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Transgender rights in the United States vary considerably by jurisdiction. In recent decades, there was an expansion of federal, state, and local laws and rulings to protect transgender Americans; however, many rights remain unprotected, and some rights are being eroded, with significant federal restrictions since 2025. Since 2020, there has been anational movement byconservative andright-wingpoliticians and organizations against transgender rights.[1] There has been a steady increase in the number of anti-transgender bills introduced each year,[2][3] especially in Republican-led states.[4] Transgender employees are nationally protected from employment discrimination following a2020 ruling where theSupreme Court held thatTitle VII protections against sex discrimination in employment extend to transgender employees. Attempts to pass anEquality Act to prohibit discrimination on the basis ofgender identity in employment, housing, public accommodations, education, federally funded programs, credit, and jury service, have all been unsuccessful.[5]
Repeated attempts to pass a Transgender Bill of Rights have failed but, if ever successful, would amend theCivil Rights Act to prohibit discrimination on the basis of sex, enforce prohibitions on discrimination in health care on the basis of gender identity and amend federal education laws to ensure that trans students are protected from discrimination. This bill would also specifically allow students to join sports teams that match their gender identity and protect access togender affirming care for minors and adults, which would subsequently overturn various bans passed at a state level by conservative legislatures across the country.[6][7] It would also federally banconversion therapy practices and forced surgery on intersex children and would invest in community services to prevent violence against trans and nonbinary people and would require theattorney general to designate a liaison within theCivil Rights Division of theDepartment of Justice dedicated to advising and overseeing enforcement of the civil rights of transgender people.[8]
Most states allow change of sex onbirth certificates anddriver's licenses, although some require proof ofgender-affirming surgery or prohibit updating these fields altogether. Some states legally recognizenon-binary citizens, and offer an "X" marker on identification documents.[9]Gender self-identification (including an "X" option) was permitted forpassports between 2022 and 2025, but was subsequentlyrepealed. Laws concerningname changes in U.S. jurisdictions are also a complex mix of federal and state rules. The Supreme Court's decision inObergefell v. Hodges established that equal protection requires all jurisdictions to recognizesame-sex marriages, giving transgender people the right to marry regardless of whether their partners are legally considered to be same-sex or opposite-sex. TheMatthew Shepard and James Byrd Jr. Hate Crimes Prevention Act, of 2009, added crimes motivated by a victim's actual or perceivedgender,sexual orientation,gender identity, ordisability to the federal definition of ahate crime. However, only some states and territories include gender identity in their hate crime laws.
Throughout the United States, transgender rights have increasingly[10] been a target of conservatives and theRepublican Party.[11][12] Since 2022, manyred state governments have restricted or eliminated transgender residents' access to genderedpublic accommodations,gender-related medical care, and accurateidentification documents. Bans or restrictions ondrag performances as well as those onqueer-relatedliterature and academic curricula (e.g.gender and sexuality studies) inpublic schools have also been instituted by severalstate governments.[13]
AfterDonald Trump's inauguration as president in January 2025, he hasactively targeted transgender people. He signed executive orders to prohibitfederal recognition of genders beyond male or female assigned at birth,gender-related medical care for people under 19,[14]military service by openly trans people,[15][16]support of social transition and instruction on gender-related topics in schools,[17] and theinclusion of trans women in women's sports.[18] Two judges have temporarily blocked the under-19 gender-affirming care ban,[19][20][21] and other aspects of these orders have faced legal challenges.[22][23][24]
On June 18, 2025, the Supreme Court ruled inUnited States v. Skrmetti that bans on gender-affirming care for minors were constitutional.[25]
InObergefell v. Hodges, the Court ruled that people have a right to marry without regard to sex. While this is commonly understood as a ruling allowing same-sex marriage, it also meant that a person's sex, whether assigned at birth or recognized following transitioning, cannot be used to determine their eligibility to marry. Prior to this ruling, the right of transgender people to marry was often subject to legal challenge—as was the status of their marriages after transitioning, particularly in cases where an individual's birth sex was interpreted to mean asame-sex marriage had taken place.[26]
In 1959,Christine Jorgensen, atrans woman, was denied a marriage license by a clerk in New York City, on the basis that herbirth certificate listed her as male;[27][28] Jorgensen did not pursue the matter in court. Later that year,Charlotte McLeod, another trans woman who underwent gender-affirming surgery in Denmark, married her husband Ralph H. Heidel in Miami. She did not mention her birth sex, however, or the fact she was still legally male, since Florida's marriage law did not require a birth certificate for the issuance of a marriage license to an individual over the age of 21.[29] In 1976, the New Jersey caseM.T. v. J.T. held that trans people who had undergone gender-affirming surgery could marry as the legal sex matching their gender identity, the first ruling of its kind. Here the court expressly considered the EnglishCorbett v. Corbett decision but rejected its reasoning.
InLittleton v. Prange (1999),[30] Christie Lee Littleton, a trans woman who had undergone gender-affirming surgery, argued to the Texas 4th Court of Appeals that her marriage to her genetically male husband (deceased) was legally binding and hence she was entitled to his estate. The court decided that the plaintiff's sex is equal to her chromosomes, which were XY (male). The court subsequently invalidated her revision to her birth certificate, as well as her Kentucky marriage license, ruling "We hold, as a matter of law, that Christie Littleton is a male. As a male, Christie cannot be married to another male. Her marriage to Jonathon was invalid, and she cannot bring a cause of action as his surviving spouse." She appealed to the Supreme Court but it denied certiorari in 2000.[26]
The Kansas Appellate Court ruling inIn re Estate of Gardiner (2001)[31] considered and rejectedLittleton, preferringM.T. v. J.T. instead. In this case, the Kansas Appellate Court concluded that "[A] trial court must consider and decide whether an individual was male or female at the time the individual's marriage license was issued and the individual was married, not simply what the individual's chromosomes were or were not at the moment of birth. The court may use chromosome makeup as one factor, but not the exclusive factor, in arriving at a decision. Aside from chromosomes, we adopt the criteria set forth by Professor Greenberg. On remand, the trial court is directed to consider factors in addition to chromosome makeup, including: gonadal sex, internal morphologic sex, external morphologic sex, hormonal sex, phenotypic sex, assigned sex and gender of rearing, and sexual identity." In 2002, theKansas Supreme Court reversed the Appellate court decision in part, followingLittleton.[citation needed][32]
The custody case ofMichael Kantaras made national news.[33] Kantaras met a woman and filed for divorce in 1998, requesting primary custody of the children. Though he won that case in 2002, it was reversed on appeal in 2004 by theFlorida Second District Court of Appeal,[34] upholding Forsythe's claim that the marriage was null and void because her ex-husband was still a woman andsame-sex marriages were illegal in Florida.[35] Review was denied by theFlorida Supreme Court.[36]
Inre Jose Mauricio LOVO-Lara (2005),[37] the Board of Immigration Appeals ruled that for purposes of an immigration visa, "A marriage between a postoperative transsexual and a person of the opposite sex may be the basis for benefits under ..., where the State in which the marriage occurred recognizes the change in sex of the postoperative transsexual and considers the marriage a valid heterosexual marriage."[37]
InFields v. Smith (2011), three transgender women in the Wisconsin prison system filed a lawsuit against Wisconsin for passing a law banning hormone treatment or gender-affirming surgery for inmates. TheU.S. District Court for the Eastern District of Wisconsin ruled in favor of the inmates. TheU.S. Court of Appeals for the Seventh Circuit affirmed and held that the Wisconsin law violated theEighth Amendment.[38] TheU.S. Supreme Court declined to hear Wisconsin's appeal.[39]
Courts are generally allowed to base custody or visitation rulings only on factors that directly affect the best interests of the child. According to this principle, if a transgender parent's gender identity cannot be shown to hurt the child, contact should not be limited, and other custody and visitation orders should not be changed for this reason. Many courts have upheld this principle and have treated transgender custody cases like any other child custody determination—by focusing on standard factors such as parental skills. InMayfield v. Mayfield, for instance, the court upheld a transgender parent'sshared parenting plan because there was no evidence in the record that the parent would not be a "fit, loving and capable parent".[40]
Other times, courts claiming to consider a child's interests have ruled against the transgender parent, leading to the parent losing access to their children on the basis of theirgender identity. For example, in 1982 in Ohio, inCisek v. Cisek, the court terminated a transgender parent's visitation rights. The court asked whether the parent's gender transition was "simply an indulgence of some fantasy". It held that there was a risk of both mental and "social harm" to the children, who might be emotionally confused upon seeing "their father as a woman".[41]
Many U.S. jurisdictions requiregender-affirming surgery before the person's legal sex can be changed. This has been criticized as forcedsterilization.[42] Some trans people wish to retain their ability to procreate. Others do not medically requirehysterectomy,phalloplasty,metoidioplasty,penectomy,orchiectomy, orvaginoplasty to treat theirgender dysphoria. In these cases, surgery is considered medically unnecessary and, for that reason, medically unethical. Additionally, surgery is generally the final series of medical procedures in a complete sex transition, and is financially prohibitive for many people.[43]
Some transgender people useassisted reproduction technology services and preservation of reproductive tissue prior to having surgery that would render them infertile. Depending on what type ofgametes the person's body naturally produces, this would include cryopreservation of semen in asperm bank or preservation ofoocytes orovum. For such individuals, access tosurrogacy andin vitro fertilization services is necessary to have children. Some people advocate specifically for transgender people to have a legal right to these services.[44]
Identity documents are a major area of legal concern for transgender people. Different procedures and requirements for legal name changes and gender marker changes onbirth certificates,driver's licenses, Social Security identification, andpassports exist and can be inconsistent. Many states have historically requiredgender-affirming surgery to change the name and gender marker; however, there are increasingly few states where this is the case, with Alabama being one of the last.[45]
Also, documents which do not match each other can present difficulties in conducting personal affairs—particularly those which require multiple, matching forms of identification. Furthermore, having documents which do not match a person's gender presentation has been reported to lead toharassment anddiscrimination.[46][47]
Previously issued federal documents generally remain valid until expiration under agency guidance; passport policy has changed multiple times since 2021 and—per agency guidance reflected below—was reinstated on June 17, 2025 to allow sex-marker changes (including “X”) after an earlier suspension.[48]
| Identification documents | Binary gender marker change allowed? | X marker allowed? |
|---|---|---|
| Certificate of Citizenship (Citizenship Certificate) | ✔ Yes, sinceMarch 31, 2023 | ✘ No, sinceApril 2, 2025 |
| Certificate of Naturalization (Naturalization Certificate) | ||
| Consular Report of Birth Abroad – Form FS-240 (CRBA) | ✘ No, sinceJanuary 23, 2025 | |
| Department of Defense Common Access Card (CAC) | ✘ No, sinceMay 8, 2025 (retroactively applied) | |
| Department of Defense Uniformed Services Identification Card (USID) | ||
| Employment Authorization Document – Form I-766 (EAD) | ✔ Yes, sinceMarch 31, 2023 | ✘ No, sinceApril 2, 2025 |
| Permanent Resident Card – Form I-551 (Green Card) | ||
| Social Security Number Card (Social Security Card) | ✘ No, sinceJanuary 31, 2025 | |
| United States Passport Book or Passport Card (U.S. Passport) | ✔ Yes, sinceJune 17, 2025 (reinstated; originallyApril 11, 2022) | |
TheState Department determines what identifying biographical information is placed on passports. FromJune 30, 2021, the Department announced it would offer an "X" gender marker and would also allow changing one's gender marker without proving any physical changes to one's sex.[49]
Previously, the policy had been amended on June 10, 2010 to allow permanent gender marker changes only if accompanied by a physician's statement that "the applicant has had appropriate clinical treatment for gender transition to the new gender."[50] Before 2010, the required statement was more specific; it was required to be from a surgeon who said that gender reassignment surgery had been completed.[51]
From April 11, 2022, any individual who is a validUS passport holder could legally have F, M or X options listed as a sex/gender marker available and recognized by way of self determination.[52] Starting in late 2023, X was also available for passport cards, emergency passports made by consulates and embassies, consular reports of birth abroad.[53]
Upon hisinauguration on January 20, 2025,Donald Trump issued an executive order titledDefending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government which directed the US federal government to replace all uses of gender, including passports, with a new legal category of biological sex from the time of conception, and to only recognize two biological sexes based on size of gametes produced. On January 23, 2025, secretary of stateMarco Rubio instructed staff to suspend all applications for passports that requested an "X" sex marker or a change to the existing sex marker.[54] In February 2025, the State Department issued new guidance stating that already-issued passports with an "X" or amended sex marker would remain valid until expired or replaced.
