According to the ACLU, 28 states are voting on anti-trans legislation in 2021.
Many bills directly impact trans children, banning them from playing sports or using the restroom.
Some bills could make it a felony for doctors to provide life-saving care to trans youth.
Trans rights are under siege in over half of the United States this year, as 28 states have proposed one or more anti-trans bills.
Trans advocate Rodrigo Heng-Lehtinen, Deputy Executive Director for the National Center for Transgender Equality, says 2021's wave of anti-trans legislation is unprecedented.
"These are organized anti-transgender forces, people who are ideologically anti-transgender, who are trying to push this everywhere that they can," Heng-Lehtinen told Insider. "So it's coordinated, it's deliberate, and it is all about using trans people and especially trans youth as a political football."
Despite medical best practice guidelines from the Endocrine Society, Child Mind Institute, and American Psychological Association recommending that states provide gender-affirming care for trans children, several states want to criminalize these vital health services.
Puberty blockers are the most common gender-affirming treatment option for trans youth under the age of 16.
Going through puberty that does not correspond with a trans child's gender can intensify their feelings of gender dysphoria - a deep distress caused by misalignment between a person's body and internal gender.
Puberty blockers essentially pause puberty for trans teens while they decide what course of gender-affirming care they want to take, with little to no permanent side effects.
Once trans youth turn 16 and decide with their parents and physician that they want to take further steps to affirm their gender, hormone replacement therapy (HRT) is usually prescribed. HRT, like testosterone or estrogen, does cause permanent changes like voice changes and body hair growth.
Studies have shown children who are unable to access gender-affirming care experience higher rates of depression, anxiety, and suicide than trans youth with supportive doctors and families.
However, Republican lawmakers continue to increase efforts to pass anti-trans laws. Anti-trans sports bills that aim to prevent trans athletes from participating in school sports teams are an increasingly common symptom of this pushback.
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Alabama is voting on two bills that would make it a felony for doctors to treat trans youth with gender-affirming care like hormone blockers and HRT.
The state legislature has also proposed anti-trans sports legislation that would prevent trans children from participating in sports teams from kindergarten to 12th grade: HB391.
On March 29, 2021, Arkansas became the first state in the US to pass a bill prohibiting doctors from treating trans youth.
HB1570 is called the "Save Adolescents From Experimentation (SAFE) Act." Governor Asa Hutchinson vetoed the bill on April 5, but Arkansas' state legislature voted to overturn the veto on April 6. The law will take effect in the summer of 2021.
Arizona's SB1511 would punish doctors with over a decade in prison for providing HRT or puberty blockers to minors.
State lawmakers are also attempting to ban trans athletes from playing school sports with bill SB1637.
Georgia's legislature is voting on a bill that would criminalize gender-affirming care, namely HRT and puberty blockers, for minors: HB401
Florida's legislature is voting on a bill that would make gender-affirming care, primarily HRT and puberty blockers, illegal for minors: HB 935.
Iowa's trans medical ban would prohibit gender-affirming care for minors with the exception of intersex youth if HF193 is passed.
Kansas will also vote on SB208, a bill that will stop trans students from participating in school sports to "create fairness in women's sports."
Kentucky's HB336 would make providing gender-affirming care for trans minors illegal and protect public officials who express views against gender-affirming care if passed.
Louisiana's SB 104 would make it illegal for doctors to provide gender-affirming care to minors without parental consent, namely gender-affirming therapy, puberty blockers, and HRT.
SB0218 would prevent trans athletes from participating in school sports if passed.
HF 1657 would specifically criminalize trans women who try to participate in girls' sports or even try to use the locker room that corresponds with their gender rather than the sex they were assigned at birth.
Mississippi's bill that would have banned gender-affirming care for trans youth, SB2171, was killed in committee.
However, Mississippi lawmakers passed a bill that will prevent trans girls from participating in female school sports, SB2536. It is unclear whether or not the law will be signed into effect by Governor Tate Reeves.
HB1077 would specifically prohibit any state funding for schools that allow trans students to participate in school sports.
SB245 and SB280 would impact all transgender people in the state if passed. SB245 would allow insurance companies and healthcare providers to refuse to cover or treat trans patients on the basis of being trans.
Montana's HB112 would require public schools to categorize sports teams based on biological sex and not allow trans people to compete.
State lawmakers will vote on a bill that would prevent trans athletes from playing on school sports teams: S3540.
New Hampshire's medical ban would criminalize and define gender-affirming care for trans minors as child abuse if passed: HB86
HB198 would stop trans athletes from playing school sports on the basis of preventing gender discrimination for cis women.
New Mexico's legislature will vote on a bill that would prevent trans students from playing school sports: HB304.
The North Carolina legislature is considering a bill that would prevent any trans person under the age of 21 from accessing gender-affirming medical care, such as HRT and puberty blockers: SB514.
The state is also considering a bill that would prevent trans girls from participating in school sports: NC H358.
North Dakota is voting on HB1298, which would stop trans athletes from participating in school teams if passed.
The "Save Women's Sports Act," SB331, would prevent trans athletes from participating in school sports teams if passed.
Ohio is voting on a bill that would prevent high schools, universities, and private schools to stop trans athletes from playing in school sports teams: HB61.
The state legislature is considering passing a bill that would prohibit trans students from playing school sports: HB972.
The state legislature is considering another bill that would prevent trans minors from accessing gender-affirming care if passed: H4047.
Texas is considering a bill that would change the definition of child abuse to include providing a trans minor with gender-affirming care. Advocates worry that if passed, SB1646 would allow trans children to be taken away from their families.
The state will also vote on HB1424, a bill that would allow insurance companies and healthcare providers to deny coverage or care to trans youth.
Utah's "Preserving Sports for Female Students Act," HB0302, would prevent trans students from playing sports at the high school or collegiate level.
If passed, the state's HB0092 would prevent doctors from treating trans minors with HRT or puberty blockers.
HB2171 would prevent minors in West Virginia from accessing gender-affirming care like HRT and puberty blockers.
AB62 would prevent trans athletes from participating in school sports teams.
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