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A total of 25 states now have restrictions on gender-affirming care. Below is a list of the effective dates, exemptions, and penalties to clinicians for providing gender-affirming care. This list will be updated as new information becomes available.

Note that some bans may be blocked due to ongoing legal battles.

Alabama

In effect: May 8, 2022

Exemptions: A "medically verifiable disorder of sex development" including a chromosome disorder

Risks to Physicians: Felony offense with up to 10 years in prison and a fine up to $15,000

Arizona

In effect: March 31, 2023

Exemptions: A "medically verifiable disorder of sex development" including a chromosome disorder, or if patients need treatment for an injury related to their gender-affirming care

Risks to Physicians: No penalty specified

Arkansas

Note: A federal judge the ban on June 20, 2023. The state’s attorney general plans to appeal.

In effect: March 13, 2023

Exemptions: A "medically verifiable disorder of sex development" including a chromosome disorder, or if patients need treatment for an injury related to their gender-affirming care. Also if the provider has seen the minor for 2 years and the minor has seen a mental health professional who certifies the minor does not have other mental health conditions

Risks to Physicians: Minor or their guardian may bring civil action against the provider for physical, psychological, emotional, or physiological injury

Florida

Note: A federal judge bans on gender care for youth and adults, but the block was and can now be enforced.

In effect: May 17, 2023

Exemptions: A "medically verifiable genetic disorder of sexual development", and the state's osteopathic and medical boards must draft rules for situations where a minor may continue treatment

Risks to Physicians: Third-degree felony or first-degree misdemeanor depending on violation, with up to 5 years in prison and fines up to $5,000

Georgia

In effect: July 1, 2023

Exemptions: A "medically verifiable disorder of sex development" including chromosome abnormality, or if it's necessary to the health of the patient. Doctors can continue treatment for those who began prior to July 1, 2023 if treatments are irreversible

Risks to Physicians: Physicians can be "held administratively accountable" to the medical board

Idaho

In effect: April 14, 2024

Exemptions: A "medically verifiable genetic disorder of sex development," if it's necessary to the health of the patient, or if it's to treat any injury from their gender-affirming care

Risks to Physicians: Felony offense with up to 10 years prison and a fine up to $5,000

Indiana

In effect: July 1, 2023

Exemptions: Doctors may continue giving hormone treatment to grandfathered patients until the end of 2023

Risks to Physicians: Minors can bring a case against a physician until they are 28; can face medical board disciplinary action

Iowa

In effect: March 22, 2023

Exemptions: A "medically verifiable genetic disorder of sex development," if it's necessary to the health of the patient, or if treating any injury from gender-affirming care

Risks to Physicians: Treatment is considered "unprofessional conduct" and doctors are subject to discipline by the medical board; providers can be sued

Kentucky

In effect: March 29, 2023

Exemptions: A "medically verifiable disorder of sex development" or if they need treatment related to their gender-affirming care

Risks to Physicians: A doctor's medical license can be revoked and providers can be sued

Louisiana

In effect: January 1, 2024

Exemptions: A "medically verifiable disorder of sex development"; providers can continue care but it must be withdrawn by the end of 2024.

Risks to Physicians: A doctor's medical license can be revoked and providers can be sued

Mississippi

In effect: February 28, 2023

Exemptions: A "medically verifiable disorder of sex development" or to treat any injury related to gender-affirming care

Risks to Physicians: Treatment is considered "unprofessional conduct" and a doctor's medical license can be revoked, in addition to up to a $500 fine; providers can be sued

Missouri

In effect: August 28, 2023

Exemptions: A "medically verifiable disorder of sex development," if previous gender-affirming care caused an injury, or if there is a physical condition that places a person in "imminent danger of death or impairment of a major bodily function"

Risks to Physicians: Treatment is considered "unprofessional conduct" and healthcare providers can have their license revoked and be sued

Montana

Note: A state judge enforcement of the ban on September 27, 2023.