In-progress passport applications, and applications received as of February 7, 2025, would be limited to male or female designations, as determined by "biological sex from the time of conception" as determined by the aforementioned executive order.[55]
Persons not born in the United States and who hold status in the United States can change the gender marker on their USCIS-issued Certificate of Naturalization, Certificate of Citizenship, Permanent Resident Card, and their State Department-issued Consular Report of Birth Abroad; these serve as foundational identity documents that may be substituted for birth certificates.[56][57] Other options include obtaining a state court order affirming the change of legal gender as a linking document, such as California's Order Recognizing Change of Gender.[58]
The United States does not currently recognize non-binary gender at a national level. Some states offer legal documentation of a third gender on birth certificates, driver's licenses, and/or state ID. Previously issued passports using the gender marker "X" remain valid until their expiration date.[48]
From 2021 to 2025, the U.S. federal government recognized a third gender option on passports or other national identity documents, joining other countries includingAustralia,New Zealand,India,Nepal,Pakistan,Bangladesh,Germany,Malta, andCanada with similar recognition.[59][60]
Third genders have traditionally been acknowledged in a number ofNative American cultures as "two spirit" people, in traditional Hawaiian culture as themāhū, and as thefa'afafine inAmerican Samoa.[61][62][63][64]
Similarly, immigrants from traditional cultures that acknowledge athird gender would benefit from such a reform, including themuxe gender in southern Mexico and thehijra of south Asian cultures.[65][66][67] On June 10, 2016, an Oregon circuit court ruled that a resident,Elisa Rae Shupe, could obtain a non-binary gender designation. TheTransgender Law Center believes this to be "the first ruling of its kind in the U.S."[9]
On September 26, 2016,intersex California resident Sara Kelly Keenan became the second person in the United States to legally change her gender to 'non-binary', citing Shupe's case as inspiration.[68]
Keenan obtained a birth certificate with anintersex sex marker. Ohio had issued a 'hermaphrodite' sex marker in 2012.[69] The State Department issued the first passport with an "X" gender marker on October 27, 2021. In January 2025, Donald Trump signedExecutive Order 14168 to revoke the recognition of a third gender, and on January 22, 2025, Secretary of StateMarco Rubio directed theDepartment of State to suspend all applications seeking a sex marker change or a nonbinary "X" sex marker.[70]
| Jurisdiction | Gender marker changes allowed | X gender changes allowed | Gender marker changed banned |
|---|---|---|---|
 Alabama | May 21, 1992[71] | N/A | October 1, 2025 (statutory, X only)[72] |
 Alaska | December 6, 2002 or prior[73] | N/A | |
 American Samoa | June 10, 2004 or after[74] | ||
 Arizona | January 1, 1968[75] | ||
 Arkansas | February 19, 1981[75] | ||
 California | January 1, 1978[76] | January 1, 2019[77] | N/A |
 Colorado | July 1, 1984[78] | September 19, 2018 ("Intersex")[79] | |
| February 14, 2019 ("X")[80] | |||
 Connecticut | May 29, 1975[81] | December 2021[82] | |
| July 1, 1997 (codified, hermaphroditism only)[75] | |||
| October 1, 2001 (codified)[75] | |||
 Delaware | May 11, 1999 or prior[83] | N/A | |
 Washington, D.C. | October 8, 1981[84] | October 22, 2014 ("Unknown")[85] | N/A |
 Florida | December 6, 2002 or prior[73] | N/A | August 2023[86] |
 Georgia | November 1, 1982[87] | N/A | |
 Guam | May 31, 1994[88] | ||
 Hawaii | May 4, 1973[75] | ||
 Idaho | April 6, 2018[89] | N/A | December 6, 2002 or prior (administrative action)[73] |
 Illinois | 1955[90] | July 14, 2020[91] | N/A |
| January 1, 1961 (codified)[75] | |||
 Indiana | July 1, 1993[92] | N/A | March 4, 2025 (executive order)[93] |
 Iowa | July 1, 1976[94] | July 1, 2025 (statutory)[95] | |
 Kansas | May 1, 1987[96][97] | February 22, 2012 (administrative action)[97] | |
| June 21, 2019[98] | July 1, 2023 (statutory)[99] | ||
 Kentucky | July 13, 1990[75] | N/A | |
 Louisiana | July 31, 1968[75] | ||
 Maine | August 1, 1982[100] | July 14, 2020[101] | N/A |
 Maryland | October 1, 1995[102] | N/A | |
 Massachusetts | 1975 or after[103] | July 1, 2024[104] | N/A |
| December 23, 1981[75] | |||
 Michigan | September 30, 1978[105] | July 8, 2021[106] | |
 Minnesota | March 29, 1978[107] | N/A | |
 Mississippi | August 23, 1994[108] | ||
 Missouri | August 28, 1984[75] | ||
 Montana | February 15, 2002[109] | N/A | May 23, 2022 (administrative action)[110] |
| September 22, 2022[111] | February 20, 2024 (administrative action)[112] | ||
| December 17, 2024[113] | N/A | ||
 Nebraska | July 16, 1994[114] | N/A | |
 Nevada | July 3, 1976[115] | January 1, 2018[116] | N/A |
 New Hampshire | November 21, 2001[117] | N/A | |
 New Jersey | November 19, 1984[118] | February 1, 2019[119] | N/A |
 New Mexico | March 21, 1981[120] | June 14, 2019[121] | |
 New York | 1970s[122] | January 9, 2023[123] | |
 North Carolina | June 11, 1975[124] | N/A | January 1, 2026 (statutory, X only)[125] |
 North Dakota | December 6, 2002 or prior[73] | N/A | August 1, 2023 (statutory, X only)[126] |
 Northern Mariana Islands | March 14, 2007[127] | N/A | |
 Ohio | 2012 or prior[128] | 2012 ("Hermaphrodite")[128] | 2015 (administrative action)[129] |
| May 26, 2021[130] | September 30, 2025 (statutory, X only)[131] | ||
 Oklahoma | 1997[132] | October 7, 2021[133] | November 8, 2021 (executive order)[134] |
| April 26, 2022 (codified)[135] | |||
 Oregon | November 1, 1981[136] | January 1, 2018[137] | N/A |
 Pennsylvania | December 6, 2002 or prior[73] | N/A | |
 Puerto Rico | 1976[138] | ||
 Rhode Island | December 6, 2002 or prior[73] | October 1, 2019[139] | N/A |
 South Carolina | May 22, 1968[140] | N/A | |
 South Dakota | July 1, 1980[141] | ||
 Tennessee | N/A | July 1, 1977 (statutory)[142] | |
 Texas | August 31, 1981[143] | N/A | August 30, 2024 (administrative action)[144] |
| September 1, 2025 (codified)[145] | |||
 Utah | August 24, 1975[146] | 2017[147] | N/A |
 Vermont | December 6, 2002 or prior[73] | July 1, 2022[148] | |
 Virginia | October 1, 1979[149] | N/A | |
 United States Virgin Islands | October 1, 2025[150] | ||
 Washington | December 6, 2002 or prior[73] | January 27, 2018[151] | N/A |
 West Virginia | May 1, 1991[152] | N/A | May 29, 2024 (statutory, X only)[153] |
 Wisconsin | May 7, 1986[154] | N/A | |
 Wyoming | December 6, 2002 or prior[73] | N/A | March 14, 2025 (statutory, X only)[155] |
U.S. states make their own laws aboutbirth certificates, and state courts have issued varied rulings about transgender people.[156][157] Most states permit the name and sex to be changed on a birth certificate, either by amending the existing birth certificate or by issuing a new one, although some require medical proof of gender-affirming surgery to do so.
These include:
Regulations were set up under a signedexecutive order for theKansas Department of Health and Environment (KDHE) by theGovernor of Kansas. In 2023,SB 180 was passed by the Kansas Legislature, which changed the laws regarding changing a person's gender markers on their birth certificate and state identity documents. The KDHE announced it would no longer issue new birth certificates with amended gender markers due to recently passed state law, and any previously issued birth certificates with a changed gender marker would be reverted to the original gender at birth if reissued.[165]
Additionally, theKansas Department of Revenue (KDOR) announced after a temporary restraining order that any credentials issued after July 10, 2023 would be required to reflect the gender of the person at birth, if known to the department.[166]Virginia removed the requirement for surgery to change the gender marker in September 2020.[167]
Tennessee will not change the sex on a birth certificate under any circumstances.[168][169][170]
In December 2020, a federal judge invalidated an unconstitutional departmental rule banning sex changes on an individual's birth certificate withinOhio.[171] In 2022,Oklahoma became the second state to ban legal gender marker change on birth certificates. This followed an executive order issued by the governor the previous year.[172][173]
Oklahoma Senate Bill 1100 also banned non-binary gender markers on birth certificates.[174] During the same year, Montana also issued a rule that banned legal gender change on birth certificates.[175]
In 2024, District Judge Mike Menahan issued an injunction blocking Montana's rule.[176]
Policies allowing a nonbinary or “X” gender marker on birth certificates followed separate legal and administrative processes through state vital records offices.New York City, which independently administers its own vital records, began issuing birth certificates with an “X” gender marker in January 2019.[177]
California’s SB 179 (the Gender Recognition Act), signed in October 2017 and implemented on January 1, 2019, also authorized nonbinary designations on birth certificates issued by the state.[178] Following these changes, additional states adopted procedures allowing amendments to birth certificates to reflect a nonbinary or third-gender marker.
Jurisdictions that currently allow a nonbinary gender marker on birth certificates includeCalifornia,Colorado,Connecticut,[179]Delaware,Hawaiʻi,Illinois,[180]Maryland,Massachusetts,Michigan,Minnesota,Nevada,New Jersey,New York,Ohio,Oregon,Pennsylvania,Rhode Island,Vermont,Virginia, andWashington, D.C. In addition,Puerto Rico permits an “X” marker on birth certificates following judicial and administrative rulings.[181]
Requirements for amending birth certificates vary by state; while some jurisdictions allow self-attestation similar to driver’s license standards, others continue to require a court order, affidavit, or medical documentation to complete the change.
The first case to consider legal gender change in the U.S. wasMtr. of Anonymous v. Weiner (1966), in which a transgender woman wished to change her name and sex on her birth certificate in New York City after having undergone gender-affirming surgery. The New York City Health Department denied the request. She took the case to court, but the court ruled that the New York City Health Code did not permit the request, which only permitted a change of sex on the birth certificate if an error was made recording it at birth.[182][183]
The decision of the court inWeiner was again affirmed inMtr. of Hartin v. Dir. of Bur. of Recs. (1973) andAnonymous v. Mellon (1977). Despite this, there can be noted as time progressed an increasing support expressed in judgments by New York courts for permitting changes in birth certificates, even though they still held to do so would require legislative action.
Classification of characteristic sex is a public health matter in New York; and New York City has its own health department which operates separately and autonomously from the New York State health department.[citation needed]
An important case in Connecticut wasDarnell v. Lloyd (1975),[184] where the court found that substantial state interest must be demonstrated to justify refusing to grant a change in sex recorded on a birth certificate.[185]
InK. v. Health Division (1977),[186] the Oregon Supreme Court rejected an application for a change of name or sex on the birth certificate of a transgender man who had undergone gender-affirming surgery, on the grounds that there was no legislative authority for such a change to be made.[citation needed]
A study conducted by Oregon epidemiologists found that within the area of Portland, Oregon, more than half of dead trans people were recorded as their assigned sex at birth on their death certificates.[187]
As of February 2024, all U.S. States except for Kansas and Florida allow the gender marker to be changed on a driver's license, although the requirements for doing so vary by state. Often, the requirements for changing one's driver's license are less stringent than those for changing the marker on the birth certificate. For example, until August 1, 2015, the state ofMassachusetts requiredgender-affirming surgery for a birth certificate change,[188] but only a form including a sworn statement from a physician that the applicant is in fact the new gender to correct the sex designation on a driver's license.[189]
As of November 2019, the Commonwealth of Massachusetts no longer requires any documentation or a sworn statement from a medical doctor in order to change one's gender marker on their drivers license/state ID. In order to change the gender marker, one only needs to fill out a new drivers license/ID card application reflecting the correct information.[190]
In May 2015, six Michigan transgender people filedLove v. Johnson in theUnited States District Court for the Eastern District of Michigan, challenging the state's policy requiring the information on a person's driver's license match the information on their birth certificate.[191][192] This policy requires transgender people to change the information on their birth certificates in order to change their driver's licenses, which at the time of filing was not possible in Tennessee, Nebraska and Ohio, where three of the plaintiffs were born, and requires a court order in South Carolina, where a fourth was born.
The remaining two residents were born in Michigan, and would be required to undergo surgery to change their birth certificates.[191] The plaintiffs in the case are represented by theAmerican Civil Liberties Union.[191][192] In November 2015, JudgeNancy Edmunds denied the State of Michigan'smotion to dismiss the case.[191]
Transgender people often seek legal recognition for aname change during a gender transition. Laws regarding name changes vary state-by-state. In some states, transgender people can change their name, provided that the change does not perpetrate fraud or enable criminal intent. In other states, the process requires a court order or statute and can be more difficult. An applicant may be required to post legal notices in newspapers to announce the name change—rules that have been criticized on grounds of privacy rights and potentially endangering transgender people to targeted hate crimes.[193] Some courts require medical or psychiatric documentation to justify a name change, despite having no similar requirement for individuals changing names for reasons other than gender transitioning.[194]
In April 2025, theMississippi Supreme Court ruled that a transgender teen could not legally change his name, despite having the support of both his parents, until he turned 21 citing a "lack of maturity". The court also misgendered the teen throughout in the ruling. The legal age of majority in Mississippi is 21, however, minors are legally allowed to change their name in other circumstances in Mississippi as long as they have parental permission.[195]
Transgender individuals in the United States face severe challenges in securing safe, stable housing. Research from the 2015 U.S. Transgender Health Survey indicates that nearly 30% of transgender people have experienced homelessness at some point in their lives, with rates rising to 41% among Black transgender individuals.[196][197] These figures reflect not only a lack of affordable and inclusive housing options but also systemic barriers, including discrimination in employment, limited access to supportive services, and social stigma, that compound housing instability for trans communities.
In shelters and crisis centers, transgender people often encounter environments that are far from safe. Studies by theVera Institute have documented routine verbal and physical abuse directed toward trans individuals in these facilities, further exacerbating their vulnerability and negatively impacting their mental and physical health.[198] In many cases, shelter staff are ill-prepared to address the unique needs of transgender clients, which can lead to misgendering, exclusion, or even violent encounters.
Policy shifts over the past decade have also played a significant role in shaping housing access for transgender people. In 2020, the Trump administration rolled back several Obama-era protections intended to ensure equal access to homeless shelters for transgender individuals. One controversial action was the issuance of guidelines instructing shelter staff on how to identify transgender women, a move widely criticized for legitimizing discriminatory practices and undermining the dignity and safety of trans people.[199][200]
However, there has been progress as well. In 2021, a memo from theU.S. Department of Housing and Urban Development (HUD) expanded the scope of the 2012 Equal Access Rule. This revised guidance declared that all individuals, regardless of their actual or perceived sexual orientation, gender identity, or marital status, must have equal access to HUD programs and affiliated shelters.[201] This policy aimed to reverse some of the previous setbacks by reinforcing nondiscrimination in federal housing programs.
Housing instability is a pervasive issue for transgender and gender nonconforming youth in the United States. While roughly 28% of LGBTQ+ youth experience homelessness or housing instability, trans and gender nonconforming youth often face even greater risks due to unique challenges related to their gender identity.[202][203][204][205] Many of these young people are forced to leave home or run away because of family rejection and mistreatment. Studies reveal that while only 23% of cisgender boys/men and 23% of cisgender girls/women report past or current housing instability, rates among trans girls/women and trans boys/men rise to 38% and 39% respectively, with nonbinary youth at 35% and gender-questioning youth at 24%.[202][205][204] These figures underscore the disproportionate vulnerability of trans and gender nonconforming youth to unstable living conditions.
The consequences of such instability extend far beyond the absence of a permanent home. Trans and gender nonconforming youth experiencing housing instability are two to four times more likely to report severe mental health challenges (including depression, anxiety, self-harm, and suicidal ideation) compared to their stably housed peers.[202][205] For instance, among LGBTQ+ youth with stable housing, 35% have seriously considered suicide and 10% have attempted it. In contrast, those who have experienced past housing instability report rates of 58% for suicidal ideation and 28% for suicide attempts, while youth who are currently homeless report rates as high as 62% and 35%, respectively.[202][205] Similarly, the risk of victimization also increases with housing instability: youth with stable housing report threat rates due to sexual orientation and gender identity at 10% and 14%, respectively; these numbers climb to 26% and 34% for those with past instability, and further to 30% and 39% among youth who are currently homeless.[202][205] These statistics indicate a stepwise escalation in mental health and safety risks correlated with the degree of housing instability.
An analysis of the data reveals that housing instability is strongly associated with elevated mental health risks among LGBTQ+ youth. The transition from a stable housing situation, where 35% report considering suicide and 10% report suicide attempts, to a state of past instability, with figures of 58% and 28%.[202][205][204] Among those currently homeless, the rates further increase to 62% and 35%, which illustrates a clear gradient of risk corresponding to housing conditions. Similarly, when examining victimization, the baseline threat due to gender identity at 14% in stable conditions rises to 34% with past instability and 39% when currently homeless.[202][205] These figures suggest that as housing stability decreases, the likelihood of encountering threats and abusive behaviors increases significantly, indicating a strong correlation between housing status and personal safety.
Further dissection of the data by gender identity highlights distinct disparities among subgroups within the LGBTQ+ community. Cisgender youth, both boys/men and girls/women, report housing instability at a rate of 23%, whereas the rates for trans girls/women and trans boys/men are substantially higher, at 38% and 39% respectively.[202][205] Nonbinary youth also face a high rate of instability at 35%, with gender-questioning youth reporting slightly lower rates at 24%.[202][205] These disparities suggest that transgender and gender nonconforming youth experience a roughly 1.5 to 1.7 times higher prevalence of housing instability compared to their cisgender peers. The data, when combined with the elevated rates of suicidal ideation, suicide attempts, and victimization, underscore the compounded challenges that these youth face.
