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These Are All the States Restricting Access to Gender-Affirming Care for Trans People

A wrinkled trans flag

From the dark heart of Oklahoma to the editorial desk at the New York Times, things are ROUGH out here for trans people in the United States. And these nine states are trying to make it rougher by attempting to restrict access to gender-affirming care—in multiple cases, the proposed bans would affect trans people of all ages. That’s why I’m going to Canada. Anything to get me away from these nine circles of Hell.

Let’s take a trip down through Dante’s Inferno and see them for ourselves, shall we?


Can anyone tell me anything about Missouri? I couldn’t tell you one thing that the state is known for except apparently being the worst. Three bills—SB236SB49, and SB164—were filed in December 2022 to institute a total ban for transgender care to minors, with an exception for intersex youth. It’s all part of the “Missouri Save Adolescents from Experimentation (SAFE) Act,” because apparently Missouri views trans healthcare as some sort of science experiment gone wrong. A fourth Missouri Senate bill would also prohibit medical professionals from administering puberty blockers and surgeries to anyone under the age of 18. Any physician that “willfully and knowingly” administers aid to trans kids will be subject to prosecution and could lose their medical license. Similarly, parents and guardians who allow their child to receive such care can be reported to state authorities for abuse and neglect. The Missouri Karens are gonna have a field day ratting out their neighbors to the government.


Montana has nature, that’s about it. Great place to visit, hellhole to live. LC3824,  LC3825LC3826, and LC3827 are a misguided effort to “protect minors from gender transitions.” One of the proposed bills seeks to limit trans minors from having gender-affirming surgeries. I wish all of the Republicans in Montana’s legislative body would climb onto one of Montana’s beautiful mountain peaks and just … stay there forever.

New Hampshire

New Hampshire, WHAT ARE YOU DOING? YOU ARE RIGHT NEXT TO VERMONT. YOU’RE SUPPOSED TO BE BLUE. WHAT IS GOING ON HERE? The fallen-from-grace state is targeting “gender transition procedures” and seeking to redefine “conversion therapy.” I don’t like the sound of that. An earlier version of the proposed bill aimed to prohibit gender-affirming healthcare for minors and “young adults.” Yikes. Two middle fingers for New Hampshire.


Oklahoma, you don’t DESERVE the musical that Rogers and Hammerstein wrote about you. NO ONE should be singing about your “waving wheat” or your “surrey with the fringe on top” because you are now officially a TRASH STATE. A bill filed in December 2022 seeks to deny “gender transition procedures” to patients younger than 21 years old, with an exception for intersex youth. This means that Oklahoma will allow you to JOIN THE ARMY before you can change your gender.

The bill will also prevent public funds, including those from the state Medicaid program, from being used to pay for gender-affirming care. It will additionally make an “any medical or surgical service” used to help someone transition a felony offense, punishable by a $100,000 fine and up to a decade in prison.

If that wasn’t bad enough, the bill will also restrict transgender Oklahomans from socially transitioning or legally changing their name or gender marker on state-issued documents. Two middle fingers aren’t enough for you, Oklahoma. I’m flipping you off with my middle toes, too.

South Carolina

Between the rock and the hard place that are North and South Carolina, South Carolina is arguably worse. A South Carolina Senate bill would ban transgender people up to 21 years old from transitioning, and anyone over 21 must provide a referral from both their primary care physician and a licensed psychiatrist diagnosing them with gender dysphoria in order to receive care. So, basically, in South Carolina you aren’t allow to identify as trans; someone else has to identify YOU as trans. A second South Carolina bill would bar physicians from giving trans-related medical care to anyone under 18, with an exception for intersex kids. A third pre-filed measure would change the definition of “gender” to the sex that a person is assigned at birth, effectively eliminating any difference between the terms. This would make it impossible for trans people to change their gender markers on state documents.


I don’t ever wanna Tennessee this state again. Nashville is now Trashville. Them’s the breaks. A measure to prohibit transgender youth under 18 from accessing gender-affirming health care is already working through the Tennessee House of Representatives, and a similar bill is gaining traction in the Senate. The state claims that its legislature has the responsibility to “protect the health and welfare of minors.” I think minors need to be protected from the state of Tennessee.


Texas, where do I even begin with you? These bills you’re proposing are 20 gallons of shit in a 10-gallon hat. HB42 and HB112 are seeking to designate gender-affirming care for minors as child abuse, and would allow state agencies to open abuse investigations into families that allow their child to pursue gender-affirming care. Another House bill would revoke liability insurance to providers who prescribe medications used to treat gender dysphoria.


Utah, all I know about you is that you’re dry, dark, and full of Mormons. And that one of your Senate Republicans, Michael Kennedy, has introduced legislation to ban all gender transition surgeries (genital surgeries, top surgery, and breast reductions) for minors with the exception of surgeries for intersex kids. Kennedy, a “family doctor,” argued that gender-affirming healthcare is not necessary for people who experience gender dysphoria, woefully ignoring the consensus view from major medical associations. Kennedy has a track record for this sort of thing, and sponsored a measure to ban trans kids from competing on sports teams or using locker rooms, bathrooms, or showers consistent with their gender identity.


Virginia, I think that you’re just mad you’re the northernmost of the southern states and so you compensate by being as conservative as humanly possible to prove that you fit in with the rest of the south. It’s like you have some sort of Napoleon complex about it. A Robert E. Lee complex? Whatever, Virginia, you need therapy. To wit: A proposed measure in Virginia would establish another “SAFE Act” that would effectively ban doctors from providing gender-affirming care to minors. The measure would also bar Virginia’s Department of Medical Assistance Services, which is responsible for the state’s Medicaid program, from providing coverage for gender-affirming procedures for kids under 18.

(featured image: Alxey Pnferov, Getty Images)

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