In Effect: October 1, 2023

Exemptions: "Medically verifiable" disorders of sex development, including chromosomal abnormalities

Risks to Physicians: Subject to medical board discipline that must include at least a year-long suspension; providers can be sued

Nebraska

In effect: October 1, 2023

Exemptions: A "medically verifiable disorder of sex development," and the state's chief medical officer will make rules around exceptions for nonsurgical procedures, such as puberty blockers and hormones for an "intense pattern of gender nonconformity or gender dysphoria"

Risks to Physicians: Treatment is considered "unprofessional conduct" and providers are subject to disciplinary action

North Carolina

In effect: October 1, 2023

Exemptions: A "medically verifiable genetic disorder of sexual development"

Risks to Physicians: Physicians can be disciplined and fined by the medical board

North Dakota

In Effect: April 20, 2023

Exemptions: "If performance or administration of the medical procedure on the minor began before the effective date of this Act." Minors currently receiving gender-affirming care will still be able to receive treatment

Risks to Physicians: Felony offense for surgery up to 10 years in prison and a fine up to $20,000, misdemeanor offense for gender-affirming medication up to 1 year in prison and a fine up to $3,000

Ohio

In effect: August 6, 2024

Exemptions: A "medically verifiable disorder of sex development," including chromosome abnormality, or treatment for an injury related to gender-affirming care.

Risks to physicians: Physicians can be sued, and treatment is considered "unprofessional conduct" subject to medical board discipline.

Oklahoma

In effect: May 2, 2023

Exemptions: Doctors can continue to provide puberty blockers or hormones for 6 months to help patients ultimately discontinue therapy

Risks to Physicians: Physicians face felony charges and license revocation, and lawsuits can be filed by a parent or guardian

South Carolina

In effect: May 21, 2024

Exemptions: Doctors can taper patients who started puberty blockers or hormones prior to August 1, 2024 until January 21, 2025

Risks to physicians: Physicians can be sued, and treatment is considered "unprofessional conduct" subject to medical board discipline

South Dakota

In effect: July 1, 2023

Exemptions: A "medically verifiable disorder of sex development" including chromosome abnormality, or treatment for an injury related to gender-affirming care

Risks to Physicians: Physicians can lose their license and providers can be sued

Tennessee

In effect: July 1, 2023

Exemptions: Patients are allowed to continue treatment if they started it before July 1, 2023, but care must end by March 31, 2024

Risks to Physicians: $25,000 per violation; license actions also possible; providers can be sued

Texas

In effect: September 1, 2023

Exemptions: Those currently on hormones or puberty blockers and those who have attended at least 12 sessions of mental health counseling over 6 months before starting treatment can continue, but should gradually be weaned.

Risks to Physicians: Physicians can lose their license

Utah

In effect: January 28, 2023

Exemptions: Hormonal treatments are prohibited for patients who haven't been diagnosed with gender dysphoria by the time the law went into effect. It also requires the state health department to conduct a systematic review of the evidence on hormonal treatments. In addition, the state's licensing department must create a "transgender treatment certification" for healthcare professionals by July 1, 2023

Risks to Physicians: Providing treatment without a transgender treatment certification will be considered "unprofessional conduct"; providers can be sued

West Virginia

In effect: January 1, 2024

Exemptions: Patients can get hormone therapy with parental consent and a diagnosis of severe gender dysphoria from two clinicians, including a mental health provider or an adolescent medicine specialist. Doctors can also prescribe hormones if a teenager is considered at risk for self-harm or suicide

Risks to Physicians: No penalty specified

Wyoming:

In effect: July 1, 2024

Exemptions: Treatments with consent of a parent or guardian that are for a "medically verifiable genetic disorder of sex development" or for "medically verifiable central precocious puberty."

Risks to Physicians: Physicians, nurses, or pharmacists can have their licenses suspended, revoked, or restricted.

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