In response to this crisis, several efforts have emerged at the policy and institutional level to address LGBTQ+ youth homelessness. Experts have emphasized the need for stronger anti-discrimination protections, such as those proposed in the federal Equality Act, which would add sexual orientation and gender identity as protected classes under the Civil Rights Act.[206] Researchers and advocates also call for increased investment in equitable housing, better inclusion of LGBTQ+ data in federal surveys, and the development of targeted resources, including LGBTQ-affirming shelters and transitional housing programs.[206]
Some critics, including journalistsEmily St. James andSaeed Jones and civil rights lawyerChase Strangio, have described US laws as fitting the United Nations' definition ofgenocide, such as those laws which ban proper transgender healthcare ("causing serious bodily or mental harm to members of the group; deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part"), and those mandating that trans children be taken away by the state ("forcibly transferring children of the group to another group").[207][208][209]
On March 3, 2023, at theConservative Political Action Conference, political commentatorMichael Knowles declared that "If it is false, then for the good of society, and especially for the good of the poor people who have fallen prey to this confusion, transgenderism must be eradicated from public life entirely—the whole preposterous ideology, at every level." This statement, and other parts of his speech, led theLemkin Institute for Genocide Prevention to raise a 'Red Flag Alert' in the US, stating "Now that ideologues of hate can openly call for the elimination of transgender identity – in the very country that has been most open to the transgender community over the last decade – we are at a new stage in the global threat against transgender people."[210]
Transgender healthcare bans have been described as dire by members of the medical community. A medical report which was published by Yale in response to bans on gender-affirming care argued that the bans were no more ethical than a prohibition on healthcare for any other life-threatening medical condition.[211] The president of the World Professional Association of Transgender Health (WPATH) wrote an opinion article in theNew York Times stating her view that these laws constituted an effort to "rid the world of transgender people."[212] Similar sentiments were expressed in a WPATH public communique: "Anti-transgender health care legislation is not about protections for children but about eliminating transgender persons on a micro and macro scale."[213]
According to the legal definition ofcrimes against humanity which is propagated at theHague by theInternational Criminal Court, "'extermination' includes the intentional infliction of conditions of life, inter alia the deprivation ofaccess to food and medicine, calculated to bring about the destruction of part of a population" when "pursuant to or infurtherance of a State or organizational policy to commit such attack."[214]
The compiling of lists of transgender citizens by governments, such as the list which was compiled by the state of Texas in 2022,[215] has been criticized by trans advocates who feared the state would "use the information to further persecute the already vulnerable trans community."[216] In August 2024, the Texas Department of Public Safety (DPS) issued a statement saying they would no longer accept court orders as a basis to change a person's sex on their drivers license, effectively banning trans people from changing their sex on their drivers license. The statement also "directs drivers license employees to send the names and identification numbers of people seeking to change their sex on their license to a particular email address" with the subject line "Sex Change Court Order." Drivers license employees are also ordered to "scan into the record" court orders or other documents associated with any sex change requests. The DPS refused to say how this information will be used.[217]
In June 2023, the Attorney General's office for the state of Tennessee mandated theVanderbilt University Medical Center to turn over the medical records of all of its transgender patients. The VUMC complied.[218]
As part of his2024 presidential campaign,Donald Trump stated that if elected, he would sign an executive order instructing every federal agency to cease the promotion of sex or gender transition at any age as well as ask Congress to pass a bill stating that the United States will only recognize two genders as determined at birth, and promised to crackdown on gender-affirming care for all ages. Additionally, Trump stated that he would make hospitals and health care providers that provide transitional hormones or surgery no longer qualify for federal funding, including Medicare and Medicaid funding. Trump has also stated he will push to prohibit hormonal and surgical intervention for minors in all 50 states.[219][220][221][222]
On the January 20, 2025, shortly after being inaugurated, President Donald Trump signed an Executive Order,[223][224] which defined sex in the eyes of the federal government as a male-female binary, with "female" and "male" defined as "a person belonging, at conception to the sex that produces the large reproductive cell" and a "person belonging, at conception, to the sex that produces the small reproductive cell" respectively.[223] The order also mandated that:
Provisions of the order have faced legal challenges, withtemporary restraining orders having been issued to suspend the withholding of federal funding to programs that fundgender-affirming care and promote "gender ideology", the forced transfers of transgender inmates to facilities congruent with their sex assigned at birth, and the mass removal of documents published by theCenters for Disease Control and Prevention,Food and Drug Administration,Department of Health and Human Services that mention topics related to "gender ideology".[24][226][227]
On January 27, 2025, Trump signed an executive order declaring that a soldier being trans “conflicts with a soldier's commitment to an honorable, truthful, and disciplined lifestyle, even in one's personal life” and that trans people “cannot satisfy the rigorous standards necessary for military service”.[228]
On March 18, 2025, JudgeAna C. Reyes blocked the executive order, ruling that banning trans people from the military likely violated their constitutional rights.[229]
On January 28, 2025, Trump signed an executive order to "Protect Children from Chemical and Surgical Mutilation". The order describedgender-affirming care for minors as "chemical and surgical mutilation of children" as well as "maiming" and "sterilizing".[230] It stated "countless children" who received such care would regret a "horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding."[231] The order also described theWorld Professional Association for Transgender Health's (WPATH) guidance as "junk science".[231][230]
The order states that the US Federal Government will not "fund, sponsor, promote, assist, or support the so-called 'transition' of a child from one sex to another."[26] The provisions include:
In response, some hospitals paused providing gender-affirming care for minors, while others continued. Attorneys general from 15 states said their states are committed to continuing to provide gender-affirming care to minors. Multiple groups filed lawsuits challenging the legality of the executive order. In response to one of the lawsuits, several federal judges issued injunctions blocking the government from withholding federal funds from hospitals that provide gender affirming care to minors.[233][227] Following the injunction, some hospitals that initially paused gender-affirming care for minors resumed the care.[234][235]
In the summer of that year, the Department of Justice began sending subpoenas to "over 20" hospitals demanding the full records of patients who received medical care under 19 - including their names, social security numbers, doctors' notes, and treatments prescribed.[236][237]
On January 28, 2025, Trump ordered a freeze on all federal funding grants, loans, and aid while those receiving them were assessed to make sure they weren't promoting "advance Marxist equity, transgenderism, and green new deal social engineering policies".[238]
On January 29, 2025, Trump signed an executive order "Ending Radical Indoctrination in K-12 Schooling".[239]
On February 5, 2025, Trump signed an executive order titled "Keeping Men Out of Women's Sports", which directs federal agencies and state attorneys general to immediately enforce a prohibition of transgender girls and women from participating in women's sports.[18][240] The order does not ban transgender men athletes from playing on male sports teams.[241] As part of this order's implementation, theDepartment of Education urged high school and college athletics organizations NCAA andNFHS to revoke female transgender athletes' records and restore cisgender athletes' ones.[242][243] The State Department also announced a ban on transgender athletes from entering the United States if they attempt to compete in women's sports, and that visa applicants suspected of such would have their file marked with the letters 'SWS25' for the purposes of tracking.[244]
The Trump administration is purportedly looking to restrict transgender people's right to possess firearms. Talks to that effect were held in the wake of theMinneapolis Annunciation Catholic Church shooting.[245]
A 2014 report by theDepartment of Justice found that 2% of trans people report being physically attacked upon visiting a doctor's office, with 3% reporting being forcibly subjected to unwanted medical procedures.[246]
According to a study published by theUCLAWilliams Institute, transgender people are the victims of violent crimes at over four times the rate of cisgender people. The study found that from 2017 to 2018, trans people experienced violent victimizations at a rate of 86.2 per 1000 people, compared to 21.7 among cis people. Trans women suffered at a rate of 86.1 per 1000, compared to cis women's 23.7, and trans men suffered at a rate of 107.5 per 1000 compared to cis men's 19.8.[247]
According to the Department of Justice in 2022, 50% of people who die in anti-LGBT hate crimes are trans women, with sexual assault being a frequent occurrence after their murders. Additionally, 50% of transgender people are physically abused after coming out as trans to a significant other.[248]
In June 2022, NBC reported "Events for transgender rights (…) have become frequent targets of extremists, militias, and far-right personalities".[249]
In August 2022, a draft report from the California Attorney General's Office found that trans people were four times more likely to be stopped by police for "reasonable suspicion" than cis people.[250]
According to the Department of Justice in 2022, 66% of trans people experience sexual assault at some point in their lives. 15% of trans people report being sexually assaulted by police or prison staff (32% for African-American trans people), while another 10% report being sexually assaulted by healthcare professionals.[251] An older study conducted by the DOJ in 2014 also found that it was not uncommon for psychiatric professionals to mandate that trans patients of theirs perform sexual favors for them in exchange for continued access to gender affirming healthcare.[246]
The Trafficking in Persons report by theState Department found that trans people are significantly overrepresented in sex trafficking victims, and a study by Loyola University Chicago found that trans people in the US are 5.6x more likely to engage in survival sex—where sex is traded for money, food, shelter, or other essential items such as phones or clothing—than their cis peers.[252][253][254]
According to the 2015 US Transgender survey, 13% of K-12 students who were out as or perceived as transgender were sexually assaulted specifically for being transgender.[255]
It's considered relatively common for transgender people to be subjected to pat downs and secondary searches while going through airport security, due to their body types deviating from the presets expected by the body scanners. These searches can range from being groped in the groin area, to being forced to strip entirely.[256][257]
Anti-trans legislation in numerous conservative states has caused some trans people and their families to flee their homes, whether to another state or another country, including the families of those who actively advocated againstanti-trans laws in their states.[258][259][260]
A number of states have passed laws protecting trans people and their families, as well as their healthcare providers, fleeing anti-trans states, from extradition. In 2022, Connecticut became the first state to implement such a law, alongside similar protections for reproductive healthcare providers and recipients.[261] Since then, Massachusetts, California, Illinois, Minnesota, New Jersey, New Mexico, Vermont, Colorado, Washington, New York, Arizona, Maine, Rhode Island, Oregon, Maryland, and the District of Columbia have passed similar laws.[262][263][264][265][4][266][267][268][269][270][271]
In June 2023, polling fromData for Progress found that 8% of transgender adults in the US have been displaced from their community or state by hostile legislation.[272]
In June 2020, theU.S. Supreme Court ruled for the first time on a case directly regarding Transgender rights. In the caseR.G. & G.R. Harris Funeral Homes Inc. v. Equal Employment Opportunity Commission, the Supreme Court held thatTitle VII of the Civil Rights Act 1964 extends protections to individuals who are transgender in Employment. This is based on discrimination on the grounds of transgender status is a form of discrimination based on sex. Prior to the rulings that Title VII protections covered transgender status, four states (Alaska, Arizona, Wisconsin, and Missouri) had not enacted specific protections based on transgender status in any employment, and 22 states had extended protections to public employment only.[273]
There is no federal law designating transgender as a protected class, or specifically requiring equal treatment for transgender people. Some versions of theEmployment Non-Discrimination Act introduced in the U.S. Congress have included protections against discrimination for transgender people, but as of 2021 no version of ENDA has passed. Whether or not to include such language has been a controversial part of the debate over the bill. In 2016 and again in 2017, Rep.Pete Olson [R-TX] introducedlegislation to strictly interpret gender identity according to biology, which would end federal civil rights protection of gender identity. It remains legal at the federal level for parents to subject transgender children toconversion therapy.
On October 4, 2017, Attorney GeneralJeff Sessions released aDepartment of Justice memo stating thatTitle VII of the 1964 Civil Rights Act prohibits discrimination based on sex, which he stated "is ordinarily defined to mean biologically male or female," but the law "does not prohibit discrimination based on gender identityper se."[274]
On January 30, 2012, HUD SecretaryShaun Donovan announced new regulations that would require all housing providers that receive HUD funding to prevent housing discrimination based on sexual orientation or gender identity.[275] These regulations went into effect on March 5, 2012.[276]
Over 225 jurisdictions including theDistrict of Columbia (as of 2016)[277] and 22 states (as of 2018) feature legislation that prohibit discrimination based on gender identity in either employment, housing, and/or public accommodations. In Anchorage, Alaska, voters chose in April 2018 to keep the existing protections for transgender people.[278] In Massachusetts, a state law prohibited discrimination in public accommodations on the basis of gender identity; in October 2016, anti-transgender activists submitted the minimum number of signatures necessary to the Secretary of the Commonwealth of withinMassachusetts to put the law up for repeal on a statewide ballot measure,[279] Massachusetts voters chose on November 6, 2018 to retain the state law, with 68% in favor of upholding law, and 32% opposed. TheMassachusetts Gender Identity Anti-Discrimination Initiative was the first-ever statewide ballot question of its kind in theUnited States.
Some states and cities havebanned conversion therapy for minors.
| State | Date effective | Employment | Housing | Public accommodations |
|---|---|---|---|---|
| Minnesota | 1993[280] |  | | |
| Rhode Island | Dec 6, 1995(public accommodation) July 17, 2001(employment and housing)[281] | | | |
| New Mexico | July 1, 2003(employment and housing) 2004(public accommodation) | | | |
| California[282] | 2004(employment and housing) Oct 9, 2011(public accommodations) | | | |
| District of Columbia | 2005(employment and housing) March 8, 2006(public accommodations) | | | |
| Maine | December 28, 2005 | | | |
| Illinois | 2005(employment and housing) 2006(public accommodations) | | | |
| Hawaii | July 11, 2005(housing and public accommodations) May 5, 2011(employment) | | | |
| Washington | 2006 | | | |
| New Jersey | 2006 | | | |
| Vermont | 2007 | | | |
| Oregon | 2007 | | | |
| Michigan | Codified in March 2023[283] | | | |
| Iowa | 2007-2025 (Gender identity no longer protected from July 1, 2025)[284] | | | |
| Colorado[285] | 2007(employment and housing) 2008(public accommodations) | | | |
| Nevada | 2011 | | | |
| Connecticut[286] | October 1, 2011 | | | |
| Massachusetts[287] | 2012(employment and housing) 2016(public accommodations)[287] | | | |
| Delaware | 2013 | | | |
| Maryland | 2014 | | | |
| Utah | 2015 | | |  |
| New York[288] | January 20, 2016 | | | |
| New Hampshire[289][290] | July 8, 2018 | | | |
| Virginia[291] | July 1, 2020 | | | |
In 2000, a court ruling in Connecticut determined that conventional sex discrimination laws protected transgender persons. However, in 2011, to clarify and codify this ruling, a separate law was passed defining legal anti-discrimination protections on the basis of gender identity.[292]
On October 16, 1976, the Court rejected plaintiff's appeal in sex discrimination case involving termination from teaching job after gender-affirming surgery from a New Jersey school system.[293]
Carroll v. Talman Fed. Savs. & Loan Association, 604 F.2d 1028, 1032 (7th Cir.) 1979, held that dress codes are permissible. "So long as [dress codes] and some justification in commonly accepted social norms and are reasonably related to the employer's business needs, such regulations are not necessarily violations of Title VII even though the standards prescribed differ somewhat for men and women."[294]
InUlane v. Eastern Airlines Inc. 742 F.2d 1081 (7th Cir. 1984)Karen Ulane, a pilot who was assigned male at birth, underwent gender-affirming surgery to attain typically female characteristics. The Seventh Circuit denied Title VII sex discrimination protection by narrowly interpreting "sex" discrimination as discrimination "against women" [and denying Ulane's womanhood].[295]
The case ofPrice Waterhouse v. Hopkins 490 U.S. 228 (1989), expanded the protection of Title VII by prohibiting gender discrimination, which includes sex stereotyping. In that case, a woman who was discriminated against by her employer for being too "masculine" was granted Title VII relief.[296]
Oncale v. Sundowner Offshore Services, Inc. 523 U.S. 75 (1998), found that same-sex sexual harassment is actionable under Title VII.[297]
A gender stereotype is an assumption about how a person should dress which could encompass a significant range of transgender behavior. This potentially significant change in the law was not tested untilSmith v. City of Salem 378 F.3d 566, 568 (6th Cir. 2004). Smith, a trans woman, had been employed as a lieutenant in the fire department without incident for seven years. After doctors diagnosed Smith withGender Identity Disorder ("GID"), she began to experience harassment and retaliation following complaint. She filed Title VII claims of sex discrimination and retaliation, equal protection and due process claims under 42 U.S.C. § 1983, and state law claims of invasion of privacy and civil conspiracy. On appeal, thePrice Waterhouse precedent was applied at p. 574: "[i]t follows that employers who discriminate against men because they do wear dresses and makeup, or otherwise act femininely, are also engaging in sex discrimination, because the discrimination would not occur but for the victim's sex."[298] Chow (2005 at p214) comments that the Sixth Circuit's holding and reasoning represents a significant victory for transgender people. By reiterating that discrimination based on both sex and gender expression is forbidden under Title VII, the court steers transgender jurisprudence in a more expansive direction. But dress codes, which frequently have separate rules based solely on gender, continue.Carroll v. Talman Fed. Savs. & Loan Association, 604 F.2d 1028, 1032 (7th Cir.) 1979, has not been overruled.
