Transgender people confront two major legal issues within the healthcare system: access to health care for gender transitioning and discrimination by health care workers.
Treatment for adults Many
Republican legislators across the country are increasingly proposing legislation to restrict gender-affirming care for adults or make such care harder to access. However, no states have outright banned gender-affirming care for adults. Efforts to restrict adults' access to healthcare relies heavily on claims from self-described "
gender-critical" organizations such as
Genspect that young people should not be recognized as adults until they turn 25. As of January 2024, seven states limit access to gender-affirming care for adults without banning it, such as allowing private health plans, Medicaid, and correctional facilities to exclude all coverage for gender-affirming care, prohibiting the use of federal funds for gender-affirming care or requiring special informed consent practices. In January 2024, in a conversation about trans healthcare with several Republican legislators, Michigan State Rep.
Josh Schriver asked, "If we are going to stop this for anyone under 18, why not apply it for anyone over 18? It's harmful across the board and that's something we need to take into consideration in terms of the endgame." Michigan State Rep.
Brad Paquette and Ohio State Rep.
Gary Click expressed agreement with that sentiment. In December 2024, Tennessee Senator,
Bo Watson said that, although banning gender-affirming care for adults may not currently be of interest to the Tennessee legislature, he would not rule out a ban in the future. In 2025, Texas Representative,
Brent Money introduced a bill in the
Texas House of Representatives that would ban gender affirming care for
transgender individuals of all ages. In July 2025,
Puerto Rico became the first place in the United States to pass a ban on gender-affirming care for people over 18, banning it for anyone under 21 years of age. Puerto Rico's LGBTQ+ Federation immediately announced plans to challenge the ban in court. •
Arkansas: On March 13, 2023, Governor
Sarah Huckabee Sanders signed a bill giving adults 15 years to file malpractice lawsuits for gender-affirming care they received as minors, whereas for other types of care (under preexisting law) a malpractice lawsuit must generally be filed within two years. These states restrict treatment for trans adults (as well as younger people): •
Florida: In August 2022, the state medical board voted to consider new standards in response to the Florida Department of Health issuing debunked guidance on gender-affirming healthcare, including false claims that it represents "experimental" treatments that lack scientific support. On May 17, 2023, DeSantis signed a law banning insurance providers from covering gender-affirming care for adults, as well as banning nurse practitioners and physicians' assistants (estimated to make up 80% of gender affirming care providers) from administering it, and banning it from being offered via telehealth. The Florida state legislature had passed the bill the previous month. In June 2024, a judge permanently blocked the law from taking effect. This has been characterized by many as a de facto ban on trans healthcare for adults, since depression and anxiety are common symptoms of gender dysphoria. A judge temporarily blocked enforcement of the order and scheduled a hearing for May 11. The attorney general withdrew this order on May 16 after the state legislature passed two bills restricting gender-affirming care for trans youth. On June 7, 2023, Governor Mike Parson signed a bill that contained a provision banning gender-affirming care for prisoners, which took effect on August 28. •
Puerto Rico: In July, 2025, Puerto Rico implemented a ban on gender affirming care for anyone under 21 years of age. Puerto Rico's LGBTQ+ Federation immediately announced plans to challenge the ban in court. On January 1, 2026, the Human Rights Campaign (HRC) filed a class action complaint with the Equal Employment Opportunity Commission (EEOC) in response to the OPM policy change. In a March 2026 ruling from the Fourth Circuit, a three judge panel found for states like West Virginia that had passed laws that removed adult gender-affirming care coverage from Medicaid financial support. The ruling relied heavily on the Supreme Court's decision in
Skrmetti, which ruled that bans on genders affirming care for minors were constitutional. The Fourth Circuit wrote that states may restrict such care to adults to "encourage citizens to appreciate their sex".
