2025–2026
Many states banned or limited sex-rejecting procedures for minors, the Supreme Court said those state bans may stand, and a federal Medicaid rule cuts funding for those procedures on minors.
Federal actions
United States v. Skrmetti (18 June 2025)
The Supreme Court upheld Tennessee’s SB 1 against an Equal Protection challenge. State bans may stand.
Official sources
HHS evidence review (November 2025)
HHS published a peer-reviewed evidence review on treatment for pediatric gender dysphoria.
Official sources
CMS Medicaid / CHIP funding rule — FINAL
CMS-2451-F ends federal Medicaid funding under 18 and CHIP funding under 19 for sex-rejecting procedures, effective 13 October 2026. A 22-state and D.C. suit is pending; the rule has not been blocked.
Official sources
Department of Justice hospital resolutions
DOJ has announced resolutions involving Texas Children’s, Cleveland Clinic, Connecticut Children’s, and Mount Sinai over pediatric sex-rejecting procedures. Those are allegations and settlements, not findings of guilt and not a state statute. DOJ states the claims resolved are allegations only.
States and D.C.
- Medical · Ban · 22
- Medical · Restriction · 3
- Medical · Litigation-setback · 2
- Medical · Proposed bill · 4
- Medical · No ban · 20
- Schools restriction · 3
click a state for more details.
- BanStatute in force.
- RestrictionNarrower than a total ban.
- Litigation-setbackBan or limit was enacted, then a court blocked it. The statute is on the books; it is not enforced.
- Proposed billA bill has been introduced. It is not a statewide law yet.
- No banNo statewide medical ban. Shield laws, if any, are in the state summary.
Alabama AL
Alabama banned puberty blockers and hormones for minors, and that ban is in force.
Official sources
Vulnerable Child Compassion and Protection Act. The 11th Circuit let the puberty-blocker and hormone prohibitions take effect. The Supreme Court dismissed the later petition, and the district case was dismissed. The ban is in force.
Alaska AK
No statewide medical policy listed.
Arizona AZ
Arizona banned irreversible gender-reassignment surgery on minors, but not hormones in general.
Official sources
SB 1138 (2022) prohibits irreversible gender-reassignment surgery on minors.
Arkansas AR
Arkansas banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
Act 626 prohibits gender-transition procedures on minors. The 8th Circuit reversed the permanent injunction on 12 August 2025 (Brandt, No. 23-2681). That is a revival of the statute, not a new law.
California CA
No statewide ban. A shield law treats sex-rejecting procedures as California public policy.
Official sources
No statewide ban. A Civil Code shield (Title 1.81.7) treats sex-rejecting procedures — puberty blockers, hormones, and surgeries provided under California law — as public policy. It limits other states from using California courts, agencies, or records to punish patients, parents, or clinicians for that care.
Colorado CO
No statewide ban — a shield law covers sex-rejecting procedures lawful in Colorado and limits other states from using Colorado process against that care.
Official sources
No statewide medical policy listed. SB23-188 is a shield: “legally protected health-care activity” includes sex-rejecting procedures lawful in Colorado, and the statute limits other states from using Colorado process against people who get or provide that care.
Connecticut CT
No statewide ban. A shield law covers sex-rejecting procedures permitted under Connecticut law.
Official sources
No statewide ban. Conn. Gen. Stat. § 52-571n is a shield: a person may recover damages when an out-of-state judgment is based on reproductive or sex-rejecting procedures that are permitted under Connecticut law.
Delaware DE
No statewide medical policy listed.
District of Columbia DC
No statewide ban. A shield law remains.
Official sources
No statewide ban. D.C. Code § 2-1461.01 (Human Rights Sanctuary Amendment Act of 2022) is a shield: District officers and employees may not help other jurisdictions investigate or prosecute sex-rejecting procedures that are lawful in the District.
Florida FL
Florida banned sex-reassignment prescriptions and procedures for minors.
Official sources
SB 254 (2023) / Fla. Stat. § 456.52 prohibits sex-reassignment prescriptions and procedures for minors, with a grandfather for treatment already underway. An 11th Circuit stay keeps the statute in force.
Georgia GA
Georgia banned hormones and surgeries for minors, but not puberty blockers.
Official sources
SB 140 (2023) prohibits certain hormone therapies and surgeries for minors for the purpose of gender transition. Puberty blockers are not expressly listed in the same terms.
Hawaii HI
No statewide medical policy listed.
Idaho ID
Idaho banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
HB 71 (2023), now Idaho Code § 18-1506C, prohibits puberty blockers and other listed gender-transition procedures on minors. Poe v. Labrador was dismissed in 2025. The ban is in force.
Illinois IL
SB 3920 would ban puberty blockers, opposite-sex hormones, and listed surgeries for minors. It is not law yet. A shield law remains.
Official sources
SB 3920 (104th General Assembly) would ban puberty blockers, opposite-sex hormones, and listed surgeries for minors. It is not law yet. Public Act 102-1117 remains a shield limiting out-of-state court process against sex-rejecting procedures lawful in Illinois.