Harrah's implemented a policy named "Personal Best", in which it dictated a general dress code for its male and female employees. Females were required to wear makeup, and there were similar rules for males. One female employee, Darlene Jesperson, objected and sued under Title VII. InJespersen v. Harrah's Operating Co., No. 03-15045 (9th Cir. April 14, 2006), plaintiff conceded that dress codes could be legitimate but that certain aspects could nevertheless be demeaning; plaintiff also citedPrice Waterhouse. The Ninth Circuit disagreed, upholding the practice of business-related gender-specific dress codes. When such a dress code is in force, an employee amid transition could find it impossible to obey the rules.[citation needed]
InGlenn v. Brumby, the11th Circuit Court of Appeals held that theEqual Protection Clause prevented the state ofGeorgia from discriminating against an employee for being transgender.[299][300]
On March 2, 2023,Tennessee governorBill Lee signed theAdult Entertainment Act, which prohibits drag performances for children.[301][302] This bill sparked outrage from the LGBT community.[303] On June 3, 2023, a federal judge ruled that the law is unconstitutional.[304] On July 18, 2024, a three judge panel on theSixth Circuit reinstated the law by ruling that the plaintiffs had lacked the standing to sue. The ruling did not address whether the law was constitutional.[305]
The states ofFlorida,Montana, andTexas have also passed laws banning public drag performances.[306][307] However, all three of these drag show bans were blocked by courts from taking effect.[308][309][310][311]
The Obama administration took the position thatTitle IX's prohibition on discrimination on the basis of "sex" encompasses discrimination on the basis of gender identity and gender expression. In 2016, theFourth Circuit became the first[312] Court of Appeals to agree with the administration on the scope of Title IX as applied to transgender students, in the case of Virginia high school student Gavin Grimm (G.G. v. Gloucester County School Board).[313] The validity of the executive's position is being tested further in the federal courts. In 2017 theACLU, representing Grimm, stated that they had stopped Grimm's "request for an immediate halt to the Gloucester County School Board's policy prohibiting him and other transgender students from using the common restrooms at school" but were "moving forward with his claim for damages and his demand to end the anti-trans policy permanently."[314] Judge Allen of the U.S. District Court of the Eastern District of Virginia, in May 2018, ruled that Grimm's discrimination claim was valid based upon Title IX and the U.S. Constitution's equal protection clause.[315][316]
In 2025, after Donald Trump signedan executive order prohibiting federal agencies from recognizing transgender identity, the U.S. Department of Education told all employees to end all programs, contracts, and policies that "fail to affirm the reality of biological sex" by affirming transgender people.[317] Another executive order titled "Ending Radical Indoctrination in K-12 Schooling"[318] declares transgender ideas or concepts to be "anti-American" and "subversive",[319] and directs law enforcement to criminally prosecute any teacher who "unlawfully facilitates" thesocial transition of a transgender minor. Listed examples of unlawful facilitation include psychiatric counseling by a school counselor, referring to the student using their preferred name and/or pronouns, referring to a student as "nonbinary", and allowing the student to use segregated facilities or participate on segregated sports teams differing from those of theirassigned sex. The order directs that educators in violation of this law be prosecuted as having committed sexual exploitation of a minor, and/or practicing medicine without a license.[320][319][321] Additionally, schools found in violation would have their federal funding revoked.[322] The order conflicted with preexisting legal precedents, as federal courts had protected gender identity from discrimination in schooling, and the federal government had limited jurisdiction over curriculum.[323]
According to theVera Institute in 2016, "transgender youth are more likely to leave school due to harassment, physical assault, and sexual violence".[198] In 2016, guidance was issued by the Departments of Justice and Education stating that schools which receive federal money must treat a student's gender identity as their sex (for example, in regard to bathrooms).[324] However, this policy was revoked in 2017.[324]
TheU.S. Department of Agriculture requires schools participating in federal food assistance programs to investigate allegations of discrimination due to sexual orientation or gender identity. In July 2022, Texas, along with more than 20 other states, sued to overturn this requirement.[325][326]
In 2024, the U.S. House of Representatives considered the "Parental Rights Over The Education and Care of Their Kids Act" aka the "PROTECT Kids Act" (HR 736). Students up toGrade 8 would need "parental consent" to change their "gender markers, pronouns, or preferred name on any school form" or "sex-based accommodations, including locker rooms or bathrooms." Schools that ignore the requirement for parental consent would lose federal funding.[327] This bill was merged into the "Parental Bill of Rights Act" and passed the House in 2024.[328]
Local K-12 school boards have adopted a variety of policies regarding trans students, ranging from allowing fully equal rights and non-discrimination for trans students, to requiring trans students to submit to a criminal background check to be allowed to use the bathroom consistent with their gender identity, to implementing full bans on expressing one's self-declared gender at all, including bans on chosen pronouns and pride flags, to even bans on mentioning the very existence of trans people.[329][330][331][332]
States have similarly passed laws both protecting and restricting LGBT inclusion in classrooms. In 2014, the Maryland Senate passed a bill that "bans discrimination based on sexual orientation and sexual identity but includes an exemption for religious organizations, private clubs and educational institutions.[333]
In 2022, the state of Florida enacted theParental Rights in Education Act, commonly known as the "Don't Say Gay Bill", banning any "classroom discussion about sexual orientation or gender identity" by school personnel or third parties, up through third grade.[334] For older students, any discussion of such must be "age appropriate or developmentally appropriate", with the goal to, according to the text of the legislation, "reinforce the fundamental right of parents to make decisions regarding the upbringing and control of their children".[335] As of July 2022, five more states have enacted similar laws.[336] In early 2023, a national proposal based on this Florida law was introduced as HR 5, "The Parents Bill of Rights Act."[337] In July 2022, the Florida Department of Education issued a memo to all Florida schools referring to transgender non-discrimination policies regarding access to public facilities as "imposing a sexual ideology" on schools, saying that any school that did not sufficiently discriminate against transgender students could be acting in violation of state law.[338]
As of April 2024[update], at least six states—Alabama, Arizona, Arkansas, Idaho, Indiana and North Carolina—have laws that, if a teacher believes a child is transgender, the teacher must notify the child's parents.[339] Additionally, Virginia asked schools to write guidance on this matter.[340] In 2025, the Utah legislature passed a bill banning transgender students of public universities from living in dorms consistent with their gender identity.[341]
In a 2021 survey by theUCLAWilliams Institute, 48.8% of trans people reported experiencing employment discrimination due to their trans status. 43.8% reported receiving verbal harassment in the workplace for being trans, and 22.4% reported being sexually harassed in the workplace in the preceding five years.[342]
According to theHuman Rights Campaign, in 2021 transgender women in the US were paid 60 cents for every dollar the average worker was paid.[343]
A study conducted by theCenter for Public Integrity in July 2022 found that in preceding month, 30% of trans adults had lost their jobs or lived with someone who had, and that in that month trans people experienced hunger at more than twice the rate that cis people did.[344]According to Ross Wicks, director of LGBTQ+ Canadian non-profit Pflag, While more than 60% of Americans favor transgender rights in education and public employment, 41% support a ban on teaching about gender identity in elementary schools.[345]
According to the 2022 US Transgender Survey, 18% of all trans adults face unemployment, while the number living below the poverty line is 34%.[346]
In February 2025, theU.S. Equal Employment Opportunity Commission moved to dismiss six of its own pending cases alleging gender identity discrimination: One in Alabama, one in California, three in Illinois and one in New York.[347][348] It cited Trump's January 20, 2025, executive order, "Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government", which defines sex as binary.[348][349]
Public support for transgender people has shifted in recent years.
As of 2021, aPBS report found that an "overwhelming" majority of Americans regardless of party affiliation supported maintaining the rights of transgender Americans, and opposed laws that would restrict their access to healthcare or participation in sports.[350]
According to thePublic Religion Research Institute, support for mandating that trans people use the bathroom corresponding to their gender assigned at birth has risen among all religious groups, with white Protestant evangelicals being the highest change, going from 41% in support to 72% in support between 2017 and 2021. 41% of total Americans hold this stance, with 31% disagreeing, and 28% not holding a position on the issue.[351] However, according to a 2022meta-analysis of research studies, these views vary widely between religious groups and denominations. The meta-analysis states thatreligiously Jewish people were more likely to report more positive attitudes towards transgender people, andBlack Protestant Christians were more likely to endorse that gender can be different from the one assigned at birth.[352]
60% of American adults reported in the summer of 2022 that they opposed allowing nonbinary marker options on government documents, while 58% reported supporting mandating that trans athletes compete on teams matching their gender assigned at birth.[351]
On the other hand, most Americans have more positive attitudes regarding transgender individuals in the workplace.[353] Although American adults overreport their support in surveys, over two-thirds of them would be comfortable with a transgender manager and support employment nondiscrimination protection for transgender people, even after correcting for this overreporting. However, stated labor market support for transgender people is lower than support for gay, lesbian, and bisexual people.
In 2019, a report analyzing 10 million US and UK social media posts over three and a half years found that of that 10 million social media posts, 15% (1.5 million) expressed transphobic sentiment.[354]
A study conducted byMedia Matters between February 2019 and February 2020 found that the top five most-interacted sources on Facebook regarding transgender people wereLifeSite News, theDaily Caller, theDaily Wire,Western Journal, and theAlliance Defending Freedom, with right wing sources on trans issues receiving 43.33 million interactions, compared to left wing sources receiving only 2.56 million.[355]
In the wake of theColorado Springs nightclub shooting, in which a man walked into an LGBTQ nightclub and opened fire, Twitter unbanned the accounts of several major anti-trans figures that had previously been suspended for breaking Twitter policies regarding the targeting of LGBTQ people,[356] while reformatting its hateful conduct policy so that a provision that banned "targeted misgendering or deadnaming of transgender individuals" was "now effectively dead", according to Vanity Fair.[357]
In February 2022,United States Senate candidateJ. D. Vance from Ohio falsely attributed the then loomingRussian invasion of Ukraine to transgender rights, saying "We didn't serve in the Marine Corps to go and fight Vladimir Putin because he didn't believe in transgender rights"[358]
In May 2022, United States RepresentativePaul Gosar issued a statement viaTwitter falsely claiming that the mass shooter in theUvalde school shooting which killed 19 elementary school children, was a "transsexual leftist illegal alien".[359]
A joint report by theHuman Rights Campaign and theCenter for Countering Digital Hate found that the Twitter accounts of RepresentativeMarjorie Taylor Greene and RepresentativeLauren Boebert were among the top three sources in the United States for the promotion and propagation of the grooming conspiracy theory.[360] In response, Lauren Boebert stated via Twitter "My tweets about groomers are only third? Guess that means I have to tweet about these sick, demented groomers even more".[361][362]
In September 2022, SenatorTed Cruz of Texas cast attention on a gender affirming healthcare doctor at University of Wisconsin, saying "She does this to children. Sterilizes & mutilates them".[363] Providing gender-affirming healthcare to trans minors is considered best practice by theAmerican Medical Association,American Psychiatric Association, theEndocrine Society,American Academy of Pediatrics, and theWorld Professional Association for Transgender Health.[364][365][366][367][368]
That same month, Republican RepresentativeBob Good from Virginia stated his belief that the high suicide rates among trans youth, widely believed to be due to systemic discrimination and lack of access to proper healthcare, were in fact due to sexual "grooming" into being transgender.[369][370] Senate CandidateHerschel Walker from Georgia was also reported as saying that trans children would not be able to get into heaven.[371]
In April 2022, the left-leaning media watchdogMedia Matters published a study stating that within a three week period spanning from March 17 to April 6,Fox News ran 170 segments on trans people, throughout which "the network spread dangerous lies about the trans community and repeatedly invoked the long-debunked myth that trans people pose a threat to minors and seek to groom them".[372]
In June 2022, theNew York Times published a front page article titled "The Battle Over Gender Therapy", which reportedly "uncritically platformed gender-critical group Genspect, and theNew York Times Magazine's article said the group has held 'web-based seminars that are critical of social and medical transition'", and that "Some parents, who are part of Genspect, told [the author] that they believed the 'rise in trans-identified teenagers was the result of a 'gender cult' – a mass craze'".[373] TheTexas Observer described the article as elevating "a handful of outliers and their discredited theories about trans people to prominence they do not enjoy among the medical community" and that "the article echoes right-wing fear-mongering about whether trans kids should be allowed to transition and even suggests their existence could be dangerous to other young people", noting that "the state of Texas is using it as evidence in an ongoing attempt to investigate trans-supportive healthcare as 'child abuse'".[374]
In July 2022, theNew York Times published an op-ed falsely attributing the overturning ofRoe v. Wade by six conservativeSupreme Court justices, to the existence of trans women causing the "erasure" of "women as a biological category".[375] This article was widely circulated, with RepresentativeRashida Tlaib issuing a statement in response saying that "During escalating assaults on trans people & trans rights nationwide, theNew York Times is featuring writers debating whether trans people should even exist and scapegoating this already-marginalized community."[376]
Since then, theNew York Times has published several more pieces arguing in favor of restricting access to gender affirming healthcare for trans people, many of which have been widely criticized as "misinformation" by medical experts.[377][378][379][380]
In February 2023, more than 200 NYT contributors signed an open letter expressing "serious concerns about editorial bias in the newspaper's reporting on transgender, non-binary, and gender nonconforming people". The letter characterized the NYT's reporting as using "an eerily familiar mix of pseudoscience and euphemistic, charged language", and raised concerns regarding the NYT's employment practices regarding trans contributors.[381]
Popularization of the grooming conspiracy theory in the United States has been linked toChristopher Rufo, who tweeted in August 2021 about "winning the language war," andJames A. Lindsay.[382][383] Following theWi Spa controversy in July 2021,Julia Serano noted that there a rise in false accusations of grooming directed towards transgender people, saying that it appeared as if there was a movement to "lay the foundation for just smearing all trans people as child sexual predators."[384]Libs of TikTok (LoTT) also helped popularize the term 'groomer' as a pejorative for LGBT people, supporters of LGBT youth,[385][386] and those who teach about sexuality.[387] In November 2021 LoTT claimed that theTrevor Project was a "grooming organization" and later in the year claimed thatChasten Buttigieg was "grooming kids."[385]
On February 24,The Heritage Foundation, a conservativeWashington, D.C.-based think tank, tweeted that the bill "protects young children fromsexual grooming".[388] On March 4,Christina Pushaw, press secretary for Florida GovernorRon DeSantis, referred to the bill as "an anti-grooming bill" and stated via twitter that anyone against it was "probably a groomer".[388]
Since then, numerous right wing pundits began describing the behavior of parents and teachers who want to allow children to express their transgender identity as grooming, and the term "groomer" has become widely used by conservative media and politicians to imply that the LGBTQ community and their allies are pedophiles or pedophile-enablers.[389][390]Slate magazine later described the word "grooming" as "the buzzword of the season".[388]
In April 2022, the left-leaning media watchdogMedia Matters published a study stating that within a three week period spanning from March 17 to April 6,Fox News ran 170 segments on trans people, throughout which "the network spread dangerous lies about the trans community and repeatedly invoked the long-debunked myth that trans people pose a threat to minors and seek to groom them".[372]
TheCanadian Anti-Hate Network has stated that trans people are "slandered the same way homosexual men were slandered in the 70s, and for the same reason: to deny them safety and equal rights," adding that "the far-right and their fellow travelers in the so-called Gender Critical or Trans-Exclusionary Radical Feminist movements use the exact same tropes in a bid to deny equal rights to trans persons."[391]Florence Ashley of theUniversity of Toronto has stated that the focus of the conspiracy on LGBT+ people and on trans people in particular is used to radicalize public opinion towards the far-right, comparing it to theWhite genocide conspiracy theory.[392]
According to a joint report in August 2022 by the AmericanHuman Rights Campaign, and the BritishCenter for Countering Digital Hate found that the 500 most influential hateful "grooming" tweets were seen 72 million times, and that "grooming" tweets from just ten influential sources were seen 48 million times. It also found thatMeta, formerly known as Facebook, had accepted up to $24,987 for ads pushing the grooming conspiracy theory, which had been served to users over 2.1 million times, and that Twitter - despite saying groomer slurs were a violation of its hate speech policy - failed to act on 99% of tweets reported for such.[360]
An area of legal concern for transgender people is access torestrooms which are segregated by gender. Transgender people have, in the past, been asked for legal identification while entering or using a gendered restroom.[393][394][395] Recent legislation has moved in contradictory directions. On one hand, non-discrimination laws have included restrooms aspublic accommodations, indicating a right to use gendered facilities which conform with a person'sgender identity.[396] On the other, some efforts have been made to insist that individuals use restrooms that match theirbiological sex, regardless of an individual's gender identity or expression.[397]
On June 1, 2015, theOccupational Safety and Health Administration (OSHA) issued nonbinding guidance titledA Guide to Restroom Access for Transgender Workers, recommending that all employers, including federal contractors, allow employees to use restrooms consistent with their gender identity.[398] The guidance remains publicly available but has no legal force. On August 18, 2016, theU.S. General Services Administration (GSA) issued GSA Bulletin FMR 2016-B1, formally titledImplementation of Executive Order 13672 – Gender Identity Non-Discrimination in Federal Facilities Managed by GSA and published in theFederal Register under the headingClarification of Nondiscrimination in the Federal Workplace. The bulletin interpreted the prohibition of sex discrimination under theFederal Management Regulation (FMR) to include gender identity, thereby extending nondiscrimination protections to transgender individuals in GSA-managed facilities—including restrooms, locker rooms, and other sex-segregated spaces—without documentation requirements.[399] The policy applied to both federal employees and members of the public visiting GSA-managed federal buildings.