Treatment for minors Each state may pass its own laws about gender-affirming care for minors. The U.S. Supreme Court decided this on June 18, 2025, in
United States v. Skrmetti, ruling that such bans do not classify by sex and thus do not require
intermediate scrutiny according to the
14th Amendment's
Equal Protection Clause. The order revokes federal funding for any institutions providing such care and directs federal agencies to take further steps. Multiple states sued, and a federal judge,
Brendan A. Hurson, blocked the order from taking effect while the
PFLAG v. Trump lawsuit is ongoing. Gender-affirming care for minors has a long history in the United States and is supported by major medical associations. Efforts to prohibit gender-affirming care for minors began in the 2010s, but did not immediately receive much attention from state legislatures. The conservative organization
Do No Harm was influential in developing model legislation that appeared starting in 2022 in Arkansas, Florida, Iowa, Mississippi, Montana, New Hampshire, and West Virginia legislatures. In 2023, 19 bans were enacted, 16 of which were being challenged in court . , 27 states had enacted some form of ban on gender-affirming care for minors. Of those, 21 have complete bans in effect, four have partial bans, and two passed bans that are currently blocked from taking effect. While some states have banned all forms of medical transition, others such as Arizona, Nebraska and Georgia have banned only specific types such as hormone therapy or surgery. Seven states have exceptions which allow minors who were already receiving gender-affirming care prior to the ban to continue their treatments. As of June 2025, 17 states and the District of Columbia have enacted "shield" laws. Of the approximately 1.6 million Americans who are transgender, about 300,000 are under the age of 18. As of October 2023, approximately 105,200 transgender youth aged 13 to 17 lived in states where gender affirming care is banned for minors. However, around 26,000 of those youth are currently still able to access care in their state due to court orders that prohibit enforcement of the laws. Conversely, around 146,700 transgender youth live in states that have passed gender-affirming care "shield" laws that support access to care by protecting doctors and parents who prescribe or seek access to medical care for youth. State level bans on gender-affirming care in the United States have led some families with transgender children to move out of their states. In May 2024, the Department of Justice indicted a Texas doctor, Eithan Haim, for alleged HIPAA violations involving
Texas Children's Hospital which he claimed was secretly providing gender-affirming care to minors. In January 2025, the Trump administration dropped the charges and the case was dismissed with prejudice. In October 2024, Texas attorney general
Ken Paxton filed suit against a doctor who allegedly provided gender-affirming care to 21 minors after it had been banned for minors in the state, the first time that such a suit has been brought in the U.S. On December 17, 2025, the House voted on H.R. 3492, the "Protect Children's Innocence Act", a bill sponsored by Marjorie Taylor Greene that would make providing gender-affirming care to minors a
Class C felony. The bill passed 216-211. The next day, the Department of Health and Human Services (HHS) announced its intent to impose a rule prohibiting hospitals from offering gender-affirming care to minors, as a condition of federal Medicare and Medicaid funding. The HHS utilized the euphemism "sex-rejecting procedures" to refer to the practice. On December 23, 2025, nineteen states and Washington D.C. joined a lawsuit against the HHS in response to its proposed ban on gender-affirming care for minors. As of the early 2020s, providing gender-affirming healthcare to trans minors is considered best practice by the
American Medical Association (AMA),
American Psychiatric Association, the
Endocrine Society,
American Academy of Pediatrics, and the
World Professional Association for Transgender Health. In 2025, the AMA rejected the
Trump administration HHS gender dysphoria report, which saying that its claims are "rooted in politics and partisanship, misrepresent the consensus of medical science, undermine the professionalism of physicians, and risk harming vulnerable young people and their families". The report was written in compliance with
Executive Order 14187, which made it illegal for the federal government to advocate in favor of gender-affirming care under the age of 19. The report contradicted the consensus of the mainstream medical community, instead advocating for
conversion therapy as the primary means of treatment for transgender youth. On February 4, 2026, a day after the
American Society of Plastic Surgeons (ASPS) heavily cited the Trump report to advocate against gender affirming surgeries under the age of 19, news outlets reported that the AMA had agreed with the ASPS. However, AMA's board released a statement claiming the media was misrepresenting what they had told them. The AMA board claimed that they never said they agreed with the ASPS statement nor had they changed their position on gender-affirming care. They said that they still support gender-affirming care as "medically necessary" and that their "recent response to questions about ASPS's position statement was intended to preserve—not diminish—access to gender-affirming care". Additionally, the AMA board said that they had sent letters to news outlets like the
New York Times asking them to correct their stories which mischaracterized their statement. On February 5, 2026, an AMA spokesperson reaffirmed the organization's support for puberty blockers for trans youth and said their position on puberty blockers had not changed, nor did they have any plans to change it. The AMA continues to oppose restrictions on gender-affirming care for trans youth. On February 17, 2026, the AMA sent letters opposing two proposed
CMS rules that would restrict doctors and hospitals from providing gender-affirming care to minors, saying the rules "interfere with the practice of medicine and undermine the physician-patient relationship" and requesting that the rules be withdrawn. In March, it was revealed that representatives for the ASPS, the AMA and several other medical organizations had met with Dr.
