States with Specific Gender Affirming Care Restrictions
A number of states have passed legislation restricting gender affirming care. These laws are not specific to audiology or speech-language pathology services, but it is unclear whether the restrictions may impact working with transgender clients.
This information is reviewed on an annual basis. Please be advised that laws, regulations, and policies may change at any time, so always check with your state for the most up-to-date information. This material is shared for informational purposes only and should not be construed as legal advice, which can only be provided by an attorney.
See also: Gender Affirming Voice Therapy Advocacy
Alabama
Alabama bans any “person” (which is widely defined) to engage in or cause any practices to be performed upon a minor to attempt to alter the appearance or affirm a minor’s perception of their gender, including: prescribing, administering medication or performing surgeries to delay or transition gender for any individual under 18 years of age. The law exempts individuals that were born with medically verifiable disorder of sex development.
Reference: HB 184 (2022) [PDF]
Arizona
Arizona prohibits a physician from providing irreversible gender reassignment surgery for any individual under 18 years of age. The law exempts individuals that were born with medically verifiable disorder of sex development, treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment.
Reference: SB 1138 (2022) [PDF]
Arkansas
Arkansas prohibits gender transition procedures for minors by a physician or other health care professional. Gender transition procedures are defined as any medical or surgical service or prescribing of drugs to alter or remove physical or anatomical characteristics that are typical for their biological sex or instill or create physiological or anatomical characteristics that are different from their biological sex.
The law exempts individuals that were born with medically verifiable disorder of sex development, treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment.
Reference: HB 1570 (2021) [PDF]
This law was struck down by the District Court for the Eastern District of Arkansas (2023).
Arkansas allows a cause of action against health care professionals by a minor who has been injured by a gender transition procedure or related treatment and the after effect of a gender transition procedure or related treatment. This right of action must be filed within 15 years of when the minor reaches 18 years of age. The law lists defenses to the civil action.
The law exempts individuals that were born with medically verifiable disorder of sex development, treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment.
Reference: SB 199 (2023) [PDF]
Florida
Florida prohibits the provision of sex-reassignment prescriptions or procedures for patients younger than 18 years of age. The prescriptions or procedures include puberty blockers, administration of hormones or medical procedures to affirm a person’s perception of their sex if that perception is inconsistent with their biological sex.
The law exempts individuals that were born with medically verifiable disorder of sex development, treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment.
Reference SB 254 (2023) [PDF]
Georgia
Georgia law prohibits irreversible procedures or therapies from being performed on minors for treatment of gender dysphoria, including sex reassignment surgeries or other surgeries to alter sexual characteristics, or hormone replacement therapy.
The law exempts individuals that were born with medically verifiable disorder of sex development, who are being treated for other medical conditions or where sex reassignment is deemed medically necessary, who are diagnosed with partial androgen insensitivity syndrome or continued hormone replacement that was started prior to July 1, 2023.
Reference: SB 140 (2023) [PDF]
Idaho
Idaho law prohibits medical providers from altering the appearance of or affirming the child’s perception of their sex if that perception is inconsistent from their biological sex, including both surgical and hormone therapies.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure.
Reference: HB 71 (2023) [PDF]
Indiana
Indiana law prohibits physicians or other practitioners from providing gender transition procedures to a minor, including medical or surgical service, or prescribing drugs related to gender transition.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment.
Reference: SB 480 (2023) [PDF]
This law is currently under a court injunction as it relates to gender transition procedures and is the subject of litigation. The ban on gender-reassignment surgeries is not affected by this injunction.
Iowa
Iowa law prohibits health care professionals from performing surgeries on or prescribing hormones to a minor for the purpose of attempting to alter the appearance of, or affirm the minor’s perception of, their gender or sex if that appearance or perception is inconsistent with the minor’s biological sex.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment.
Reference: SF 538 (2023) [PDF]
Kentucky
Kentucky law prohibits a health care provider from performing surgery or prescribing hormone therapy for any minor for the purposes of altering the appearance of or validating their perception of their sex if it is inconsistent with their biological sex.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure.