Indiana IN
Indiana banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
SEA 480 (2023) prohibits gender-transition procedures for minors, including puberty blockers, with stated exceptions. The 7th Circuit vacated the preliminary injunction. The ban is in force.
Iowa IA
Iowa banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
SF 538 (2023) prohibits gender-transition procedures and certain prescriptions for minors.
Kansas KS
Kansas passed a ban, but a court blocked the puberty-blocker and hormone parts, so access is restored for now.
Official sources
SB 63 (Help Not Harm Act, 2025) is an enacted statute. A Douglas County District Court temporary injunction on 15 May 2026 blocked enforcement of the puberty-blocker and hormone sections (now K.S.A. 65-28,139(a)(2), (a)(3), (b)(2), and (b)(3)). The Attorney General noticed an appeal. A court blocked enforcement of the puberty-blocker and hormone sections.
Kentucky KY
Kentucky banned sex-rejecting services for minors, and that ban is in force.
Official sources
KRS 311.372 prohibits drugs that delay or stop normal puberty, plus hormones and listed surgeries for minors.
Louisiana LA
Louisiana banned certain sex-rejecting procedures for minors, and that ban is in force.
Official sources
HB 648 (2023) prohibits certain gender-transition procedures for minors.
Maine ME
No statewide ban. A shield law remains.
Official sources
No statewide ban. 14 M.R.S. § 9002 is a shield: “legally protected health-care activity” includes sex-rejecting procedures authorized under Maine law, so other states have a harder time using Maine process against that care.
Maryland MD
No statewide medical policy listed.
Massachusetts MA
No statewide medical policy listed.
Michigan MI
HB 4467 would ban puberty blockers, opposite-sex hormones, and listed surgeries for minors. It is not law yet.
Official sources
HB 4467 (2025–2026) would ban puberty blockers, opposite-sex hormones, and listed surgeries for minors. The House passed it; the Senate referred it to Government Operations on 10 June 2026. It is not law yet.
Minnesota MN
No statewide ban. A shield law remains.
Official sources
No statewide ban. Minn. Stat. § 543.23 is a shield: Minnesota courts generally will not honor out-of-state subpoenas aimed at sex-rejecting procedures that are lawful in Minnesota.
Mississippi MS
Mississippi banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
HB 1125 (2023) prohibits gender-transition procedures for minors.
Missouri MO
Missouri banned sex-rejecting interventions for minors, and that ban is in force.
Official sources
SB 49 / Mo. Rev. Stat. § 191.1720 prohibits gender-transition surgery and, until 28 August 2027, puberty blockers and opposite-sex hormones for minors. The Missouri Supreme Court upheld it on 13 January 2026.
Montana MT
Montana passed a ban, but courts blocked it, so access is restored for now.
Official sources
SB 99 (2023) is an enacted statute, later codified at MCA 50-4-1001 and following, covering puberty blockers and other listed interventions. In Cross v. State, 2024 MT 303, the Montana Supreme Court affirmed a preliminary injunction. The Missoula district court permanently enjoined enforcement on 13 May 2025. The statute exists; a court blocked enforcement.
Nebraska NE
Nebraska bans gender surgeries under 19. New puberty blockers and hormones require a pattern that began or worsened at puberty, at least 40 hours of gender-identity therapy, informed consent, and a 7-day wait; courses started before Oct 1, 2023 may continue.
Official sources
LB 574 (2023), the Let Them Grow Act (Neb. Rev. Stat. § 71-7304), provides that a health care practitioner shall not perform gender-altering procedures on anyone younger than 19 except as the Act allows. Surgeries under 19 are not excepted. Continuation of puberty blockers and/or cross-sex hormones is allowed if the course began before October 1, 2023. New puberty blockers and cross-sex hormones are allowed only as nonsurgical procedures under § 71-7305 and DHHS 181 NAC 8 (adopted 17 March 2024): a long-lasting and intense pattern of gender nonconformity or gender dysphoria that began or worsened at the start of puberty; at least 40 gender-identity-focused therapeutic contact hours before prescribing; signed informed consent (and patient assent for unemancipated minors); and a minimum seven calendar day waiting period after informed consent before prescribing, administering, or delivering the drugs.
Nevada NV
No statewide medical policy listed.
New Hampshire NH
New Hampshire banned puberty blockers and hormones of the opposite sex for minors, and that ban is in force.
Official sources
HB 377 (Chapter 275, 2025) prohibits puberty blockers and cross-sex hormones for the purpose of altering a minor’s sexed appearance, effective 1 January 2026, with continuation for treatment begun before that date.
New Jersey NJ
A1847 would prohibit sex-rejecting medical services for people under 21. It is not law yet.
Official sources
A1847 (222nd Legislature, 2026–2027) would prohibit sex-rejecting medical services for people under 21. It is not law yet. Enacted P.L. 2022, c. 51 remains a reproductive-health shield only.
New Mexico NM
No statewide ban — a shield law limits public bodies from interfering with access to sex-rejecting procedures that are lawful in New Mexico.
