A large majority of transgender adults in the United States – 78% – say living with a gender different from the one assigned to them at birth has made them more satisfied with their lives, according to a recent survey from The Washington Post and Kaiser Family Foundation.

Among respondents, more than three-quarters had changed their type of clothing, hairstyle or grooming habits to align with their preferred gender, while 31% had used hormone treatments and 16% had undergone gender-affirming surgery or a related surgical treatment to alter their appearance.

But such options are becoming available on a more limited basis, as politicians in multiple states have attempted to restrict trans Americans’ ability to seek gender-affirming medical treatments. In some states, such as Georgia and Tennessee, bans for minors were approved in the first quarter of 2023.

What Is Gender-Affirming Care?

The Human Rights Campaign, a LGBTQ+ advocacy group, defines gender-affirming care as “age-appropriate care that is medically necessary for the well-being of many transgender and non-binary people who experience symptoms of gender dysphoria, or distress that results from having one’s gender identity not match their sex assigned at birth.” The organization notes both the American Medical Association and American Academy of Pediatrics support “age-appropriate, gender-affirming care for transgender and non-binary people.”

Conservatives often oppose the concept of gender-affirming care – which may or may not include surgical or other interventions – for various reasons, including religious beliefs and concerns about child abuse. “You don’t disfigure 10-, 12-, 13-year-old kids based on gender dysphoria,” Florida Gov. Ron DeSantis, a Republican, said at an August news conference.

Some have expressed concern about a lack of data on the possible long-term consequences of gender-affirming medical treatment for minors. A Reuters investigation, for example, found “no large-scale studies have tracked people who received gender-related medical care as children to determine how many remained satisfied with their treatment as they aged and how many eventually regretted transitioning.” Others, according to the article, have raised alarms about children who are not appropriately evaluated before receiving gender-affirming medical care.

These States Have Banned Gender-Affirming Care

Below are the states that have moved to restrict some form of gender-affirming care for minors so far in 2023, based largely on legislation tracking from the Equality Federation, an advocacy accelerator that works with a network of state-based LGBTQ+ organizations.

Some states, such as Arizona and Alabama, passed bans prior to this year and are not included on the list. Alabama’s law has since been blocked by a federal judge as it faces a challenge in court.

Dozens of bills are still being considered by lawmakers in other states, according to the federation. And officials elsewhere, including in Florida and Missouri, have bypassed state legislatures altogether.

Signed into law by new Republican Gov. Sarah Huckabee Sanders in March, Arkansas’ law will make health care providers liable for civil action for up to 15 years after a minor turns 18 if they performed a gender transition procedure on that minor – essentially making it easier to file malpractice lawsuits in these situations. On that note, experts say the law acts as a de facto ban on gender-affirming care for children because it makes it nearly impossible for providers to get malpractice insurance, according to the AP. In 2021, state lawmakers passed the nation’s first ban on gender-affirming care for minors. The move was temporarily blocked shortly after, but on June 20, 2023, a federal judge issued a permanent injunction against it, ruling the ban unconstitutional. It marked the first time such a state ban was overturned, but the more recent law signed by Sanders was still set to go into effect.

The state Department of Health’s Board of Medicine announced a new rule in March that prohibits several types of therapies and procedures for treating gender dysphoria in minors. The methods of care covered include sex reassignment surgeries and puberty-blocking therapies. Minors already being treated with the rule’s referenced therapies prior to the effective date of it were allowed to continue. Then, on May 17, DeSantis signed into law a similar gender-affirming care ban from the state legislature, which, in addition to prohibiting procedures from being performed on minors, also grants Florida courts “temporary emergency jurisdiction” over a child if they have been subjected to or “threatened” with sex-reassignment prescriptions or procedures. The law also requires transgender adults to get written consent before undergoing such procedures by using a form adopted by the Board of Medicine and Board of Osteopathic Medicine, according to Reuters. But on June 6, a district court judge in Florida issued a preliminary injunction that temporarily blocked enforcement of some parts of the law for specific plaintiffs.

