The Current Status of Transgender Healthcare Laws

Transgender care in the United States is precarious at the moment. Over the last few years, access to gender-affirming care has become one of the most contested issues in state and federal courts - with the issue making its way to the Supreme Court this summer. And after the highest court’s decision and other actions, access to such care may likely depend on where you live and your health coverage plan.

A Look at State Transgender Care Laws and Restrictions

As of July 2025, 27 states have passed bans on gender-affirming care for children and teenagers.* According to The Williams Institute, there are over 300,000 high-school aged transgender youth in the U.S. today with 40% of them living in these 27 states. But it’s not only children affected by such bans. Some states - Oklahoma, Kansas, Texas, and South Carolina - have considered banning care for people up to 26 years old.

Additionally, several states prohibit the use of public funds to provide transgender care for anyone regardless of age. So, adults who receive their healthcare through Medicaid, work in the public sector, or are incarcerated, would be unable to access gender-affirming care.

Federal Rules on Transgender Care

In his first few weeks back in office, President Trump issued an executive order prohibiting federal funding for procedures such as puberty blockers, hormone therapy, and gender-affirming surgery for anyone under 19 - even though the majority of states consider 18-year-olds legal adults. The order also directs federal agencies to enforce it, including the Department of Justice.

In April 2025, Attorney General Bondi issued a DOJ memorandum that outlined the agency’s guidelines the DOJ is to follow in order to implement President Trump’s executive order, which includes investigating medical providers and pharmaceutical companies that mislead the public regarding the side effects of gender-affirming care for minors.

Then, in June 2025, the Supreme Court heard a challenge to Tennessee’s SB1 law, which bans puberty blockers or hormones to minors that allow them to present as the gender with which they identify. This statute explicitly prohibits “medical procedures from being administered to or performed on minors when the purpose of the medical procedure is to:

(1)   Enable a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex; or

(2)   Treat purported discomfort or distress from a discordance between the minor’s sex and asserted identity”

In essence, this law effectively bans doctors from prescribing, administering or dispensing puberty blockers or hormones, as well as performing trans-affirming surgery.

The Supreme Court, in a 6-3 ruling, upheld Tennessee’s SB1. Chief Justice Roberts asserted that the Supreme Court’s role was to determine whether or not the law violated the equal protection guarantee of the Fourteenth Amendment. They concluded it does not, leaving “questions regarding its policy to the people, their elected representatives, and the democratic process.” The court cited that England’s National Health Services pulled back on providing gender-affirming care to transgender youth to demonstrate that there are open questions around factual issues - before medical authorities and regulatory bodies - so debates over how laws like SB1 may impact society are better left for the states to address.**

A week later, President Trump’s administration finalized a rule that bans health plans offered on the Affordable Care Act exchanges from “providing coverage for specified sex-trait modification procedures” - surgery, puberty blockers, and hormone treatment. 

Then two weeks after the finalization of that rule, the DOJ announced it had issued more than 20 subpoenas to doctors and clinics that provide gender-affirming care to adolescents. Soon after, a multistate coalition filed a lawsuit challenging these efforts arguing that they “violate the Constitution, exceed federal authority, and undermine state laws that require equal access to medical treatment.” It is too soon to know where these investigations will lead.

Where Transgender Care Currently Stands

Between sweeping laws, executive actions, rules, directives, and a Supreme Court decision, accessibility to transgender healthcare is constricting. The challenges by determined states may have an impact but given the conservative momentum and the decision by our highest court, the stakes are high. This is a legal environment that will continue to evolve.

*New Jersey has not imposed such a ban.

**These bans in England and some U.S. states rely on the widely debunked and discredited Case Review.