On January 20, 2021, PresidentJoe Biden signedExecutive Order 13988: Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation, which directed agencies to ensure that access to bathrooms and other sex-segregated facilities in federal buildings was provided based on gender identity, consistent with the Supreme Court's decision inBostock v. Clayton County (2020). EO 13988 was never formally repealed, but its enforcement was largely superseded in practice beginning January 21, 2025, following PresidentDonald Trump's issuance ofExecutive Order 14168: Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government, which redefined federal policy to recognize only “biological sex” and directed agencies to remove gender-identity-based access rules from federal facilities.[400][circular reference][401][circular reference]
On April 29, 2024, theEqual Employment Opportunity Commission (EEOC) issued and immediately put into effect its updatedEnforcement Guidance on Harassment in the Workplace, which for the first time explicitly stated that gender identity discrimination under Title VII includes denying employees access to restrooms consistent with their gender identity, as well as imposing dress codes or pronoun usage inconsistent with a person's gender identity. The guidance applied to all covered employers, including federal agencies, and was intended to provide interpretive clarity in light of the Supreme Court's decision inBostock v. Clayton County.[402]
On May 5, 2025, a federal class-action Equal Employment Opportunity complaint titledWithrow v. National Guard, et al. was filed by LeAnne Withrow, a civilian employee of the Illinois National Guard, against the National Guard Bureau, Department of Defense, and Office of Personnel Management. The complaint alleges that enforcement of “biological sex” bathroom rules against transgender federal employees violates Title VII, as interpreted byBostock v. Clayton County, as well as the Fifth Amendment and the Administrative Procedure Act.[403] The case remains pending before the Equal Employment Opportunity Commission.
On May 9, 2025, GSA formally rescinded Bulletin 2016-B1, ending the explicit requirement for gender-identity–based access to sex-segregated facilities in GSA-managed federal buildings.[404] On May 15, 2025, in the caseState of Texas and the Heritage Foundation v. Equal Employment Opportunity Commission (N.D. Tex., No. 2:24-CV-173), a federal district court—Judge Matthew Kacsmaryk—vacated nationwide the portions of the April 2024 EEOC guidance that addressed gender identity, including restroom, dress, and pronoun accommodations, ruling that EEOC had exceeded its statutory authority under Title VII.[405][406]
On July 10, 2025, theU.S. Office of Personnel Management (OPM) issued updated government-wide guidance to all executive branch agencies to implementExecutive Order 14168's redefinition of "sex" as biological. The memo directed agencies to remove gender identity language and related promotional material from all internal and external policies, forms, and communications; to designate all single-sex intimate spaces—explicitly including restrooms, locker rooms, and lactation rooms—based solely on biological sex as defined at birth; and to certify compliance to OPM by August 11, 2025.[407] The guidance applies to all employees of the executive branch and to individuals accessing single-sex facilities within federally controlled workplaces and properties, but does not impose requirements on state or local government facilities outside of federal jurisdiction.
Numerous jurisdictions and states have passed or considered so-called "bathroom bills" which restrict the use of bathrooms by transgender people, forcing them to choose facilities in accordance with their biological sex.[408][409][410] As of May 2024[update], Alabama, Arkansas, Florida, Idaho, Iowa, Kansas, Kentucky, Mississippi, North Dakota, Oklahoma, Tennessee and Utah have such laws.[411][412]
On March 23, 2016,North Carolina passed a comprehensive bathroom restriction bill (thePublic Facilities Privacy & Security Act, also known as "HB2"), overriding a prior municipalCharlotte non-discrimination ordinance on the same subject.[413] It was quickly signed into law by Gov.Pat McCrory, but on March 30, 2017, following national controversy, the part of the law related to bathrooms was repealed.[414] According to the ACLU, the partial repeal still allowed discrimination against transgender persons.[415]
In April 2016, objecting to the "bathroom predator myth", a coalition of over 200 U.S. organizations for sexual assault and domestic violence survivors noted that, while "over 200 municipalities and 18 states" had legal protections for transgender people, none of these places had tied an increase in sexual violence to these nondiscrimination laws.[416]
In September 2016,California governorJerry Brown signed a bill requiring all single-occupancy bathrooms to be gender-neutral, effective since March 1, 2017.[417] California is the first U.S. state to adopt such legislation.[418] Vermont, New Mexico and Illinois have since followed suit in 2019.[419]
On May 2, 2019, Tennessee governor Bill Lee signed into law legislation defining a trans person using the bathroom corresponding with their gender identity as "indecent exposure." TheTennessee Equality Project had complained about the bill's original language, and although that language was altered before it became law, the organization still believed the bill was harmful to trans people.[420]
On April 8, 2022, Alabama Governor Ivey signed a bathroom bill applying to public schools.[421] As of March 2024[update], she is likely to sign a similar bill applying to universities.[422]
On May 3, 2023, the Florida legislature passed the "Safety in Private Spaces Act", which the governor was expected to sign, making it a second-degree misdemeanor to use a bathroom other than that which is designated for people of one's sex assigned at birth.[423] An earlier attempt in 2015 had failed.[424]
In September 2021, following extensiveright wing protests, aLos Angeles trans woman was charged by theLAPD with felony indecent exposure after she was recorded using the women's changing room at a local nude spa. The trans woman had two previous convictions for indecent exposure and a conviction for failing to register as a sex offender.[425][426] The nude spa in question had an explicitly trans-inclusive policy, and mandated nudity in gender segregated areas.[427]
In February 2023, another trans woman was charged with indecent exposure for using the changing room at the YWCA inXenia, Ohio, despite the facility's policy also being one of support.[428]
InDoe v. Regional School Unit, theMaine Supreme Court held that a transgender girl had a right to use the women's bathroom at school because her psychological well-being and educational success depended on her transition. The school, in denying her access, had "treated [her] differently from other students solely because of her status as a transgender girl." The court determined that this was a form of discrimination.[429]
InMathis v. Fountain-Fort Carson School District 8 (2013), Colorado's Division of Civil Rights found that denying a transgender girl access to the women's restroom at school was discrimination. They reasoned, "By not permitting the [student] to use the restroom with which she identifies, as non-transgender students are permitted to do, the [school] treated the [student] less favorably than other students seeking the same service." Furthermore, the court rejected the school's defense—that the discriminatory policy was implemented to protect the transgender student from harassment—and observed that transgender students are in fact safest when a school does not single them out as different. Based on this finding, it is no longer acceptable to institute different kinds of bathroom rules for transgender andcisgender people.[429]
In May 2016, guidance was issued by theUnited States Department of Justice and theUnited States Department of Education stating that schools which receive federal money must treat a student's gender identity as their sex (for example, in regard to bathrooms).[324] However, this policy was revoked in 2017.[324]
In October 2016, the Court agreed to take onthe case of whether a transgender boy, Gavin Grimm, could use the boys' bathroom in hisVirginia high school. Grimm wasassigned female at birth but is a transgender male. For a while, he was permitted access to the boys' bathroom but was later denied access after a new policy was adopted by the local school board. The ACLU took on the case, stating that girls objected when he tried to use the girls' bathroom in accordance with the new policy and that he was humiliated when the school directed him to use a private bathroom, unlike other boys. After challenging the policy, he won his case in the Court of Appeals in 2015 in a tie vote.[430][431] This marked the first ruling by an appeals court to find that transgender students are protected under federal laws that ban sex-based discrimination.[432] However, later in 2016 the U.S. Supreme Court agreed to put that ruling on hold.[433] Then in 2017 the U.S. Supreme Courtvacated the decision of the 4th U.S. Circuit Court of Appeals and refused to hear the case.[434] Later in 2017, it was announced that the 4th Circuit would send the case back to the district court for the judge to determine whether the case wasmoot because Grimm graduated.[435] The District Court found the case was not moot, and ruled in favor of Grimm, which was later upheld by the Fourth Circuit on appeal in August 2020, using the Supreme Court's recent decision inBostock v. Clayton County as a basis for their decision.[436]
A similar case had occurred in the public schools ofDallas, Oregon, which had allowed transgender students to use the restrooms and locker rooms of the school based on their gender identity on the basis of the 2016 federal policy. Parents of other students had sued to have the policy overturned, but the policy was upheld at both theUnited States District Court for the District of Oregon and theUnited States Court of Appeals for the Ninth Circuit. The Supreme Court denied to hear the challenge to the Ninth Circuit in November 2020, leaving that decision in place.[437]
Rights to restrooms that match one's gender identity have also been recognized in the workplace and are actively being asserted in public accommodations. In Iowa, for example, discrimination in public accommodations on the basis of sexual orientation and gender identity has been prohibited by law since 2007 through the Iowa Civil Rights Act.[429]
InCruzan v. Special School District #1, decided in 2002, a Minnesota federal appeals court ruled that it is not the job of the transgender person to accommodate the concerns of cisgender people who express discomfort with sharing a facility with a transgender person. Employers need to offer an alternative to the complaining employee in these situations, such as an individual restroom.[429]
Equal Employment Opportunity Commission (EEOC) chairCharlotte A. Burrows issued guidelines in 2021 stating that "employers may not deny an employeeequal access to a bathroom, locker room, or shower that corresponds to the employee's gender identity."[438]
Federalhate crimes legislation include limited protections for gender identity. TheMatthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act of 2009 criminalized "willfully causing bodily injury (or attempting to do so with fire, firearm, or other dangerous weapon)" on the basis of an "actual or perceived" identity. However, protections for hate crimes motivated on the basis of a victim'sgender identity orsexual orientation is limited to "crime affect[ing] interstate or foreign commerce or occur[ring] within federal special maritime and territorial jurisdiction." This limitation only applies to gender identity and sexual orientation, and not to race, color, religion or national origin.[439] Therefore, hate crimes which occur outside these jurisdictions are not protected by federal law.
22 states plusWashington D.C. have hate crimes legislation which includes gender identity or expression as a protected group. They areVermont,Massachusetts,Connecticut,New Jersey,Delaware,Illinois,Maryland,Missouri,Minnesota,Colorado,New Mexico,Nevada,Rhode Island,Washington,Oregon,California,Hawaii,Maine,Tennessee,Puerto Rico,Utah,Virginia[440] andNew York. Twenty-seven states have hate-crimes legislation which exclude transgender people. Six states have no hate-crimes legislation at all.[441]
Numerous municipalities have passed hate-crime legislation, some of which include transgender people. HoweverArkansas,North Carolina andTennessee recently passed laws which ban municipalities from enacting such protections for sexual orientation, gender identity or expression.[442][443]
Transgender people confront two major legal issues within the healthcare system: access to health care for gender transitioning and discrimination by health care workers.
ManyRepublican legislators across the country are increasingly proposing legislation to restrict gender-affirming care for adults or make such care harder to access. However, no states have outright banned gender-affirming care for adults. Efforts to restrict adults' access to healthcare relies heavily on claims from self-described "gender-critical" organizations such asGenspect that young people should not be recognized as adults until they turn 25.[444][445][446]
As of January 2024, seven states limit access to gender-affirming care for adults without banning it, such as allowing private health plans, Medicaid, and correctional facilities to exclude all coverage for gender-affirming care, prohibiting the use of federal funds for gender-affirming care or requiring special informed consent practices.[447]
In January 2024, in a conversation about trans healthcare with several Republican legislators, Michigan State Rep.Josh Schriver asked, "If we are going to stop this for anyone under 18, why not apply it for anyone over 18? It’s harmful across the board and that's something we need to take into consideration in terms of the endgame." Michigan State Rep.Brad Paquette and Ohio State Rep.Gary Click expressed agreement with that sentiment.[448][449]
In December 2024, Tennessee Senator,Bo Watson said that, although banning gender-affirming care for adults may not currently be of interest to the Tennessee legislature, he would not rule out a ban in the future.[450]
In 2025, Texas Representative,Brent Money introduced a bill in theTexas House of Representatives that would ban gender affirming care fortransgender individuals of all ages.[451][452]
In July 2025,Puerto Rico became the first place in the United States to pass a ban on gender-affirming care for people over 18, banning it for anyone under 21 years of age. Puerto Rico's LGBTQ+ Federation immediately announced plans to challenge the ban in court.[453][454]
These states make it easy for trans adults to sue their doctors:
These states restrict treatment for trans adults (as well as younger people):
In August 2025, theOffice of Personnel Management (OPM) stated in an internal memo that beginning in 2026, gender-affirming care would no longer be covered by theFederal Employees Health Benefits and Postal Service Health Benefits programs.[477]
Each state may pass its own laws about gender-affirming care for minors. The U.S. Supreme Court decided this on June 18, 2025 inUnited States v. Skrmetti, ruling that such bans do not classify by sex and thus do not requireintermediate scrutiny according to the14th Amendment'sEqual Protection Clause.[25]
Five months before the outcome ofU.S. v. Skrmetti, President Donald Trump signed anexecutive order in an effort to federally prevent gender-affirming care for all people under 19 years old.[478] The order revokes federal funding for any institutions providing such care and directs federal agencies to take further steps.[479] Multiple states sued,[480] and a federal judge,Brendan A. Hurson, blocked the order from taking effect while thePFLAG v. Trump lawsuit is ongoing.[481][482][483]
Gender-affirming care for minors has a long history in the United States and is supported by major medical associations.[484][485] Efforts to prohibit gender-affirming care for minors began in the 2010s, but did not immediately receive much attention from state legislatures.[486] The conservative organizationDo No Harm was influential in developing model legislation that appeared starting in 2022 in Arkansas, Florida, Iowa, Mississippi, Montana, New Hampshire, and West Virginia legislatures.[487][488] In 2023, 19 bans were enacted,[489][490] 16 of which were being challenged in court as of January 2024[update].[447]
In February 2024, theAmerican Psychological Association approved a policy statement supporting unobstructed access to health care and evidence-based clinical care for transgender, gender-diverse, and nonbinary children, adolescents, and adults, as well as opposing state bans and policies intended to limit access to such care.[491][492]
As of August 2025[update], 27 states had enacted some form of ban on gender-affirming care for minors.[493] Of those, 21 have complete bans in effect, four have partial bans, and two passed bans that are currently blocked from taking effect. While some states have banned all forms of medical transition, others such as Arizona, Nebraska and Georgia have banned only specific types such as hormone therapy or surgery. Seven states have exceptions which allow minors who were already receiving gender-affirming care prior to the ban to continue their treatments.[447] Currently, all 27 states make exceptions for puberty blockers, hormones and surgery for cisgender and intersex children.[447] Only one state, West Virginia, makes exceptions in cases of "severe dysphoria". There is also currently only one state, Missouri, that has a ban which is set to expire after a certain period of time. Nearly all states with restrictions include specific provisions with penalties for providers and 4 states include provisions directed at parents or guardians.[447] An additional 4 states include laws/policies that impact school officials such as teachers and counselors, among others.[447]
At the same time, many Democrat-controlled states have gone in the opposite direction and enacted laws protecting access to gender affirming care for minors and adults. These laws, often called "shield" laws, often explicitly combine protections for gender-affirming care and abortion and cover a variety of protections including protecting both providers and patients from being punished, mandating insurance providers to cover the procedures and acting as "sanctuary states" that protect patients traveling to the state from other states that have banned such treatments among other things.[494] As of June 2025, 17 states and the District of Columbia have enacted "shield" laws.
