Attacks on Gender-Affirming Care

Republican lawmakers across the United States have escalated political efforts to criminalize the provision of gender-affirming health care, especially for minors, as part of an alarming national rise in anti-LGBTQ+ legislation. American Oversight is investigating these attacks on gender-affirming care and has filed dozens of public records requests across several states seeking more information about the proposed or implemented bans.

Several state legislatures have introduced bills targeting young transgender and non-binary people’s access to this essential care, which includes a range of practices that support transgender and gender non-conforming people that are necessary as part of their gender transitions, from using the correct name and pronouns to medical treatments like hormone therapy and puberty blockers. Surgical treatment is another option for some people, typically adults.

Many of the bans on gender-affirming care for minors have been challenged in court by civil rights groups, including in Arkansas (the first state to implement such a ban), Indiana, and Oklahoma. Bans have already gone into effect in several states, and misinformation about care has fueled an increase in harassment and threats to medical providers.

American Oversight has uncovered records that provide a behind-the-scenes look at how these measures have impacted the work of state officials. In Missouri, attacks on LGBTQ+ rights have had a chilling effect that led to the removal of vital health information from a state health department website. Other documents we obtained revealed how officials in Texas’ child welfare agency were caught off-guard by Gov. Greg Abbott’s February 2022 directive to label the provision of gender-affirming care as “child abuse.”

These attacks on gender-affirming care are part of a coordinated national effort to roll back key protections, and the access landscape changes nearly every day. American Oversight will update this page as new findings become available.

Click each state for more information about our investigations of attacks on gender-affirming care:

Arizona |  Florida | Indiana | Idaho | Mississippi | Missouri | Montana | Nebraska

North Carolina | North Dakota | Oklahoma | Texas | Utah | West Virginia

Texas

Texas’ ban on minors’ access to gender-affirming care went into effect in September 2023 following a heated legal battle brought by LGBTQ+ rights groups. American Oversight filed several public records requests seeking the release of communications from Texas officials — including Gov. Greg Abbott and Attorney General Ken Paxton — about gender-affirming care services or with groups known to promote anti-LGBTQ+ measures.

In February 2022, following Paxton’s release of a legal opinion that labeled gender-affirming care for minors as “child abuse,” Abbott ordered the Texas Department of Family and Protective Services (DFPS) to investigate reports of the provision of such care. In response, American Oversight filed public records requests seeking further information about Abbott’s order from DFPS, the Texas Medical Board, and the Texas Health and Human Services Commission, as well as from Paxton’s and Abbott’s offices.

In August 2022, we obtained records that showed DFPS leadership instructed staff not to communicate in writing about Abbott’s directive. The documents, which also show that lower-level employees were not authorized to handle those cases and that DFPS adopted new policies and procedures in response to Abbott’s directive, were cited in two briefs we filed in Texas cases challenging the implementation of the directive.

Florida

Gov. Ron DeSantis signed a bill banning gender-affirming care for Florida’s minors in May 2023. Adults also face barriers to treatment access. 

We sent records requests to Florida Surgeon General Joseph A. Ladapo and his chief of staff seeking the release of any communications about gender-affirming care in the months before it was banned for minors. We also filed several requests with the Florida Department of Health and other offices seeking the release of any communications officials may have had about gender-affirming care or with anti-LGBTQ+ organizations.

In 2023, we obtained records showing meetings between conservative groups pushing far-right measures and the offices of multiple Florida officials, including DeSantis. Other records showed that DeSantis’ office had received several reports on gender-affirming care and other topics from the conservative Manhattan Institute between April 2022 and January 2023.

Indiana

Indiana House Republicans approved a bill banning all gender-affirming care for minors in the state in March 2023. That same month, Indiana Attorney General Todd Rokita sent a letter asking several medical facilities in the state to document their provision of gender-affirming care to minors. 

American Oversight filed a public records request with Rokita’s office for records related to the letter. We also filed a request with the state health department seeking the release of related communications, guidance, or implementation directives. Rokita’s office response to our request stated it had found 85 responsive records but was “exercising its statutory discretion to except all 85 records from disclosure.”

“The responsive records are not being disclosed because they are intra-agency or interagency advisory or deliberative material that are expressions of opinion or are of a speculative nature, and that are communicated for the purpose of decision making,” the response letter stated. 

In July 2023, a federal court blocked portions of the state bill that would have restricted minors’ access to hormones and puberty blockers, but left the bill’s ban on gender-affirming surgeries for minors in place.

Missouri

Missouri banned gender-affirming care for minors in August 2023 amid challenges by civil rights groups. The state law bans medical providers from distributing hormones or puberty blockers to minors and prohibits the state’s Medicaid program from covering gender-affirming care services for anyone, including adults. It also restricts access to such care for people in jail. 

Before the ban, in March 2023, Attorney General Andrew Bailey had issued emergency rules that severely restricted minors’ access to gender-affirming care, later announcing that the rules would also restrict adults’ access to the same care. Missouri officials abruptly announced the termination of Bailey’s emergency rules in May 2023, a week after the state House approved legislation banning gender-affirming care for children in the state. 

