Most states in South have banned gender-affirming care for trans youth

Gender-affirming treatments, including puberty blockers, hormones and surgeries, are now inaccessible for transgender minors in much of the South because of new laws that heavily restrict or ban such care for youths younger than 18.

Since 2021, lawmakers in 12 of the 16 states considered regionally South by the U.S. Census Bureau have passed legislation that prevents medical professionals from administering gender-affirming health care to transgender youths, accounting for more than half of bans enacted nationwide. Laws passed in states including Florida and Missouri also restrict access to care for some transgender adults.

Four Southern states — Delaware, Maryland, South Carolina and Virginia — plus Washington, D.C., have not enacted a law or policy banning gender-affirming health care. That isn’t for a lack of trying, however. Bills that were introduced this year in Virginia and South Carolina failed to advance through the respective state Legislature before the end of the session.

Democratic governors in Kentucky, Louisiana and North Carolina this year vetoed their states’ gender-affirming health care bans but were ultimately overpowered by Republicans in their respective state's Legislature. Arkansas’s GOP-controlled Legislature in 2021 similarly voted to override then-Gov. Asa Hutchinson’s veto of the state’s first-in-the-nation ban.

It isn’t entirely surprising that the South, where a majority of states have either Republican trifectas or conservative supermajorities in the legislature, has become a breeding ground for legislation restricting access to transgender health care, said Logan Casey, a senior policy researcher at the Movement Advancement Project.

“Many of the states in the South are effectively a single-party government,” he said, adding that, although most voters have vocalized their support of LGBTQ-inclusive policies, gerrymandering and voter suppression in the South have made it more difficult “to vote in elected officials who actually share their preferences and their beliefs.”

Recent surveys suggest majorities of voters oppose legislation banning gender-affirming health care for transgender minors, and more than 60 percent of voters in a Data for Progress poll conducted in March said there is “too much legislation” aimed at “limiting the rights of transgender and gay people in America.”

“We've seen a long history of the South being used as a laboratory for anti-LGBT legislation,” said Adam Polanski, director of communications at the Campaign for Southern Equality. 

“There’s some level of experimentation that’s going on in the South because it’s so easy to pass things” thanks to its lopsided state legislatures, he said.

The Campaign for Southern Equality, which advocates for LGBTQ rights in the South, estimates that roughly 90 percent of transgender young people in the South currently live in a state where a ban on gender-affirming care has been passed, meaning, for many families with transgender children, the closest health care provider may be hours — and hundreds of miles — away from their homes.

A program launched earlier this year by the group, the Southern Trans Youth Emergency Project, has already distributed more than $250,000 to families to help cover the cost of things like travel expenses, Polanski said.

“When your state legislature can just steamroll over you, despite your honest sharing of your story and expressing the needs of your family, it can feel really demoralizing. It’s important to note that [LGBTQ people] are here and they're fighting back,” he said.

Southern appeals courts rule on side of health care bans

Most gender-affirming health care bans enacted in the South have been challenged in court, and a majority have been temporarily blocked by court orders. In June, Arkansas’s ban became the first such law to be ruled unconstitutional and struck down. The state is appealing that decision.

In July, however, a panel of the Sixth Circuit Court of Appeals accepted a request by Tennessee’s attorney general to lift an injunction issued by a lower court, becoming the first federal court to allow a ban on gender-affirming health care to take effect. Six days later, the same court lifted an injunction on Kentucky’s ban.

Alabama this week became the third state in the nation to have its previously-blocked gender-affirming health care ban reinstated. The 11th Circuit Court of Appeals on Monday lifted an injunction that had for over a year prevented Alabama officials from enforcing a 2022 law that makes it a felony — punishable by up to 10 years in prison — for doctors to provide puberty blockers or hormone replacement therapy to transgender people younger than 19.

“The use of these medications in general — let alone for children — almost certainly is not ‘deeply rooted’ in our nation’s history and tradition,” a three-judge panel for the 11th Circuit wrote Monday, citing the Supreme Court decision overturning Roe v. Wade.

Recent court decisions highlight that, especially in the South, “access to care can change at the drop of a hat,” said Casey, of the Movement Advancement Project.

“It’s really leaving transgender youth and their families in a really scary place of uncertainty and fear and precarity not knowing what’s going to happen tomorrow — if any court-based relief or anything like that is going to vanish the next day,” he said. “That's really not a way to be able to build a life and that's not what kids need to be able to thrive.”