Of the approximately 1.6 million Americans who are transgender, about 300,000 are under the age of 18.[495] As of October 2023, approximately 105,200 transgender youth aged 13 to 17 lived in states where gender affirming care is banned for minors. However, around 26,000 of those youth are currently still able to access care in their state due to court orders that prohibit enforcement of the laws. Conversely, around 146,700 transgender youth live in states that have passed gender-affirming care "shield" laws that support access to care by protecting doctors and parents who prescribe or seek access to medical care for youth.[489] An analysis fromKFF in late January 2024 estimated that 38% of trans youth between the ages of 13-17 in the United States lived in states with laws limiting youth access to gender-affirming care.[447]
Bans on gender-affirming care have been criticized as governments interfering with the patient-doctor relationship and taking away healthcare decisions from parents and families for their children.[496][497] State level bans on gender-affirming care in the United States have led some families with transgender children to move out of their states.[498][499][500]
In May 2024, the Department of Justice indicted a Texas doctor, Eithan Haim, for alleged HIPAA violations involvingTexas Children's Hospital which he claimed was secretly providing gender-affirming care to minors. In January 2025, the Trump administration dropped the charges and the case was dismissed with prejudice.[501][502]
In October 2024, Texas attorney generalKen Paxton filed suit against a doctor who allegedly provided gender-affirming care to 21 minors after it had been banned for minors in the state, the first time that such a suit has been brought in the U.S.[503]
| State | Authority | Signed | Effective | Notes |
|---|---|---|---|---|
| Arkansas | State legislature | April 6, 2021 | Permanently blocked | On April 6, 2021, the legislature—overriding GovernorAsa Hutchinson's veto ona bill that banned puberty blockers, hormones, and surgery for minors and from referring them to other providers.[486] However, courts temporarily[504] and then permanently blocked the law.[505] |
| Texas | Texas AGKen Paxton GovernorGreg Abbott | February 22, 2022 June 2, 2023 | Blocked by injunction (order) September 1, 2023 (legislation) | In February 2022, the state Attorney General ordered a ban on gender-affirming care for trans youth, with criminal penalties for failing to report suspected violations.[506][507] However, the order is currently blocked by injunction.[508] In June 2023, the governor signed a law to ban this care for minors.[509] On August 25, 2023, a district court judge blocked the law from taking effect. In response, the Attorney General's office filed an appeal with the Texas Supreme Court, a move that automatically pauses the judge's injunction and allowed the law to go into effect on September 1, 2023, as originally planned.[510] On June 28, 2024, the Texas Supreme Court upheld the law.[511] |
| Alabama | GovernorKay Ivey | April 8, 2022[512] | May 8, 2022[513] | It is a felony for a medical provider to give gender-affirming healthcare to transgender people under 19 (the age of majority in Alabama). In May 2022, a federal judge ruled that the ban on surgery was enforceable. However, the ban on puberty blockers and hormones was not enforceable while the law is challenged in court.[514] In August 2023, the11th U.S. Circuit Court of Appeals reversed the decision, allowing the ban on puberty blockers and hormones to take effect.[515] |
| Utah | GovernorSpencer Cox | January 27, 2023[455][456][457][458] | ||
| South Dakota | GovernorKristi Noem | February 13, 2023[516][517][518] | ||
| Mississippi | GovernorTate Reeves | February 28, 2023[519][520] | ||
| Tennessee | GovernorBill Lee | March 2, 2023[521][522] | ||
| Florida | Florida Board of Medicine GovernorRon DeSantis | August 26, 2024 (legislation) Blocked (state board of medicine rule) | The state board of medicine rule took effect on March 16, 2023.[523][524] Additionally, on May 17, 2023, Governor DeSantis signeda ban into law, and it took effect immediately. It applies only to new patients, not those who were already receiving gender-affirming care.[525] However, on June 6, 2023, a court temporarily blocked enforcement of both the board rule and the law.[526] In June 2024, a judge permanently blocked the law from taking effect.[465] In August 2024, the 11th Circuit Court of Appeals stayed the permanent injunction while the matter is appealed.[466] | |
| Iowa | GovernorKim Reynolds | March 22, 2023[527] | ||
| Georgia | GovernorBrian Kemp | March 23, 2023[528] | July 1, 2023 | Bans hormones and surgery while continuing to allow puberty blockers. Minors who began hormones prior to July 1, 2023 are allowed to continue treatment.[529][530] |
| West Virginia | GovernorJim Justice | March 29, 2023[531] | May 7, 2025[532] | The bill made exceptions for minors who have received parental consent and are diagnosed with "severe gender dysphoria" by two doctors. Due to this exception, experts did not expect the ban to have much of an impact.[533] In May 2025, GovernorPatrick Morrisey signed a bill ending this exception.[534] |
| Kentucky | State legislature | March 29, 2023 | July 14, 2023 | The legislature overrode GovernorAndy Beshear's veto, banning gender-affirming healthcare for trans minors.[535] Federal appeals judges allowed the ban to remain in effect during legal challenges to overturn it.[536][537] |
| Arizona | GovernorDoug Ducey | March 30, 2022 | March 31, 2023 | Bans gender-affirming surgery for minors, but not hormones and puberty blockers. The bill also makes some exceptions, including in the case of someone born intersex.[538][539] In mid 2023, a new Governor,Katie Hobbs reversed course by signing a series of executive orders which include shield-style protections for gender-affirming care, ensuring that it remains legal in Arizona. It also bans conversion therapy, requires insurance plans to cover gender-affirming care and bars state agencies from cooperating with civil and criminal cases in states where gender-affirming health care is illegal.[540] |
| Idaho | GovernorBrad Little[541][542] | April 4, 2023 | April 15, 2024 | It would also make it a felony for any medical practitioner to help a minor seek gender-affirming treatment. On December 27, 2023, a federal judge blocked the law from taking effect.[543] On April 15, 2024, theUS Supreme Court responded to an emergency request filed in February by temporarily allowing the ban to go into effect while further legal challenges to it play out in the lower courts. The ruling did not resolve the underlying legal challenges raised by the case nor did the justices rule on the larger issue of bans on gender-affirming treatment for minors. The ruling also does not apply to the two plaintiffs in the lawsuit.[544][545] |
| Indiana | GovernorEric Holcomb[546] | April 5, 2023 | February 27, 2024 | On June 16, 2023, a federal judge temporarily blocked the law from taking effect.[547] On February 27, 2024, the7th Circuit Court of Appeals reversed the decision allowing the ban to take effect.[548] |
| North Dakota | GovernorDoug Burgum | April 20, 2023 | On April 20, 2023, North Dakota GovernorDoug Burgum signed a law criminalizing trans health care for minors. However, the law notably makes exceptions for medication treatment for "rare circumstances with parental consent". The law also allows medication treatment for early onset puberty and minors who were already receiving gender-affirming care will still be able to receive treatment.[549] | |
| Montana | GovernorGreg Gianforte | April 28, 2023[550] | Blocked | On September 27, 2023, a Montana District Court judge prevented it from taking effect.[551] On December 11, 2024, the Montana Supreme Court upheld the ban and suggested the ban is likely unconstitutional and sent it back to the district court for trial.[552] If the ban does take effect, some treatments would remain legal for minors who are not suffering from gender dysphoria. |
| North Carolina | State legislature | August 17, 2023 | Ban on gender-affirming care, such as hormones, puberty blockers, and surgery, for minors. The ban only applies to transgender children and still allows such treatments for intersex and cisgender children. The ban also only applies to new patients. Transgender children who started treatment prior to August 1, 2023 will be allowed to continue receiving treatment.[553] GovernorRoy Cooper vetoed the bill on July 5, 2023,[554] but the state legislature overruled his veto on August 17, therefore making the bill law.[555] | |
| Missouri | Governor Mike Parson | June 7, 2023 | August 28, 2023 | People receiving puberty blockers or hormones before the ban went into effect may continue taking them. Otherwise, blockers and hormones are banned until 2027. Surgery is also banned. A 2024 lawsuit by the ACLU was unsuccessful.[556] |
| Louisiana | State Legislature | January 1, 2024 | On June 29, 2023,John Bel Edwards vetoed a ban on blockers, hormones, and surgery for minors. On July 18, theLouisiana State Legislature overrode his veto. | |
| Oklahoma | Governor Kevin Stitt | May 1, 2023 | On May 1, 2023, GovernorKevin Stitt signed a bill that makes it a felony for doctors to provide gender-transition medical care for anyone under the age of 18.[557] In October 2023, a judge declined to stop the law from taking effect.[558] | |
| Nebraska | Governor Jim Pillen | October 2, 2023 | October 2, 2023 | On October 2, 2023, the state Department of Health and Human Services announced that Republican GovernorJim Pillen had approved emergency regulations banning gender affirming surgeries for minors. Puberty blockers and hormone treatments for minors still remain legal, however applicants must now wait seven days and undergo at least 40 hours of "clinically neutral" therapy before starting them. The new regulations went into effect immediately.[559] |
| Ohio | State legislature | April 30, 2025 | On January 5, 2024, GovernorMike DeWine signed an executive order banning gender-affirming surgeries for minors.[560] Previously, on December 29, 2023, he had vetoed the Saving Adolescents from Experimentation (SAFE) Act (HB68) passed (mostly along party lines) by theOhio Legislature on December 13 which banned gender-affirming surgeries as well as hormones and puberty blockers for minors. The bill includes exceptions for this kind of care for non-transgender youth, and it allows children who were already receiving gender-affirming care in Ohio to continue their treatment.[561] On January 24, 2024, the legislature overrode DeWine's veto thereby making HB68 law.[562] On April 16, 2024, a judge temporarily blocked the ban from taking effect.[563] On August 6, 2024, a judge overturned the injunction and allowed the law to take effect immediately.[564] On March 18, 2025, the state's 10th District Court of Appeale reversed the judge's decision and reinstated the injunction.[565] On April 30, 2025, theSupreme Court of Ohio ruled 4-3 that the ban could take effect while further court battles play out.[566] | |
| Wyoming | Governor Mark Gordon | March 22, 2024 | July 1, 2024 | On March 22, 2024, Wyoming GovernorMark Gordon signed a law criminalizing trans health care for minors.[567] |
| South Carolina | Governor Henry McMaster | May 21, 2024 | May 21, 2024 | On May 21, 2024, South Carolina GovernorHenry McMaster signed a law banning trans health care for minors. The law, which went into effect immediately, also requires principals, teachers and other school staff members to tell parents when their children want to use a name other than their legal one, or pronouns that do not match their sex assigned at birth. It also bars adults under 26 from using Medicaid to cover the costs for trans health care.[568] This part of the bill is in direct opposition to a4th U.S. Circuit Court of Appeals ruling from the month prior which ruled that state Medicaid bans on gender-affirming care in the 4th Circuit, which includes South Carolina, are unconstitutional.[569] |
| New Hampshire | Governor Chris Sununu (genital surgeries) Governor Kelly Ayotte (puberty blockers, hormones and other surgeries) | July 19, 2024 (genital surgeries) August 1, 2025 (puberty blockers, hormones and other surgeries) | January 1, 2025 (genital surgeries) January 1, 2026 (puberty blockers, hormones and other surgeries) | On July 19, 2024, New Hampshire GovernorChris Sununu signed a law banning gender-affirming genital surgeries for minors. However, puberty blockers, hormones and non-genital surgeries such as mastectomies remained legal for trans youth.[570][571] On August 1, 2025, GovernorKelly Ayotte signed a bill ending puberty blockers, hormones and non-genital surgeries for minors in the state too. However, the bill contains an exception which allows minors already receiving care to continue it.[572] |
| Kansas | State legislature | February 18, 2025 | On February 18, 2025, the Kansas state legislature overrode GovernorLaura Kelly's veto of Senate Bill 63 which bans gender-affirming care for minors. Children already receiving gender-affirming care in Kansas must stop receiving it by December 31, 2025.[573][574] | |
| Puerto Rico | GovernorJenniffer González-Colón | July 17, 2025 | July 17, 2025 | On July 17, 2025, Puerto Rico GovernorJenniffer González-Colón signed Senate Bill 350 which bans on gender-affirming care for anyone under 21 years of age. It also bars public funding for gender-affirming care and threatens doctors who violate the ban with up to 15 years in prison, a $50,000 fine, and the permanent loss of their licenses. Puerto Rico's LGBTQ+ Federation immediately announced plans to challenge the ban in court.[454][453] |
| State | Authority | Signed | Effective | Notes |
|---|---|---|---|---|
| Connecticut | GovernorNed Lamont | May 5, 2022 | May 5, 2022 | On May 5, 2022, Governor Ned Lamont signed House Bill 5414, a shield law that designates Connecticut as a "safe harbor" which protects people who provide abortions and gender affirming care in the state, as well as legal protections for people seeking abortions and gender-affirming health care from out-of-state.[575][576] |
| Massachusetts | GovernorCharlie Baker | July 29, 2022 | July 29, 2022 | On July 29, 2022, Governor Charlie Baker signed a shield law which protects access to abortion and gender-affirming health care in the state.[577] |
| California | GovernorGavin Newsom | September 30, 2022 | January 1, 2023 | On September 30, 2022, Governor Gavin Newsom signed SB 107, a shield law which designates California as a "sanctuary state" for trans youth and their families who are fleeing from other states that have banned the practice.[578] |
| District of Columbia | MayorMuriel Bowser | November 21, 2022 | November 21, 2022 | On November 21, 2022, Mayor Muriel Bowser signed into law D.C. ACT 24-646, the Human Rights Sanctuary Amendment Act of 2022, which protects the right to bodily autonomy and of those seeking care for abortion, contraception, sexual conduct, intimate relationships, and gender affirmation.[579] |
| Illinois | GovernorJB Pritzker | January 13, 2023[580] | January 13, 2023 | On January 13, 2023, Governor JB Pritzker signed into law HB4664, a reproductive rights and gender affirming care omnibus bill that protects health care providers and their patients from legal attacks by neighboring states and expands reproductive and gender affirming health care access and options across the state. The bill takes historic action to protect Illinois providers and their patients, thousands of whom have traveled to Illinois to access essential care now banned in their home states. |
| New Mexico | GovernorMichelle Lujan Grisham | March 16, 2023 | March 16, 2023 | On March 16, 2023, Governor Michelle Lujan Grisham signed into law House Bill 7, the Reproductive and Gender-Affirming Health Care Act, which prohibits public bodies, including local municipalities, from denying, restricting, or discriminating against an individual's right to use or refuse reproductive health care or health care related to gender.[581] |
| Vermont | GovernorPhil Scott | March 29, 2023 | September 2023 | On March 29, 2023, Governor Phil Scott signed into law House Bill 89 and Senate Bill 37, which establish a slate of protections for both providers and seekers of gender affirming health care, as well as those seeking or administering abortions.[582] |
| New Jersey | GovernorPhil Murphy | April 4, 2023 | April 4, 2023 | On April 4, 2023, Governor Phil Murphy signed Executive Order No. 326 establishing New Jersey as a safe haven for gender-affirming health care by directing all state departments and agencies to protect all persons, including health care professionals and patients, against potential repercussions resulting from providing, receiving, assisting in providing or receiving, seeking, or traveling to New Jersey to obtain gender-affirming health care services.[583] |
| Colorado | GovernorJared Polis | April 14, 2023 | April 14, 2023 | On April 14, 2023, Governor Jared Polis signed into law a trio of health care bills enshrining access to abortion and gender-affirming procedures and medications in Colorado. These bills ensure people in surrounding states and beyond can go to Colorado to have an abortion, begin puberty blockers or receive gender-affirming surgery without fear of prosecution.[584] |