Reference: SB 150 (2023) [PDF]
Louisiana
Louisiana law prohibits physicians or other medical health care professionals from providing gender transition procedures to any minor. The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment.
Reference: SB 463 (2023)
Mississippi
Mississippi law prohibits health care professionals from providing gender transition procedures to minors, including performing surgery or prescribing hormone therapy. The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure.
Reference: HB 1125 (2023) [PDF]
Missouri
Missouri law prohibits a health care provider from performing gender transition surgery or prescribing hormones for the purpose of gender transition for minors. The law allows minors who began taking hormones prior to August 28, 2023, to continue with treatment. Gender affirming surgeries for adult inmates and prisoners is prohibited.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment.
Reference: SB 49 (2023) [PDF]
Montana
Montana law prohibits health care professionals from providing surgical or hormone treatment to address a minor’s perception of their biological sex.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure.
Reference: SB 99 (2023) [PDF] and SB 49 (2023)
Nebraska
Nebraska law prohibits health care practitioners from performing gender altering procedures on individuals under the age of nineteen, including surgical or hormone treatment. This does not prevent continued hormone treatment if started prior to the date of the law.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment.
Reference: LB 574 (2023) [PDF]
North Carolina
North Carolina law prohibits medical professionals from performing gender transition surgery or prescribing hormone treatment to a minor.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment.
Reference: HB 808 (2023) [PDF] (pending Governor’s signature)
North Dakota
North Dakota law prohibits surgery or hormone therapy for minors to change or affirm their perception of their sex if it is inconsistent with their biological sex. This does not prevent continued hormone treatment if started prior to the date of the law.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure.
Reference: HB 1254 (2023) [PDF]
Oklahoma
Oklahoma law prohibits physicians from providing gender reassignment medical treatment to minors.
The law exempts individuals that were born with medically verifiable disorder of sex development.
Reference: SB 613 (2023) [PDF]
South Dakota
South Dakota prohibits health care professionals from performing surgery or prescribing hormone treatment for the purpose of attempting to alter the appearance of, or to validate a minor's perception of their sex, if that appearance or perception is inconsistent with their biological sex.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure.
Reference: HB 1080 (2023) [PDF]
Tennessee
Tennessee law prohibits a health care provider from performing or offering to perform, or administering or offering to administer to a minor, a medical procedure if the performance or administration of the procedure validates a minor's perception of their sex, if that appearance or perception is inconsistent with their biological sex.
The law exempts treatment of a congenital defect, disease or physical injury, or a procedure that began prior to the law.
Reference: SB 1 (2023) [PDF]
Texas
Texas law prohibits a health care provider from performing surgery or hormone therapy for the purposes of transitioning a child’s biological sex to affirm their perception of their sex if it is inconsistent with their biological sex.
The law exempts individuals that were born with medically verifiable disorder of sex development or precocious puberty.
Reference: SB 14 (2023) [PDF]
Utah
Utah law prohibits a health care provider from providing surgery or hormonal treatment on a minor for the purpose of effectuating or facilitating an individual's attempted sex change. The law requires a systematic medical evidence review of hormonal transgender treatment to minors to consider when deciding to lift that moratorium. Health care providers may provide treatment to minors diagnosed with gender dysphoria prior to the date of the law.
The law exempts individuals that were born with medically verifiable disorder of sex development or precocious puberty.
Reference: SB 16 (2023) [PDF]
West Virginia
West Virginia law prohibits a physician from providing irreversible gender reassignment surgery or gender altering medication to minors.
The law exempts individuals that were born with medically verifiable disorder of sex development, or treatment of injury caused by a gender transition procedure, or other physical injury or illness that would put the individual in imminent danger of death or impairment. The law also exempts minors experiencing severe gender dysphoria if they meet certain criteria.
Reference: HB 2007 (2023) [PDF]
