March 31, 2023

Exemptions: A “medically verifiable disorder of sex development” including a chromosome disorder, or if patients need treatment for an injury related to their gender-affirming care

Risks to Physicians: No penalty specified

Arkansas

In effect: March 13, 2023

Exemptions: A “medically verifiable disorder of sex development” including a chromosome disorder, or if patients need treatment for an injury related to their gender-affirming care. Also if the provider has seen the minor for 2 years and the minor has seen a mental health professional who certifies the minor does not have other mental health conditions

Risks to Physicians: Minor or their guardian may bring civil action against the provider for physical, psychological, emotional, or physiological injury

Florida

Other: The board of medicine enacted a new standard of care

Exemptions: Patients already being treated with puberty blockers or hormones prior to the effective date can continue treatment. Nonsurgical interventions can continue in IRB-approved clinical trials that include “longitudinal assessments of the patients’ physiologic and psychologic outcomes”

Risks to Physicians: Can be held “administratively accountable to the board” for violations

Georgia

In effect: July 1, 2023

Exemptions: A “medically verifiable disorder of sex development” including chromosome abnormality, or if it’s necessary to the health of the patient. Doctors can continue treatment for those who began prior to July 1, 2023 if treatments are irreversible

Risks to Physicians: Physicians can be “held administratively accountable” to the medical board

Idaho

In effect: January 1, 2024

Exemptions: A “medically verifiable genetic disorder of sex development,” if it’s necessary to the health of the patient, or if it’s to treat any injury from their gender-affirming care

Risks to Physicians: Felony offense with up to 10 years prison and a fine up to $5,000

Indiana

In effect: July 1, 2023

Exemptions: Doctors may continue giving hormone treatment to grandfathered patients until the end of 2023

Risks to Physicians: Minors can bring a case against a physician until they are 28; can face medical board disciplinary action

Iowa

In effect: March 22, 2023

Exemptions: A “medically verifiable genetic disorder of sex development,” if it’s necessary to the health of the patient, or if treating any injury from gender-affirming care

Risks to Physicians: Treatment is considered “unprofessional conduct” and doctors are subject to discipline by the medical board; providers can be sued

Kentucky

In effect: March 29, 2023

Exemptions: A “medically verifiable disorder of sex development” or if they need treatment related to their gender-affirming care

Risks to Physicians: A doctor’s medical license can be revoked and providers can be sued

Oklahoma

In effect: May 2, 2023

Exemptions: Doctors can continue to provide puberty blockers or hormones for 6 months to help patients ultimately discontinue therapy

Risks to Physicians: Physicians face felony charges and license revocation, and lawsuits can be filed by a parent or guardian

Mississippi

In effect: February 28, 2023

Exemptions: A “medically verifiable disorder of sex development” or to treat any injury related to gender-affirming care

Risks to Physicians: Treatment is considered “unprofessional conduct” and a doctor’s medical license can be revoked, in addition to up to a $500 fine; providers can be sued

Missouri

Other: Emergency Rule (the rule has been temporarily halted by a judge)

Exemptions: If there’s ongoing treatment and the provider meets the 23+ criteria required to continue

Risks to Physicians: Felony offense with up to 4 years in prison

Montana

In Effect: April 28, 2023

Exemptions: “Medically verifiable” disorders of sex development, including chromosomal abnormalities

Risks to Physicians: Subject to medical board discipline that must include at least a year-long suspension; providers can be sued

North Dakota

In Effect: April 20, 2023

Exemptions: “If performance or administration of the medical procedure on the minor began before the effective date of this Act.” Minors currently receiving gender-affirming care will still be able to receive treatment

Risks to Physicians: Felony offense for surgery up to 10 years in prison and a fine up to $20,000, misdemeanor offense for gender-affirming medication up to 1 year in prison and a fine up to $3,000

South Dakota

In effect: July 1, 2023

Exemptions: A “medically verifiable disorder of sex development” including chromosome abnormality, or treatment for an injury related to gender-affirming care

Risks to Physicians: Physicians can lose their license and providers can be sued

Tennessee

In effect: July 1, 2023

Exemptions: Patients are allowed to continue treatment if they started it before July 1, 2023, but care must end by March 31, 2024

Risks to Physicians: $25,000 per violation; license actions also possible; providers can be sued

Texas

Other: In February 2022, Gov. Greg Abbott directed the state’s Department of Family Protective Services to investigate all instances of “sex-change” procedures, as they constitute child abuse. The state’s Supreme Court blocked the measure in September 2022, but an immediate appeal by the state allowed investigations to continue.

Utah

In effect: January 28, 2023

Exemptions: Hormonal treatments are prohibited for patients who haven’t been diagnosed with gender dysphoria by the time the law went into effect. It also requires the state health department to conduct a systematic review of the evidence on hormonal treatments. In addition, the state’s licensing department must create a “transgender treatment certification” for healthcare professionals by July 1, 2023

Risks to Physicians: Providing treatment without a transgender treatment certification will be considered “unprofessional conduct”; providers can be sued

West Virginia

In effect: January 1, 2024

Exemptions: Patients can get hormone therapy with parental consent and a diagnosis of severe gender dysphoria from two clinicians, including a mental health provider or an adolescent medicine specialist. Doctors can also prescribe hormones if a teenager is considered at risk for self-harm or suicide

Risks to Physicians: No penalty specified