Gender-Affirming Care Access Laws Affect 38% of Trans Youth

Nearly two-fifths of trans youth ages 13 to 17 live in a state with legal restrictions to gender-affirming care access, which is the result of 23 states enacting such policies, according to a new KFF policy tracker.

“Gender-affirming care supports and affirms gender identity through social, psychological, behavioral, or medical interventions,” according to KFF.

Gender-affirming care has been defined as healthcare by leading medical societies, like the American Academy of Pediatrics and the American Medical Association. Gender-affirming care is medically necessary and evidence-based, both organizations have long stated.

But statewide policies are putting that healthcare in jeopardy, the KFF report showed.

“The past few years have seen a rapid increase in the number of states enacting laws and other policies that restrict minors’ access to gender-affirming care,” the KFF researchers wrote. “In the last 18 months, the number of states with laws or policies limiting minors’ access to gender affirming care has increased more than five-fold, climbing from just four states in June 2022 to 23 by January 2024.”

Overall, 23 states have laws restricting youth access to gender-affirming care. That’s up from four states that had restrictions in June 2022.

These restrictions limit care access for 38 percent of trans people ages 13 to 17. States with laws restricting access to gender-affirming care include Alabama, Arkansas, Arizona, Florida, Georgia, Iowa, Idaho, Indiana, Kentucky, Louisiana, Missouri, Mississippi, Montana, North Carolina, North Dakota, Nebraska, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Utah, and West Virginia.

Legal restrictions to gender-affirming care can be difficult to navigate, in large part because the laws vary by state. Some states have laws that only restrict youth access to surgical intervention, which is rare among youth anyway, according to KFF. In Georgia, Florida, Ohio, North Carolina, Nebraska, and North Dakota, the laws allow some exceptions, such as for youth who began gender-affirming care prior to the law’s passage.

This variable legal landscape can make it difficult for pediatric patients and their parents or caregivers to know what is and is not allowed in their state and how they can access care in other states.

And it’s not just the child who is impacted. In 21 of the 23 states with gender-affirming care limitations, there are provisions enforcing penalties against providers who provide this type of treatment to patients. These penalties range from loss of medical license or referral to medical boards to felonies. Arizona and West Virginia are the only two states that do not penalize the treating provider for administering gender-affirming care.

Meanwhile, four states penalize the parents of children seeking gender-affirming care, putting the parents’ custody of the child at risk, or risking a child abuse investigation.

Similarly, teachers, counselors, and other officials are targeted by these laws. School officials are barred from “encouraging” or “coercing” kids to obtain gender-affirming care in Alabama, and Mississippi law prohibits anyone, including school officials, from “aiding and abetting” access to gender-affirming care.

These laws are not without their pushback, KFF noted, with 16 of 23 facing legal challenges.

“These laws and policies have political implications, but importantly also have the potential to affect the wellbeing of young trans people and LGBTQ people more broadly, with implications as well for health care providers, parents, and teachers,” KFF concluded.

The data is already showing that state laws are impacting patient access to care for trans kids. In July 2023, a report in JAMA showed that state-level restrictions are leaving some trans kids traveling up to 8.5 hours to access gender-affirming care.

Half of US kids ages 10 to 17 live more than an hour from a clinic offering gender-affirming care. That’s compared to only 27 percent of youths who lived that far away prior to restrictions.

For some kids, the travel times are exorbitant and prohibitive.

Prior to state-level restrictions on gender-affirming care, less than 2 percent of kids lived more than a one-day drive (defined as eight hours of total drive time, or four hours one way). But today, 25 percent of kids face that long of a travel distance.

The JAMA study did not look into how many kids did not access gender-affirming care due to these travel distances, but the researchers did indicate that this could be a problem.

“Increased costs and time burdens of travel may further contribute to delayed treatment, inability to access care, and worse mental health for transgender youths,” they said.

“With more than 1 in 4 gender clinics located in states with restrictions, it is unknown whether existing clinics may have capacity to meet the increased need of out-of-state patients,” they added in reference to gender clinics that would be able to stay open.

These travel barriers come as trans people of any age struggle to access care. In a June 2023 KFF report, trans people said cost was their biggest barrier to care, which is the same for many cis-gender people. But those issues were compounded by the challenge of finding a provider who is knowledgeable about trans healthcare.