American Oversight filed several records requests for communications and analyses related to Bailey’s emergency rules, including any communications between Bailey and external entities regarding transgender health care. 

We also requested the release of communications about the rules or the state’s ban from the offices of a number of officials, including state Sens. Mike Moon, Holly Thompson Rehder, Rick Brattin, Denny Hoskins, and Tony Luetkemeyer and state Reps. Brad Hudson and Jamie Burger.

We obtained records from the state’s health department revealing that in January an official had instructed employees to delete links from the department’s adolescent health information page. This included medical information for teenagers about sexual health, contraception, gender, relationships, and puberty, as well as links to low-cost sexual health providers and “resources for creating affirming learning environments for LGBTQ youth.”

Mississippi

Mississippi enacted a ban on gender-affirming care for minors in February with Gov. Tate Reeves’ signing HB 1125, which prohibits doctors from providing gender-affirming care to minors and outlaws surgical gender-affirming procedures for minors and adults. 

American Oversight requested the release of records related to the passing of HB 1125 — including any potential communications with anti-LGBTQ+ groups — from the offices of Gov. Reeves, Sen. Joey Fillingane, and Reps. Nick Bain and Gene Newman, who authored and sponsored the bill.

Montana

In April 2023, the Montana legislature passed a ban on gender-affirming care for minors, which was temporarily blocked in September, days before it was set to take effect. 

American Oversight submitted multiple requests to the office of Gov. Greg Gianforte seeking records and communications related to the state’s ban. We have also requested the release of records related to gender-affirming care from the state’s Department of Public Health and Human Services. 

Additionally, American Oversight requested records from the office of state Sen. John Fuller, who sponsored the bill banning gender-affirming care for minors, including communications Fuller or members of his staff had with anti-LGBTQ+ groups such as the Alliance Defending Freedom and the Heritage Foundation.

Nebraska

In May 2023, Nebraska lawmakers passed legislation, quickly signed into law by Gov. Jim Pillen, that prohibited health care professionals in the state from providing gender-affirming care to people younger than 19. The law, Nebraska Legislative Bill 574, outlaws gender-affirming surgical procedures and restricts minors’ access to hormones and puberty blockers, and also bans abortion after 12 weeks — a rare conglomeration of issues that has been challenged by civil rights groups.

American Oversight filed multiple requests to Pillen’s office, the state’s health department, and the office of Attorney General Mike Hilgers for communications, analyses, or other records related to LB 574.

Idaho

Gov. Brad Little signed a bill banning the provision of gender-affirming care for minors in April 2023, with the law — which not only bans the use of hormone blockers for minors, but also makes it a felony for providers to give gender-affirming services to patients under 18 — initially set to take effect in January 2024. In late December 2023, a federal judge issued an injunction temporarily blocking the law from going into effect.

American Oversight has filed several public records requests seeking the release of any analyses or guidance concerning the anti-trans policies, including from the governor’s office, the attorney general’s office, the state Senate, the Department of Health and Welfare, the Board of Education, and state Rep. Bruce Skaug, the bill’s sponsor.

Arizona

Gov. Doug Ducey signed a bill banning gender-affirming care for minors in May 2022. American Oversight submitted multiple records requests seeking information about the bill, including to the offices of Ducey and the bill’s sponsor, state Sen. Warren Petersen.

North Carolina

A ban on minors’ access to gender-affirming care went into effect in North Carolina in August 2023, after the state’s Republican legislature overrode the governor’s vetoes of HB 808, which prohibits surgical transition procedures and the provision of hormone treatments to minors.

American Oversight filed public records requests with the offices of state Reps. Hugh Blackwell, Mark Pless, Ken Fontenot, and John Torbett — the sponsors of HB 808 — seeking communications they may have had with anti-LGBTQ+ groups or activists.

North Dakota

In April 2023, Gov. Doug Burgum signed a bill that restricts most minors’ access to gender-affirming health care and makes it a felony for health care professionals to provide anyone under 18 with gender-affirming services.

We requested the release of records of analyses Burgum’s office or the state health department may have conducted regarding the impact of the restrictive laws.

Oklahoma

Gov. Kevin Stitt signed into law a bill prohibiting minors’ access to gender-affirming care in May 2023, prompting American Oversight to submit multiple requests seeking related communications from Stitt’s office or the state Department of Human Services.

We are also investigating Stitt’s 2022 threat to withhold funding from an Oklahoma hospital system if it did not stop providing gender-affirming care services to minors, and have filed requests seeking more information about the move.

Utah

Gov. Spencer Cox signed SB 16 into law in January 2023, prohibiting minors in the state from receiving gender-affirming care. We requested the release of records related to that bill from Cox’s office and the office of state Sen. Mike Kennedy, the bill’s sponsor. We also filed a public records request with the state’s health department seeking the release of any reports, analyses, proposals, or impact projections related to SB 16.

West Virginia

Gov. Jim Justice signed a ban on gender-affirming care for minors in March 2023. American Oversight requested the release of communications related to the ban or about gender-affirming services from Gov. Justice’s office and the state Department of Health and Human Resources. Among the records we are seeking are potential communications with anti-LGBTQ+ groups.