Mehmet Oz, a member of the Trump administration who vehemently opposes gender-affirming care prior to the release of their new statement. During the meeting, Dr. Oz attempted to pressure the organizations to abandon their support for gender-affirming care. The
Society for Evidence-Based Gender Medicine (SEGM), an SPLC-designated hate group was also present at the meeting and Kathleen McDeavitt, one of the co-authors of the HHS report, also gave a presentation at the meeting. This led to speculation and accusations that the ASPS and AMA statements opposing surgeries for minors may have been influenced by the Trump administration, although the ASPS, for its part, denies this.
Bans for minors Related scholarship Some legal scholars have argued that bans on gender-affirming care for minors may fail to satisfy rational basis review due to internal inconsistencies in the regulation of medical interventions on sex characteristics. Katri and Sudai contend that such laws prohibit treatments for transgender minors while permitting comparable or more invasive interventions on intersex children, thereby undermining the coherence of the asserted state interests and calling into question their rationality.
Protections for minors Related studies In one 2016 study, the effect of puberty blockers was shown to be fully reversible. Earlier studies (e.g., these in 2012 and 2015) indicated ongoing long-term research into potential effects on the brain.
Awareness of providers The lack of knowledge and education related to transgender health is an obstacle transgender people face. A 2011 study published in
JAMA reported that medical students cover up to "only five hours" of LGBT related content. A different study done by Lambda Legal in 2010 stated that 89.4% of transgender people felt that there are not enough medical providers that are "adequately trained" for their needs. This lack of medical training makes it harder for transgender people to find suitable and proper healthcare. A 2017 report by the
Center for American Progress found 29 percent of transgender people reporting they were denied care by a medical provider in the preceding year due to their gender identity or sexual orientation. The same study found that 21 percent of trans people reported medical providers used abusive or harsh language when they sought care. The
Affordable Care Act (ACA) of 2010, specifically Section 1557, prohibits sex discrimination in federally funded health care facilities, and in 2012 the federal
Department of Health and Human Services (HHS) clarified that this includes discrimination based on transgender status. The government's final rule in 2016 determined that the ACA forbid discrimination based on gender identity. The ACA also forbids insurance providers from refusing to cover a person based on a pre-existing condition, including being transgender. However, a federal judge in Texas in 2016 issued a
nationwide injunction stopping the ACA's transgender antidiscrimination protections from taking effect, and in 2019 that same court issued a final ruling that was binding on HHS. This rule was in effect for nearly a year until it was reversed by the Biden administration, restoring the Obama-era policy. Complaints sent to HHS during the Trump administration indicated that medical providers were still frequently denying care to transgender people on the basis of their gender identity. In 2020, the Supreme Court ruled in
Bostock v. Clayton County that discrimination on the basis of sexual orientation or gender identity is necessarily also discrimination "because of sex" as prohibited by
Title VII of the Civil Rights Act of 1964, and thus that Title VII protects employees against such discrimination. A 2022 study on the allocation of ventilators during the pandemic found that respondents across the entire political spectrum were, when presented with the choice between allocating a ventillator to a cisgender man or a transgender person, on average less likely to allocate it to the trans person than to the cis man. In particular, respondents with conservative political leanings, when given a choice between allocating a ventilator to a cis man or a trans woman, were 14.3% less likely to allocate it to the trans woman, and when given a choice between allocating a ventilator to a cis man or a trans man, were 18.6% less likely to allocate it to the trans man. Republican amendments to funding bills could defund trans healthcare, affecting hundreds of thousands of trans adults and children by restricting access to essential medical treatments like hormone therapy and surgeries.