Senate Bill 140 was signed into law by Georgia’s Republican Gov. Brian Kemp in late March. The legislation, pushed forward by the Republican majority in the state’s General Assembly, prohibits “certain surgical procedures for the treatment of gender dysphoria in minors from being performed in hospitals and other licensed healthcare facilities.” There are exceptions, including treatments that are deemed “medically necessary” and situations covering continued treatment for minors undergoing “irreversible hormone replacement therapies” prior to July 1, 2023. But a federal judge on Aug. 20 granted a preliminary injunction which blocked the portion of the law banning doctors from starting hormone therapy for transgender minors. The prohibition on surgical procedures was not covered by the injunction.

The state’s GOP Gov. Brad Little approved a bill that criminalizes providing gender-affirming care for youth. Signed on April 4 and going into effect in January 2024, the law makes it a felony to provide hormones, puberty blockers or other gender-affirming medical care to minors. Little said in a letter confirming the bill signing that policymakers “should take great caution whenever we consider allowing the government to interfere with loving parents and their decisions about what is best for their children.”

Republican Gov. Eric Holcomb signed into law on April 5 a bill banning all gender-affirming care for minors, after previously saying there was “some vagueness to it,” according to the AP. The governor said in a statement that “permanent gender-changing surgeries with lifelong impacts and medically prescribed preparation for such a transition should occur as an adult, not as a minor.” Parts of the law, however, were blocked by a federal judge on June 16 following a request for a preliminary injunction by the American Civil Liberties Union of Indiana. The order stops the law’s ban on puberty blockers and hormone treatments for minors from going into force on July 1, but does not impact the restriction on gender-affirming surgeries.

Iowa’s ban, signed into law on March 22, prohibits health care professionals from “knowingly” performing certain medical practices on minors if they are “for the purpose of attempting to alter the appearance of, or affirm the minor’s perception of, the minor's gender or sex, if that appearance or perception is inconsistent with the minor's sex.” Practices covered by the law include hormone therapies and surgical procedures. As with other states’ laws, there are some exceptions, including a “medically verifiable disorder of sex development.”

The state on March 29 joined others in banning gender-affirming medical care for minors when the Republican-led Kentucky General Assembly voted to override Democratic Gov. Andy Beshear’s veto, becoming the first state led by a Democrat to approve such a ban in 2023. The law notes that any health provider who violates the prohibition can have their license or certificate revoked. A federal judge on June 28 temporarily blocked the portion of the law that would have banned transgender youth from accessing puberty blockers and hormone therapy, but that same judge lifted the injunction on July 14 – allowing the restrictions to go into effect. A federal appeals court panel on July 31 allowed the state to continue enforcing the law.

With a successful override attempt of Democratic Gov. John Bel Edwards’ veto by the state’s Republican supermajority legislature, Louisiana approved a ban on gender-affirming care for minors on July 18. The law, which goes into effect on Jan. 1, 2024, covers procedures such as hormone therapies, puberty blockers and gender-reassignment surgeries. The ban’s ultimate approval came after a Republican lawmaker cast a tie-breaking vote to kill the legislation in May. But it was eventually resurrected and passed before Edwards’ veto.

Mississippi’s law – among the first to be enacted in 2023 – bans any person from knowingly providing or engaging in conduct that aids and abets the performance of gender transition procedures on a minor in the state. The ban also prohibits the use of public funds or tax deductions for such procedures. Republican Gov. Tate Reeves said when he signed the bill into law that “radical activists” are telling children they are “just a surgery away from happiness,” according to the AP.

GOP Gov. Mike Parson on June 7 signed a bill that will restrict gender-affirming health care for minors and some adults in Missouri starting in late August. The law prevents the state’s Medicaid division from covering such treatment for people of any age, and prohibits providers from prescribing puberty-blockers or cross-sex hormones to minors until Aug. 28, 2027, unless they were being treated prior to the bill’s effective date. Missouri initially banned gender-affirming care in April through an emergency regulation from state Attorney General Andrew Bailey that limited treatments for both minors and adults, the latter of which was believed to be a first in the country. But Bailey terminated the rule – which had already been on pause due to a lawsuit – on May 16, citing the state legislature’s imminent ban. A circuit judge on Aug. 25 allowed the law to take effect.