Official sources
No statewide medical policy listed. HB 7 (2023) is a shield: it limits public bodies from interfering with access to sex-rejecting procedures that are lawful in New Mexico, including against out-of-state pressure.
New York NY
No statewide ban. A shield law limits out-of-state subpoenas.
Official sources
No statewide ban. CPLR § 3119 is a shield: New York limits out-of-state subpoenas aimed at legally protected health activity, including sex-rejecting procedures performed in New York.
North Carolina NC
North Carolina banned certain sex-rejecting procedures for minors, and that ban is in force.
Official sources
HB 808 (2023) prohibits certain gender-transition procedures for minors.
North Dakota ND
North Dakota banned sex-reassignment procedures for minors, and that ban is in force.
Official sources
HB 1254 (2023) / N.D.C.C. 12.1-36.1-02 prohibits puberty blockers and listed hormones and surgeries for gender-transition purposes on minors. The North Dakota Supreme Court upheld it on 17 September 2026.
Ohio OH
Ohio banned certain sex-rejecting services for minors, and that ban is in force.
Official sources
HB 68 / R.C. 3129.02 prohibits puberty blockers and opposite-sex hormones for gender transition in minors, with stated exceptions. The Ohio Supreme Court stayed a later lower-court injunction, so the ban remains in force.
Oklahoma OK
Oklahoma banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
SB 613 (2023) prohibits gender-transition procedures for minors.
Oregon OR
No statewide ban. A shield law remains.
Official sources
No statewide ban. Oregon Laws 2026, chapter 52 (HB 4088) is a shield: Oregon’s policy is to protect lawful sex-rejecting procedures provided in Oregon and to limit certain interstate cooperation against that care. ORS 24.500 already treats contrary out-of-state actions as against Oregon public policy.
Pennsylvania PA
HB 1033 would ban puberty blockers, opposite-sex hormones, and surgeries for minors. It is not law yet.
Official sources
HB 1033 (2025–2026) would ban puberty blockers, opposite-sex hormones, and surgeries for minors. It was referred to House Health on 24 March 2025. It is not law yet.
Rhode Island RI
No statewide medical policy listed.
South Carolina SC
South Carolina banned sex-rejecting procedures for minors, and that ban is in force.
Official sources
H. 4624 (2024) prohibits gender-transition procedures for minors.
South Dakota SD
South Dakota banned certain treatments meant to alter a minor’s sex characteristics, and that ban is in force.
Official sources
HB 1080 (2023) prohibits certain medical treatments intended to alter a minor’s sex characteristics.
Tennessee TN
Tennessee banned medical gender transition for minors, and that ban is in force.
Official sources
SB 1 / Tenn. Code Ann. title 68, ch. 33. Upheld against an Equal Protection challenge in United States v. Skrmetti (2025).
Texas TX
Texas banned sex-rejecting procedures and certain prescriptions for minors, and that ban is in force.
Official sources
SB 14 (2023) prohibits gender-transitioning procedures and certain prescriptions for minors.
Utah UT
Utah banned puberty blockers, certain hormones, and surgeries for minors for gender transition, and that ban is in force.
Official sources
SB 16 (2023) prohibits puberty blockers, certain hormones, and surgeries for minors for gender transition, with stated exceptions. 2026 HB 174 further tightens continuation of hormones. The ban is in force.
Vermont VT
No statewide medical policy listed.
Virginia VA
No statewide medical policy listed.
Washington WA
No statewide ban. A shield law protects lawful sex-rejecting procedures in Washington.
Official sources
No statewide ban. Chapter 7.115 RCW is a shield: Washington public policy is to protect lawful sex-rejecting procedures — including care that would be illegal in another state — and to limit out-of-state court process aimed at patients, parents, or clinicians for that care.
West Virginia WV
West Virginia banned sex-reassignment surgery and sex-altering medication for minors, and that ban is in force.
Official sources
HB 2007 / W. Va. Code § 30-3-20 prohibits gender-reassignment surgery and gender-altering medication for minors, including puberty blockers. 2025 amendments removed the former severe-dysphoria pathway. The ban is in force.
Wisconsin WI
No statewide medical policy listed.
Wyoming WY
Wyoming banned specified surgeries, puberty blockers, and certain hormones for children, and that ban is in force.
Official sources
SF0099 (2024), enrolled as SEA 52 / Chapter 113 and codified at W.S. 35-4-1001, prohibits specified surgeries, puberty blockers, and certain hormone doses for children, with a congenital / DSD and central-precocious-puberty exception. Main prohibitions took effect 1 July 2024.
Territories
U.S. territories are not the 50-state-and-D.C. grid and are not on the choropleth. Puerto Rico is listed here as a territory, not a 50th state.
Puerto Rico
BannedPuerto Rico banned sex-rejecting drugs and surgeries for people under 21.
Official sources
U.S. territory — not a 50th state. Ley 63-2025 bans sex-rejecting drugs and surgeries under 21.
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