| Minnesota | GovernorTim Walz | April 27, 2023 | April 27, 2023 | On April 27, 2023, Governor Tim Walz signed a shield law protecting minors fleeing from other states to receive gender-affirming care. It also amends child custody and child welfare provisions related to out-of-state laws interfering in the use of gender-affirming health care; amending provisions related to warrants, arrests, and extraditions related to out-of-state laws on gender-affirming health care. It also rules that a court order for the removal of a child issued in another state because the child's parent or guardian assisted the child in receiving gender-affirming care in this state must not be enforced in this state. In addition, it rules that a law of another state that authorizes a state agency to remove a child from the child's parent or guardian because the parent or guardian allowed the child to receive gender-affirming health care is against the public policy of this state and must not be enforced or applied in a case pending in a court in this state.[585] |
| Washington | GovernorJay Inslee | May 9, 2023 | May 9, 2023 | On May 9, 2023, Governor Jay Inslee signed a shield law designating Washington as a "sanctuary state" for trans youth.[586] |
| Maryland | GovernorWes Moore | June 6, 2023 | June 6, 2023 | On June 6, 2023, Governor Wes Moore signed an executive order to protect gender affirming health care in Maryland. The order will protect those seeking, receiving, or providing gender affirming care in Maryland from attempts at legal punishment by other states.[587] |
| New York | GovernorKathy Hochul | June 26, 2023 | June 26, 2023 | On June 26, 2023, Governor Kathy Hochul signed a shield law designating New York as a "sanctuary state" for trans youth. This law protects access to transition-related medical care for transgender minors and bars state courts from enforcing the laws of other states that might authorize a child to be taken away if the parents provide gender-affirming medical care, including puberty blockers and hormone therapy. It also prohibits New York courts from considering transition-related care for minors as child abuse and bars state and local authorities from cooperating with out-of-state agencies regarding the provision of lawful gender-affirming care in New York.[588] |
| Arizona | GovernorKatie Hobbs | June 28, 2023 | June 28, 2023 | On March 30, 2022, GovernorDoug Ducey signed a bill banning gender-affirming surgery for minors, but not hormones and puberty blockers. The bill also makes some exceptions, including in the case of someone born intersex.[538] On June 28, 2023, a new Governor,Katie Hobbs reversed course by signing a series of executive orders which include shield-style protections for gender-affirming care, ensuring that it remains legal in Arizona. It also bans conversion therapy, requires insurance plans to cover gender-affirming care and bars state agencies from cooperating with civil and criminal cases in states where gender-affirming health care is illegal.[540] |
| Oregon | GovernorTina Kotek | July 13, 2023 | July 13, 2023 | On May 9, 2023, Governor Tina Kotek signed a law protecting access to abortion and gender affirming care for trans youth. Minors between the ages of 15 and 17 can receive gender affirming care without parental permission, whereas youth ages 14 and under must have parental permission.[589] |
| Maine | GovernorJanet Mills | April 23, 2024 | April 23, 2024 | On April 23, 2024, GovernorJanet Mills signed a shield law designating Maine as a "sanctuary state" for gender-affirming care and abortion providers and makes access to such treatments "legal rights" in Maine. It states that criminal and civil actions against providers and patients are not enforceable if the access to that care occurred in Maine. Additionally, the bill prevents cooperation with out-of-state arrest warrants for gender-affirming care and abortion that happen within the state. It also protects doctors who provide gender-affirming care and abortion from actions by medical boards, malpractice insurance, and other regulating entities that seek to economically harm them or dissuade them from providing care. The bill also explicitly enshrinesWPATH'sStandards of Care into state law for the coverage of transgender healthcare.[590][591] |
| Rhode Island | GovernorDaniel McKee | June 25, 2024 | June 25, 2024 | On June 25, 2024, GovernorDaniel McKee signed a shield law designating Rhode Island as a "sanctuary state" for gender-affirming care and abortion providers and makes access to such treatments "legal rights" in Rhode Island. The bill also protects providers from being sued for providing care.[592] |
| Delaware | GovernorMatt Meyer | June 20, 2025 | June 20, 2025 | On June 20, 2025, GovernorMatt Meyer signed Executive Order No. 11 establishing Delaware as a "sanctuary state" for gender-affirming care by protecting patients and providers from bans and restrictions in other states. It also forbids state agencies from giving up "medical records, data or billing information, or utilize state resources that could help any criminal or civil investigation against someone receiving or providing gender-affirming care" and prohibits the state professional regulations board from disbarring healthcare providers because they provide gender-affirming care.[593][594] |
In one 2016 study, the effect of puberty blockers was shown to be fully reversible.[595] Earlier studies (e.g., these in 2012 and 2015) indicated ongoing long-term research into potential effects on the brain.[596][597]
The lack of knowledge and education related to transgender health is an obstacle transgender people face.[598] A 2011 study published inJAMA reported that medical students cover up to "only five hours" of LGBT related content.[599] A different study done by Lambda Legal in 2010 stated that 89.4% of transgender people felt that there are not enough medical providers that are "adequately trained" for their needs.[600] This lack of medical training makes it harder for transgender people to find suitable and proper healthcare.[598] A 2014 report by the Department of Justice found that 50% of trans people had actually had to teach their medical providers about trans healthcare.[246]
A 2014 report by the Department of Justice found that 28% of trans people reported being harassed in medical settings, 19% reported being refused care, 2% reported being physically attacked in a doctor's office, 10% reported being sexually assaulted in one, 9% had been involuntarily committed, and 3% subjected to unwanted medical procedures. The report further found that it was not uncommon for trans people to be forced by psychiatric professionals to provide sexual favors in exchange for being allowed continued access to gender affirming medical care.[246]
Transgender people also sometimes experience discrimination by healthcare professionals, who have refused to treat them for conditions both related and unrelated to their gender identity.[601][602][603] A 2017 report by theCenter for American Progress found 29 percent of transgender people reporting they were denied care by a medical provider in the preceding year due to their gender identity or sexual orientation. The same study found that 21 percent of trans people reported medical providers used abusive or harsh language when they sought care.[604]
TheAffordable Care Act (ACA) of 2010, specifically Section 1557, prohibits sex discrimination in federally funded health care facilities, and in 2012 the federalDepartment of Health and Human Services (HHS) clarified that this includes discrimination based on transgender status. The government's final rule in 2016 determined that the ACA forbid discrimination based on gender identity.[605] The ACA also forbids insurance providers from refusing to cover a person based on a pre-existing condition, including being transgender. However, a federal judge in Texas in 2016 issued anationwide injunction stopping the ACA's transgender antidiscrimination protections from taking effect, and in 2019 that same court issued a final ruling that was binding on HHS.[606][605] On June 12, 2020, the Trump administration issued a new rule stating that sexual orientation and gender identity were not covered under the anti-discrimination protections of theAffordable Care Act.[607] This rule was in effect for nearly a year until it was reversed by the Biden administration, restoring the Obama-era policy.[608]
Complaints sent to HHS during the Trump administration indicated that medical providers were still frequently denying care to transgender people on the basis of their gender identity.[606]
Some jurisdictions have their own laws prohibiting discrimination on the basis of sex, gender identity or gender expression in public accommodations, as well as under medical malpractice and misconduct law.[609]
In 2020, the Supreme Court ruled inBostock v. Clayton County that discrimination on the basis of sexual orientation or gender identity is necessarily also discrimination "because of sex" as prohibited byTitle VII of the Civil Rights Act of 1964, and thus that Title VII protects employees against such discrimination.
A 2022 study on the allocation of ventilators during the pandemic found that respondents across the entire political spectrum were, when presented with the choice between allocating a ventillator to a cisgender man or a transgender person, on average less likely to allocate it to the trans person than to the cis man. In particular, respondents with conservative political leanings, when given a choice between allocating a ventilator to a cis man or a trans woman, were 14.3% less likely to allocate it to the trans woman, and when given a choice between allocating a ventilator to a cis man or a trans man, were 18.6% less likely to allocate it to the trans man.[610]
Republican amendments to funding bills could defund trans healthcare, affecting hundreds of thousands of trans adults and children by restricting access to essential medical treatments like hormone therapy and surgeries.[611]
1 in 6 patients in the United States are treated in a Catholic facility.[612] In March 2023, the United States Catholic Bishops issued guidelines for Catholic hospitals, entitled "Moral Limits to the Technological Manipulation of the Human Body", which banned the provision of gender affirming healthcare by such hospitals entirely.[613]
A form of discrimination in healthcare settings is known as "trans broken arm syndrome", in which a doctor mistakenly assumes that a trans person's medical ailments stem from their trans status or gender-affirming care and consequently treats their problem incorrectly or denies them care entirely. Trans patients often hide their trans status when visiting a doctor if their problem, such as a broken arm, isn't related to their trans status.[614] This is especially common in rural or more conservative areas.[615]
A 2022 survey from theCenter for American Progress revealed that 19 percent of trans individuals had experienced this form of discrimination in the past year.[616]
Transgender people have the right to medical privacy. According to theHealth Insurance Portability and Accountability Act (HIPAA), medical providers and insurance companies are prohibited from disclosing any personal medical information including a person's transgender status.[617] HIPAA also allows transgender people to access and receive a copy of their medical records from health care facilities.[617]
It can be difficult for transgender people to find insurance coverage for their medical needs.[618]
Even though there is medical consensus that hormone therapy and gender-affirming surgery (GAS) are medically necessary for many transgender people, the kinds of health care associated with gender transition are sometimes misunderstood as cosmetic, experimental or simply unnecessary. This has led to public and private insurance companies denying coverage for such treatment.[619] Courts have repeatedly ruled that these treatments may be medically necessary and have recognizedgender dysphoria as a legitimate medical condition constituting a "serious medical need".[620]
The ban on Medicare coverage for gender reassignment surgery was repealed by the US Department of Health and Human Services in 2014. Insurance companies, however, still hold the authority to decide whether the procedures are a medical necessity.[618] Thus, insurance companies can decide whether they will provide Medicare coverage for the surgeries.[618]
Under federal tax laws, the Internal Revenue Code, section 213, defines the purpose of "medical care" as "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body."[621] Only cosmetic surgeries promoting the physical or mental health of an individual can qualify for medical deductions. Transgender people have used the diagnosis of gender dysphoria to qualify for deductible health care.[621]
The idea that transition-related care is cosmetic or experimental has been ruled as discriminatory and out of touch with current medical thinking. The AMA and WPATH have specifically rejected these arguments, and courts have affirmed their conclusion.[622][623] In a case brought byGay and Lesbian Advocates and Defenders (GLAD),O'Donnabhain v. Commissioner, for instance, theInternal Revenue Service lost its claim that such treatments were cosmetic and experimental when a transgender woman deducted her GAS procedures as a medical expense. Courts have also found that psychotherapy alone is insufficient treatment for gender dysphoria, and that for some people, GAS may be the only effective treatment.[620]
In April 2024, The Biden administration announced expansive new protections for gay and transgender medical patients, prohibiting federally funded health providers and insurers from discriminating on the basis of sexual orientation and gender identity. The new rules overturn Trump-era restrictions, but preserve religious exemptions.[624] In June 2024, the Attorneys General in fifteen Republican-led states sued the Biden administration over the new rules. On July 3, 2024 a federal judge temporarily blocked enforcement of the new rule.[625]
In June 2022, the Florida Agency for Healthcare Administration, the agency which is responsible for overseeing the state'sMedicaid service, released a report which stated that transgender hormone therapy is "experimental and investigational".[626][627] The report was quickly rebuffed by the wider scientific community, with experts fromYale in July publishing an analysis in which they stated that the report ignored accepted scientific studies and consensus regarding gender dysphoria, had its writers chosen from those with ties to anti-LGBTQ groups specifically for their bias, cited sources with no scientific merit - including a student blog post and a letter to the editor, and that if the state used the same standard it used in the report to evaluate other treatments, it would no longer allow Medicaid to pay for a wide array of common medications.[627] The Yale analysis also stated that "it seems clear that the report is not a serious scientific analysis but, rather, a document crafted to serve a political agenda" and that "medical treatment for gender dysphoria does meet generally accepted professional medical standards and is not experimental or investigational".[628]
On August 21, 2022, Florida issued state Medicaid regulations banning coverage of sexual reassignment surgery, hormone replacement therapy, puberty blockers and "any other transgender healthcare initiatives" for all individuals, regardless of age.[629][630] On June 21, 2023, the court decided inDekker v. Weida that Medicaid must continue to covergender-affirming healthcare.[631] The decision was appealed. On October 13, 2023, legal representatives from 19 states—principally Attorneys GeneralSteve Marshall of Alabama,Tim Griffin of Arkansas, andJonathan Skrmetti of Tennessee—submitted an amicus brief arguing that the court should reverse its decision and forbid Medicaid coverage of all gender-affirming care, including care for adults. The amicus brief cited theDobbs decision.[632] On November 22, 2024, the11th U.S. Circuit Court of Appeals heard arguments appealing the case.[633]
In 1992,UC Irvine researchers published an article detailing medical experiments performed on every trans female inmate in the California state prison system, ending with all subjects being indefinitely taken off hormone therapy. When the study began, prison policy was to provide hormone therapy to all inmates who had proof of receiving hormone therapy prior to incarceration. In 1988, prison policy changed on the basis of the claim that "hormone therapy was not beneficial to the inmates' general health." The authors wrote: "withdrawal of therapy was also associated with adverse symptoms in 60 of the 86 transsexuals. Rebound androgenization, hot flashes, moodiness, and irritability or depression were the most frequent complaints."[634] At the time, no right to access gender appropriate care existed inCalifornia state prisons.
