At least 11 US states have placed restrictions or outright bans on gender-affirming treatments for young people under 18.
Two states in the southern United States have advanced laws limiting access to gender-affirming healthcare for transgender youth, as part of a wave of Republican-led legislation critics decry as discriminatory and dangerous.
Kentucky and West Virginia join at least nine other states in implementing restrictions on treatments that leading medical groups like the American Academy of Pediatrics say can be necessary and even life-saving for transgender young people.
But proponents of the restrictions argue that people under the age of 18 are too young to undergo gender-affirming treatments, which can range from temporary, reversible measures like puberty blockers — which pause sexual development — to hormone treatment and surgery.
Medical research, however, suggests that regret for such gender-affirming treatment is rare.
The first of Wednesday’s laws came in Kentucky, where a heavily Republican legislature used its supermajority to override an earlier veto from Democratic Governor Andy Beshear.
Following a vote of 29 to eight in the state Senate, Kentucky’s House of Representatives passed the law along party lines, 76 to 23. The law’s language not only restricts gender-affirming healthcare but also forces doctors to halt services for patients already undergoing treatment.
If a sudden end to care will harm the patient, the law requires doctors to establish a timeline to end the treatment. Those restrictions are set to take effect in three months.
Kentucky’s bill also goes beyond healthcare. Schools will be barred from holding discussions of sexual orientation and gender identity, while educational districts must craft policies to ensure students use toilets corresponding to the gender on their birth certificates.
The debate in Kentucky’s state Capitol grew heated as the vote neared. State police later reported that 19 people were arrested for trespassing after protesting from the House gallery.
“We are denying families, their physicians and their therapists the right to make medically-informed decisions for their families,” Karen Berg, a Democratic state Senator, said in opposition to the bill. Her 24-year-old child was a transgender activist who died by suicide in December.
Meanwhile, Berg’s colleague, Republican state Senator Robby Mills, decried gender-affirming treatment as “dangerous for the health” of children.
That rhetoric was echoed on Wednesday in West Virginia, where Republican Governor Jim Justice signed his state’s ban on gender-affirming healthcare for patients under age 18.
The law, set to take effect in January 2024, does include a rare exception: allowing prescribed puberty blockers and hormone therapy for teenagers shown to be at risk of self-harm. But in those cases, patients must have parental consent and a diagnosis of severe gender dysphoria from two doctors.
West Virginia has the highest per capita rate of transgender young people in the US, according to a 2017 study from the Williams Institute, a think tank at the UCLA School of Law.
The laws in both Kentucky and West Virginia join a wave of Republican legislation across the country that critics denounce as an attack on LGBTQ+ rights. And they are both likely to be challenged in court.
Federal judges have already blocked the enforcement of laws restricting gender-affirming care in Alabama and Arkansas, and the American Civil Liberties Union of Kentucky has already announced it intends “to take this fight to the courts”.
“To all the trans youth who may be affected by this legislation: we stand by you, and we will not stop fighting. You are cherished. You are loved. You belong,” the organisation said in its statement.
Nearly two dozen states around the US are currently considering restrictions on gender-affirming care.