Signed into law on April 28 by Republican Gov. Greg Gianforte, Montana’s ban on gender-affirming care for minors covers both surgical procedures and medications such as puberty blockers and testosterone. As with other state laws, the prohibition has exceptions including for someone “diagnosed with a disorder of sexual development.” Any physician who performs a banned procedure can be also sued in the 25 years following it if the after-effects result in any injury, “including physical, psychological, emotional or physiological harms.” The law takes effect on Oct. 1, according to the AP. Democratic state Rep. Zooey Zephyr, a transgender woman, was exiled from the Montana House floor after she said her fellow Republican lawmakers would have “blood on their hands” if they passed the bill.

Republican Gov. Jim Pillen signed into law on May 22 a bill that prohibits gender-affirming medical care for minors, which covers people under the age of 19 in Nebraska. The law, which also bans abortions at 12 weeks of pregnancy, includes a ban on surgical procedures and limitations on “prescribed drugs related to gender alteration.” The rules for the latter are to be determined by the state’s chief medical officer – a political appointee, according to the AP. The gender-affirming care portion of the new law goes into effect on Oct. 1, 2023.

The state’s Republican-dominated legislature on Aug. 16 voted to successfully override a veto from Democratic Gov. Roy Cooper and approve a ban on gender-affirming care for minors in North Carolina. The bill’s language covers both transition surgeries and puberty-blocking drugs or cross-sex hormones. The law goes into effect immediately, but as with other state bans that have been approved, there are some exceptions to the prohibition.

Republican Gov. Doug Burgum on April 19 signed a veto-proof bill into law that criminalizes providing gender-affirming medical care to minors. The law, which went into effect immediately as an “emergency measure,” makes performing sex reassignment surgery on a minor a felony, and makes providing gender-affirming medication such as puberty blockers to minors a misdemeanor. Burgum recommended in a statement that “thoughtful debate around these complex medical policies should demonstrate compassion and understanding for all North Dakota youth and their families,” according to the AP.

GOP Gov. Kevin Stitt on May 1 signed into law a ban on gender-affirming care for minors in Oklahoma, saying he was “thrilled” to do so and “protect our kids.” The bill allows for any physician who knowingly provides gender transition procedures to be charged with a felony, but the prosecution must occur before the minor patient turns 45. The law went into effect immediately, but on May 18 the state agreed to not enforce it while opponents sought a temporary court order blocking it.

Signed into law on Feb. 13, House Bill 1080 prohibits South Dakotan health care professionals from administering various types of gender-affirming procedures on minors. If a provider violates the law, the legislation requires a professional or occupational licensing board to revoke any license or certificate held by the provider. GOP Gov. Kristi Noem strongly supported the bill before signing it, according to the AP.

Tennessee’s legislation, which was signed by Gov. Bill Lee in March but was set to go into effect on July 1, bans health care providers from performing or offering to perform a medical procedure on a minor if its purpose is to enable that minor “to identify with, or live as, a purported identity inconsistent with the immutable characteristics of the reproductive system that define the minor as male or female.” It also prohibits such procedures if the purpose is to treat “purported discomfort or distress from a discordance between the minor's sex and asserted identity.” There are exceptions, and the law establishes penalties for providers who violate it. Just days before its July 1 effective date, a federal judge on June 28 temporarily blocked the portion of the law that would have banned transgender youth from accessing puberty blockers and hormone therapy. U.S. District Judge Eli Richardson, however, did not block the law’s ban on surgical procedures. A federal appeals court on July 8 temporarily reversed Richardson’s ruling, meaning the law can take effect at least until the court conducts a full review.

GOP Gov. Greg Abbott on June 2 signed a bill banning gender-affirming care for minors in Texas. The law contains exceptions similar to other states’ efforts at restricting transition care. The Texas Supreme Court on Aug. 31 allowed the law to go into effect on Sept. 1, overruling a state district judge who had issued a temporary injunction against the ban a week prior. The law’s passage was not Texas’ first attempt at limiting gender-affirming care: Abbott in 2022 ordered the investigation of families who were receiving such care, but the order was halted by a judge in the state.

Republican Gov. Spencer Cox signed into law on Jan. 28 the first gender-affirming care ban of the year. The Utah legislature’s Senate Bill 16 restricts health providers from performing “sex characteristic surgical procedures on a minor for the purpose of effectuating a sex change” or hormonal transgender treatment on minors who weren’t diagnosed with gender dysphoria before July 1, 2023. Cox said his approval of the law was an effort at least in part to pause “these permanent and life-altering treatments for new patients until more and better research can help determine the long-term consequences,” the AP reported.