According to the Vera Institute, 16% of trans adults in the US have been incarcerated, compared to 2.7% of cis adults, and trans people make up 59% of prison sexual assault victims.[198]
In September 2011, a California state court denied the request of a California inmate, Lyralisa Stevens, for gender-affirming surgery at the state's expense.[635]
On January 17, 2014, inKosilek v. Spencer a three-judge panel of theFirst Circuit Court of Appeals ordered theMassachusetts Department of Corrections to provide Michelle Kosilek, a Massachusetts inmate, with gender-affirming surgery. It said denying the surgery violated Kosilek's Eighth Amendment rights, which included "receiving medically necessary treatment ... even if that treatment strikes some as odd or unorthodox".[636]
On April 3, 2015, the U.S. Department of Justice intervened in a federal lawsuit filed inGeorgia to argue that denying hormone treatment for transgender inmates violates their rights. It contended that the state's policy that only allows for continuing treatments begun before incarceration was insufficient and that inmate treatment needs to be based on ongoing assessments.[637] The case was brought by Ashley Diamond, an inmate who had used hormone treatment for seventeen years before entering the Georgia prison system.[638]
On May 11, 2018, the US Bureau of Prisons announced that prison guidelines issued by the Obama Administration in January 2017 to allow transgender prisoners to be transferred to prisons housing inmates of the gender which they identify with had been rescinded and that assigned sex at birth would once again determine where transgender prisoners are jailed.[639]
In August 2022, a federal judge in Nebraska ruled against a transgender woman who had been denied gender affirming care in prison, and placed in a cell with a male sex offender that proceeded to sexually assault her. In his ruling, the judge declared there to be insufficient evidence of deliberate indifference on the prison's part to the plaintiff's gender dysphoria, and that the plaintiff hadn't sufficiently proven that she'd suffered more than minimal injuries from the sexual assault, stating that he found no support for the notion that a substantial risk of harm or deliberate indifference to it "could be plausibly inferred from a prospective cellmate's conviction of sexual offenses coupled with the alleged vulnerability of a transgender inmate transitioning to a woman in a men's prison".[640]
A 2018 report from theIndiana Maurer University School of Law, along with a subsequent report in theUCLA Journal of Gender and Law,[641] found that, based on accounts of former inmates, it was common for trans women placed in men's prisons to be assigned to cells with aggressive cisgender male cellmates to maintain social control and to, as one inmate described it, "keep the violence rate down". Trans women used in this manner are often raped daily. This process is known as "V-coding", and has been described as so common that it is effectively "a central part of a trans woman's sentence".[642]
The prisoners serving as "customers" for these women are informally referred to as "husbands". A 2021 California study found that 69% of trans women prisoners reported being made to perform sexual acts they would have rather not, 58.5% reported being violently sexually assaulted, and 88% overall reported having taken part in a "marriage-like relationship".[643] Trans women who physically resist the rape are often criminally charged with assault and placed in solitary confinement, the assault charge then being used to extend the woman's prison stay and deny her parole.[644]
It is common for correctional officers to publicly strip search trans women inmates, putting their bodies on display for staff members and other inmates. Trans women in this situation are sometimes made to dance, present, or masturbate at the correctional officers' discretion.[645] A 2017 study by theSylvia Rivera Law Project found that 75% of trans women respondents in New York state prisons were subjected to sexual violence by a correctional officer, with 32% being victimized by two or more COs and 27% of respondents being forced to perform oral sex for a CO.[646]
Transgender men in ICE custody under the Trump Administration have reportedly been specifically subjected to forced labor programs, with justifications given by guards including "If you wanna be a man, I’ll treat you like a man" and "Aren’t you strong enough? Aren’t you a man?". Those who refused faced punishments including beatings and solitary confinement, with many also reporting severe sexual abuse.[647][648] Data is hard to come by, however, as starting in 2025 ICE stopped complying with a federal law which required them to report data on transgender people in their custody.[649]
As of October 2023, nine states regulate pronoun use.[650] In April 2024, theU.S. Equal Employment Opportunity Commission (EEOC) issued guidance on gender ID pronouns. Employers refusing to use transgender workers' preferred pronouns or bar them from using bathrooms that match their known gender identity commit unlawful sex-based harassment acts.[651]
In February 2025, an employee of the Texas Real Estate Board was fired after refusing to remove pronouns from his email signature.Elon Musk and Texas governor Greg Abbott announced their support for the firing on social media.[652]
In May 2025, theU.S. District Court for the Northern District of Texas struck down the April 2024 EEOC guidance on gender ID pronouns inTexas v. EEOC.[653] The court ruled that the EEOC guidance is inconsistent withTitle VII of the 1964 Civil Rights Act and exceededU.S. Supreme Courtprecedent.[654]
In 2000, theUS Ninth Circuit Court of Appeals concluded that "gay men with female sexual identities [sic] in Mexico constitute a 'particular social group'" that was persecuted and was entitled to asylum in the US (Hernandez-Montiel v. INS).[655][656] Since then, several cases have reinforced and clarified the decision.[657]Morales v. Gonzales (2007) is the only published decision in asylum law that uses "male-to-female transsexual" instead of "gay man with female sexual identity".[657] An immigration judge stated that, underHernandez-Montiel, Morales would have been eligible for asylum (if not for her criminal conviction).[658]
Critics have argued that allowing transgender people to apply for asylum "would invite a flood of people who could claim a 'well-founded fear' of persecution".[656] Precise numbers are unknown, butImmigration Equality, a nonprofit for LGBT immigrants, estimates hundreds of cases.[656]
The United States has no process for accepting visa requests forthird gender citizens from other countries. In 2015, trans HIV activist Amruta Alpesh Soni's request for avisa was delayed because her gender is listed as "T" (for transgender) on her Indian passport. In order to receive a visa, theState Department requires the gender identification on the visa to match the gender identification on the passport.[659] On the other hand, the asylum process is expensive and transgender migrants do not have any voice in the asylum seeking process.[660] For example, transgender asylum seekers must wait for their case to be processed at the U.S./Mexico Border in detention centers.[660] Transgender asylum seekers must wait in detention where they may undergo rape, sexual assault, or harassment from authorities.[661] ICE Detention Center agents and staff have been found to be responsible for more counts of sexual victimization against transgender migrants than detainees or inmates, specifically during strip searches in multiple studies.[662] Transgender asylum seekers remain in detention oftentimes in solitary confinement which is extremely harmful for physical and mental health.[662] ICE facilities along the U.S./Mexico Border deny transgender migrants Hormone Replacement Therapy (HRT) and fail to maintain records on access migrants have to the treatment. In addition, transgender migrants andtransgender asylum seekers are sexually assaulted due to unsafe facilities which are separated through gender binaries.[662]
Discharges for gender transitioning were once commonplace. In one case, a trans person who had had gender-reassignment surgery was discharged from the Air Force Reserve, a decision supported by the Court of Appeals.[663][664]
In 2015, the Pentagon reviewed its policy regarding transgender service members and announced that its ban would be removed.[665] It announced on June 30, 2016, that, effective immediately, existing servicemembers who came out as transgender would no longer be discharged, denied reenlistment, involuntarily separated, or denied continuation of service simply because of their gender,[666] and that, starting in July 2017, people who already identify as transgender were welcome to join the military so long as they had already adapted to their self-identified gender for at least an 18-month period.[666]
PresidentDonald Trump tweeted on July 26, 2017, that transgender individuals will not be allowed to "serve in any capacity in the U.S. military".[667]Chairman of the Joint Chiefs of Staff GeneralJoseph Dunford pushed back, saying that the Secretary of Defense needed time to review this order. "In the meantime," he said, "we will continue to treat all of our personnel with respect."[668] On August 1, 2017, thePalm Center released a letter signed by 56 retired generals and admirals, opposing the proposed ban on transgender military service members. The letter stated that, if implemented, the ban would "deprive the military of mission-critical talent" and would compel cisgender service members "to choose between reporting their comrades or disobeying policy".[669] To challenge Trump's intended policy, at least four lawsuits were filed (Jane Doe v. Trump,Stone v. Trump,Karnoski v. Trump, andStockman v. Trump), as well as bipartisan Senate and House bills (S. 1820 and H.R. 4041). On August 25, 2017, Trump signed apresidential memorandum to formalize his request for an implementation plan from the Secretary of Defense and the Secretary of Homeland Security.[670] Several days later, Secretary of DefenseJim Mattis announced that he would set up a panel of experts to provide recommendations and that, meanwhile, currently serving transgender troops would be allowed to remain.[671] Afteranother memorandum in 2018, and afurther memorandum in 2019, the procedures regarding serving in the armed forces were finalized.
PresidentJoe Biden reversed the policy the first Trump Administration put in place to ban transgender people from serving in the military on January 25, 2021, only five days after he took theoath of office.[672] Biden said, "It is my conviction as Commander in Chief of the Armed Forces that gender identity should not be a bar to military service. Moreover, there is substantial evidence that allowing transgender individuals to serve in the military does not have any meaningful negative impact on the Armed Forces."
Biden's executive order was implemented in a step by step process. The order Trump signed banning transgender people from the military was to be reversed, the Department of Defense was to correct the record of anyone dismissed from service due to their gender identity, and the Secretary of Defense and the Secretary of Homeland Security were to begin the process of allowing transgender service members to serve openly. On April 30, 2021, the United States Department of Defense enacted a new policy which required better medical service and assistance to transgender people serving in the United States Military.[673]
In February 2024, the Veterans Administration issued a final ruling that it would not cover gender-affirming surgery.[674][675]
TheNational Defense Authorization Act for Fiscal Year 2025, a bipartisan bill which Biden signed in December 2024, includes language to ban transgender healthcare financing for certain procedures for minor children of military members.[676] The text states "medical interventions for the treatment of gender dysphoria that could result in sterilization may not be provided to a child under the age of 18."[677]
On January 27, 2025, Trump signed an executive order called "Prioritizing Military Excellence and Readiness".[678] On February 7, Defense SecretaryPete Hegseth signed a memo by the same name.[679] On February 26, Under Secretary of Defense for Personnel and Readiness,Darin S. Selnick, signed a memo with more details. The effect is to ban trans people from the military.[680] In March, U.S. District Court JudgeAna C. Reyes inTalbott v. United States[681][682] and U.S. District Court JudgeBenjamin H. Settle inShilling v. United States issued preliminary injunctions.[683] However, on May 6, the Supreme Court allowed the ban on trans personnel to take effect.[684]
IRS Publication 502[685] lists medical expenses that are tax-deductible to the extent they 1) exceed 7.5% of the individual's adjusted gross income, and 2) were not paid for by any insurance or other third party. For example, a person with $20,000 gross adjusted income can deduct all medical expensesafter the first $1,500 spent. If that person incurred $16,000 in medical expenses during the tax year, then $14,500 is deductible. At higher incomes where the 7.5% floor becomes substantial, the deductible amount is often less than thestandard deduction, in which case it is not cost-effective to claim.
IRS Publication 502 includes several deductions that may apply to gender transition treatments, including some operations.[685]The deduction for operations was denied to a trans woman but was restored in tax court.[686] The deductibility of the other items in Publication 502 was never in dispute.
27 U.S. States have banned transgender people from sports under their gender identity in various capacities. These states includeAlabama,[689]Arizona,[690]Arkansas,[691]Florida,[692]Georgia,[693]Idaho,[694]Indiana,[695]Iowa,[696]Kansas,[697]Kentucky,[698]Louisiana,[699]Mississippi,[700]Missouri[701]Montana,[702]Nebraska[703]New Hampshire,[571]North Carolina,[704]North Dakota,[705]Ohio,[706]Oklahoma,[707]South Carolina,[708]South Dakota,[709]Tennessee,[710]Texas,[711]Utah,[712]West Virginia,[713] andWyoming.[714] The passage of legislation against transgender youth has seen increases in calls toTrans Lifeline, a suicide crisis hotline run by and for transgender people.[715] Some of these bans only apply to school sports and some only apply to transgender women, but not transgender men.
In Oklahoma, all students who wish to play sports must submit a notarized affidavit of biological sex assigned at birth, under penalty of perjury.[716]
In August 2022,USA Cycling, citing new regulations on trans athletes, retroactively stripped trans woman Leia Genis of her silver medal earned at the Track National Championships that had taken place in 2022.[717]
Transgender rights organizations have argued that these discriminatory laws are not about protecting women's sports, but rather are attempts to "undermine the existence of transgender people."[718] Transgender advocates have commented that hormone replacement therapy and testosterone suppression reduces muscle mass and physical strength in transgender women, reducing the possibility of a competitive advantage.[719] Transgender inclusion in sports is supported by theWomen's Sports Foundation, theWomen's National Basketball Players Association (WNBPA), theNational Women's Law Center, andAthlete Ally, as well asUnited States Women's National Soccer Team CaptainMegan Rapinoe, tennis legendBillie Jean King, WNBAMinnesota Lynx coachCheryl Reeve, andWNBA starCandace Parker.[720][721][722][723]
TheUS Department of Education said in 2021 that transgender students are protected under Title IX.[724]
In November 2022, the 9th Circuit Court of Appeals ruled that the Miss United States of America pageant was allowed to categorically bar trans women from the competition, stating that the pageant's purpose was to celebrate "the ideal vision of American womanhood", and that allowing trans women to compete would make the pageant unable to do this. (This is a different pageant fromMiss USA, which does admit trans women.)[725][726]
In early 2023, the Florida High School Athletics Association recommended that all female athletes be mandated to supply up to date information on their menstrual cycles to a database accessible by their school's administrators. This was speculated by many to be a method of both enforcing abortion restrictions, and detecting any female athletes who might be trans women in violation of the state's ban.[727]
In early 2023, a federal bill that would ban transgender women from competing in women's sports nationwide was introduced as HR 734, "Protecting Women and Girls in Sports Act."[337] The bill passed the house in April 2023 with all Republicans voting for it and all Democrats voting against it. The Senate, as expected, did not take up the bill. President Biden vowed to veto it if it reached his desk.[728][729]
In April 2023, the Biden administration proposed aTitle IX rule change which would declare blanket "one size fits all" bans on trans athletes from teams consistent with their genders a violation of Title IX, but would authorize such bans if done for a number of reasons, including "fairness in competition". According to the proposal, this would most likely mean that bans that apply to elementary school students would be forbidden, but bans on high school and college students would be authorized under Title IX.[730][731]
After two delays, the final changes to Title IX were published in April 2024. The new changes cemented protections for LGBT students under federal law and reversed a number of Trump-era policies that dictated how schools should respond to cases of alleged sexual misconduct in K-12 schools and college campuses. They also effectively broadened the scope of Title IX by extending the law's reach to prohibit discrimination and harassment based on sexual orientation and gender identity, and widen the range of sexual harassment complaints that schools will be responsible for investigating. However, it did not explicitly say schools are forbidden from banning transgender women from competing in women's sports.[732][733] In response to these new changes, over 20 republican-led states sued the Biden Administration and refused to follow the new rules.[734] In June 2024, a judge temporarily blocked President Biden's proposed changes to the interpretation of Title IX in Texas.[735] A few days later, a judge issued an injunction temporary blocking the rules in Idaho, Louisiana, Mississippi and Montana.[736][737] The week after that, a judge temporarily blocked the law in Tennessee, Kentucky, Ohio, Indiana, Virginia and West Virginia.[738] On July 2, 2024, a federal judge temporarily blocked the law in Kansas, Alaska, Utah and Wyoming.[739] This ruling also blocks the rule from taking effect in schools inStillwater, Oklahoma, the home of a middle school student who joined the lawsuit, as well as any schools attended by members of theYoung America's Foundation and the children of members ofMoms for Liberty — two national conservative groups that signed onto the lawsuit.[740] On July 17, 2024, theFifth andSixth Circuits upheld two of the blocks.[741] On July 26, 2024, a federal court temporarily blocked the rule from taking effect in Iowa, Arkansas, Missouri, Nebraska, North Dakota and South Dakota.[742] On August 1, 2024, the rule went into effect in all the states that had blocked them.[743]
On August 16, 2024, the Supreme Court, in a 5-4 ruling, denied an emergency request from the Biden Administration to reinstate the law while further legal battles play out in the lower court. The ruling did not address the merits of the lawsuits or whether the new rules were constitutional.[744][745][746]
On January 9, 2025, U.S. District court judgeDanny C. Reeves struck down the Biden administration's expanded protections nationwide in response to the lawsuit filed by the states of Tennessee, Kentucky, Indiana, Ohio, Virginia, and West Virginia.[747][748]
In 2025, President Donald Trump signedExecutive Order 14201, titled "Keeping Men Out of Women's Sports". The executive order threatens to ban federal funding from any educational institution that allows transgender girls or women to play on girls' teams, claiming a violation ofTitle IX.[749][18] The executive order threatens to revoke federal funding from any elementary, secondary, and post-secondary institution that allows transgender girls to play on girls' teams, claiming they are in violation ofTitle IX.[749] The order is exclusive to transgender women and does not bar transgender male athletes from playing on male sports teams.[750]
The Supreme Court will hearLittle v. Hecox during its 2025-26 term, a case related to state laws in Idaho and West Virginia banning transgender women from playing in women's sports, both of which were found to violate the Equal Protection Clause and Title IX by theNinth Circuit and theFourth Circuit, respectively.[751]
| Transgender identity | / (Most states recognize and allow the ability of transgender individuals to change their legal gender, no federal recognition) |
| Right to change gender on birth certificates or passports | / (Currently blocked on passport applications;[752] legal gender change allowed in 47 states and DC; prohibited by statute inTennessee as of 2020 and inMontana andOklahoma as of 2022)[753][172] |
| Legal recognition of non-binary gender | / (No federal recognition, state-level recognition in 22 states) |
| Anti-discrimination laws in employment | (Since 2020) |
| Anti-discrimination laws in housing | / (Legal protections in22 states) |
| Anti-discrimination laws in public accommodations | / (Protections in only a minority of states) |
| Anti-discrimination laws in health insurance | |
| LGBTanti-bullying law in schools and colleges | / (Varies by state) |
| LGBT anti-discrimination law inhospitals | |
| Freedom of expression | /(Multiple "Don't say gay" laws in states limit instruction and discussion of LGBT issues in the classroom; other states have formal protections)[754] |
| Transgender people allowed toserve openly in the military | |
| Transgender people allowed in the military | |
| Transgender health care, such as access to GAS and hormone medications not restricted by law | / (Multiple states have blocked state Medicaid funding for transgender health care services, and have also made health care for youth withgender dysphoria illegal. On January 28, 2025, President Trump signed an executive order revoking federal funding for those who provide gender affirming care to those under 19 years of age.) |
| Transgender identity declassified as a mental illness | (Reclassified as 'gender dysphoria' under DSM-5 since 2013)[755] |
| Transgender people allowed to play in sports that match their gender identity | / (Multiple states and an executive order have banned transgender women and girls from competing in women's sports.) |
This article incorporates text from this source, which is in thepublic domain.To prevent the consequences of going through a puberty that doesn't match a transgender child's identity, healthcare providers may use fully reversible medications that put puberty on hold.