Catholic hospitals 1 in 6 patients in the United States are treated in a Catholic facility. In March 2023, the United States Catholic Bishops issued guidelines for Catholic hospitals, entitled "Moral Limits to the Technological Manipulation of the Human Body", which banned the provision of gender affirming healthcare by such hospitals entirely.
Trans Broken Arm Syndrome A form of discrimination in healthcare settings is known as "trans broken arm syndrome", in which a doctor mistakenly assumes that a trans person's medical ailments stem from their trans status or gender-affirming care and consequently treats their problem incorrectly or denies them care entirely. Trans patients often hide their trans status when visiting a doctor if their problem, such as a broken arm, is not related to their trans status. This is especially common in rural or more conservative areas. A 2022 survey from the
Center for American Progress revealed that 19 percent of trans individuals had experienced this form of discrimination in the past year.
Medical privacy Transgender people have the right to medical privacy. According to the
Health Insurance Portability and Accountability Act (HIPAA), medical providers and insurance companies are prohibited from disclosing any personal medical information including a person's transgender status. HIPAA also allows transgender people to access and receive a copy of their medical records from health care facilities. Even though there is medical consensus that hormone therapy and gender-affirming surgery (GAS) are medically necessary for many transgender people, the kinds of health care associated with gender transition are sometimes misunderstood as cosmetic, experimental or simply unnecessary. This has led to public and private insurance companies denying coverage for such treatment. Courts have repeatedly ruled that these treatments may be medically necessary and have recognized
gender dysphoria as a legitimate medical condition constituting a "serious medical need". The ban on Medicare coverage for gender reassignment surgery was repealed by the US Department of Health and Human Services in 2014. Insurance companies, however, still hold the authority to decide whether the procedures are a medical necessity. Only cosmetic surgeries promoting the physical or mental health of an individual can qualify for medical deductions. Transgender people have used the diagnosis of gender dysphoria to qualify for deductible health care. In a case brought by
Gay and Lesbian Advocates and Defenders (GLAD), ''O'Donnabhain v. Commissioner'', for instance, the
Internal Revenue Service lost its claim that such treatments were cosmetic and experimental when a transgender woman deducted her GAS procedures as a medical expense. Courts have also found that psychotherapy alone is insufficient treatment for gender dysphoria, and that for some people, GAS may be the only effective treatment. In June 2024, the Attorneys General in fifteen Republican-led states sued the Biden administration over the new rules. On July 3, 2024 a federal judge temporarily blocked enforcement of the new rule.
State Medicaid Coverage In June 2022, the Florida Agency for Healthcare Administration, the agency which is responsible for overseeing the state's
Medicaid service, released a report which stated that transgender hormone therapy is "experimental and investigational". The report was quickly rebuffed by the wider scientific community, with experts from
Yale in July publishing an analysis in which they stated that the report ignored accepted scientific studies and consensus regarding gender dysphoria, had its writers chosen from those with ties to anti-LGBTQ groups specifically for their bias, cited sources with no scientific merit – including a student blog post and a letter to the editor, and that if the state used the same standard it used in the report to evaluate other treatments, it would no longer allow Medicaid to pay for a wide array of common medications. On August 21, 2022, Florida issued state Medicaid regulations banning coverage of sexual reassignment surgery, hormone replacement therapy, puberty blockers and "any other transgender healthcare initiatives" for all individuals, regardless of age. On June 21, 2023, the court decided in
Dekker v. Weida that Medicaid must continue to cover
gender-affirming healthcare. The decision was appealed. On October 13, 2023, legal representatives from 19 states—principally Attorneys General
Steve Marshall of Alabama,
Tim Griffin of Arkansas, and
Jonathan Skrmetti of Tennessee—submitted an amicus brief arguing that the court should reverse its decision and forbid Medicaid coverage of all gender-affirming care, including care for adults. The amicus brief cited the
Dobbs decision. On November 22, 2024, the
11th U.S. Circuit Court of Appeals heard arguments appealing the case. ==Prisoners' rights==