A new law signed by GOP Gov. Jim Justice on March 29 prohibits minors from being prescribed hormone therapy and puberty blockers, or from receiving gender-affirming surgery. The law, which will take effect in January 2024, contains an exception geared toward youth for whom “treatment with pubertal modulating and hormonal therapy is medically necessary to treat the minor’s psychiatric symptoms and limit self-harm, or the possibility of self-harm.” In these cases, the minor must receive consent from their parents or guardians along with two medical providers.

。封闭期间，施工人员将不分昼夜的抢修道路，以清理之前飓风引发的重大山体滑坡。 Advertise with us 这段路是奥克兰前往Northland的主路。关闭期间，交通局建议司机们选择三条道路之一绕行。

二 | 绕行意味着从奥克兰到Whangārei的行程将增加20到70公里不等。东线方案（下图橙色）：走Cove Road绕行Waipū，该路线仅适合轻型交通工具。因为有羊肠弯道，带拖车的皮卡或卡车被禁止通行。中线方案（下图绿色）：走Oakleigh Road绕行Paparoa，适合绝大多数交通工具。西线方案（下图蓝色）：走12号和14号高速绕行Dargaville，该路线最远，需要额外行驶70公里，适合最重型卡车。全国公路运输协会首席执行官Justin Tighe-Umbers表示，司机们普遍感到失望。 “他们当中很多人已经跑了二三十年车，期间一直呼吁解决路的问题。明明是世界上最可预测的问题，但我们没有采取任何措施。现在我们要在最坏的时候和最不该的地段，关闭一条主干道，”他说新西兰应该有为期五十年的道路交通规划，而不是总是试着小修小补。据交通局估计，即使在Brynderwyns进行修复，该路段最多也只能再服务5-7年。

三 | Tighe-Umbers说目前最大的问题还是时间和成本。

四 | 之前一天就能往返奥克兰和Northland，但如今许多司机——尤其是走西线的——将无法完成往返，不得不增加过夜费用和更多路上时间。 Tighe-Umbers说当地一家林业公司就跟他说，接下来九周不会再砍伐任何树木。

五 | 一位奶场主也说，他每天必须经过Brynderwyns。预计绕道会额外增加15万纽币，而他无法转嫁这笔费用。 “他们通常无法转嫁，因为他们签了以特定价格交付货物的合同，而市场根本不会承担额外的运输成本。” “对他们来说，九周是一段非常漫长的时间，”Tighe-Umbers说。国家党政府已经承诺会优先考虑用一条四车道的新路替代原路段，最有可能从Brynderwyns以西经过，但迄今为止没有公布时间表或预算。相关阅读：奥克兰交通局今夏将修复550公里道路，资金削减交通安全如何保障？奥克兰有大约1000公里的道路需要维修，5到10年才能修完…… 五年来国家公路上出现的坑洼超过21万个，最多的地区是…… 未来10天，新西兰大部分地区气温将超过20摄氏度，天气晴好厄尔尼诺来袭新西兰今夏出现热带气旋的风险有多大？炎热干燥！今年夏天新西兰的气温或将飙升至39度厄尔尼诺现象来了！几周之内，新西兰气候会发生怎样的巨大变化？厄尔尼诺来袭 2024或成史上最热一年注：本文为编译/原创，欢迎转发分享；但严禁复制等未经授权的非法使用。违反上述声明者，本网将追究其相关法律责任。使用授权请联系[email protected]。 chineseherald.co.nz All Rights Reserved 版权所有 (责编：鸮鹦鹉) 相关内容数百条肥美鲷鱼冲上奥克兰海滩，渔业局：鱼没问题，但别吃与前总理们相比，Christopher Luxon上任后人气没有提升，原因何在？夜间奥克兰西区发生两起逮捕事件，两人受重伤，四人被拘留奥克兰Ellerslie华人夫妇遇害案：两名被告面临新的指控新西兰儿童部被严厉警告：“完全不可接受” 国家党“百日计划”即将收尾，新政府2024年关键字：减！绿党议员猝然离世，国会将史无前例迎来第三位华人议员？工党人事大洗牌！他辞职去当大学校长只因羁绊太深？。

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