Bans on Best Practice Medical Care for Transgender Youth

Bans on best-practice medical care represent one of the most extreme and coordinated political attacks on transgender people in recent years. These bills target transgender youth by blocking their access to best-practice medical care, care that is backed by years of rigorous research and endorsed by the American Academy of Pediatrics, the American Medical Association, and other leading health authorities. These bills not only display a fundamental lack of understanding of transgender children, but they also ban access to medical care often by criminalizing either the doctors or even the parents of transgender youth seeking to provide best-practice medicine for children in their care.

For more on these efforts, including how these attacks have become more extreme over time,
read MAP’s 2023 spotlight report.

State bans best practice medication and surgical care for transgender youth, though ban may not be in effect (see note)

25 states

State does not ban best practice medical care for transgender youth

23 states + 5 territories + D.C.

State ban makes it a felony crime to provide certain forms of best practice medical care for transgender youth

6 states

State bans best practice surgical care for transgender youth

2 states

State has "shield" law protecting access to transgender health care

16 states + D.C.

*Notes (and see the “Citations” tab or click “Citations & More Information” below the map legend for more information about every state):
–Arizona banned surgical care for transgender minors in 2022, but in 2023 a new governor issued an executive order with “shield” style protections for transgender health care that is still legal in the state. Go to the transgender healthcare “shield” Equality Map to learn more about these laws.
–Multiple states have “grandfather” clauses, “weaning off” clauses, or limited exceptions for some transgender youth and/or for some types of medication. Click “Citations” to read more detail about each bill or to access the law’s language directly.

Bans Permanently Blocked
The following laws are permanently blocked from being enforced, though appeals may be ongoing. Transgender youth should still be able to access care legally.
–Arkansas: In June 2023, a federal judge permanently blocked the state’s 2021 ban, ruling it unconstitutional. However, the state has said it will appeal the ruling, and the state also passed a new law in 2023 (effective 90 days after the legislature adjourns) that will allow individuals who receive gender-affirming care as minors (or the family members of those minors) to sue their medical providers for malpractice, among other provisions. The 2023 permanent block builds on an earlier temporary block issued in July 2021.

Bans Temporarily Blocked (In Full or In Part)
The following laws are at least partially blocked from being enforced, though these court cases are still ongoing. Transgender youth should still be able to access care legally to the extent each of these blocks allow.
-Montana, fully blocked: In Sept 2023, a state district court temporarily blocked the state’s ban on youth’s care from being enforced while the lawsuit continues.

Bans Not Yet in Effect
The following laws are not yet in effect. Transgender youth should still be able to access care legally to the extent each of these situations allow.
-New Hampshire: The state’s ban will not go into effect until January 1, 2025.

Recommended citation:
Movement Advancement Project. [Year of access]. “Equality Maps: Bans on Best Practice Medical Care for Transgender Youth.”
https://www.mapresearch.org/equality-maps/healthcare/youth_medical_care_bans. Accessed [day of access].

37% of transgender youth (ages 13-17) live in states that ban best practice medication and surgical care for transgender youth

60% of transgender youth (ages 13-17) live in states that do not ban best practice medical care for transgender youth

3% of transgender youth (ages 13-17) live in states that ban best practice surgical care for transgender youth

key

Key

State has law that only covers sexual orientationLaw covers sexual orientation
State has law that covers sexual orientation and gender identityLaw covers sexual orientation and gender identity/expression

Law covers association
Law prevents schools from adding LGBTQ protections

Law bans transgender students from using school facilities consistent with their gender identity

State	Anti-bullying	Nondiscrimination	Year Passed
	Citations	Citations
Alabama
Alaska
American Samoa
Arizona
Arkansas	State has law that covers sexual orientation and gender identity		2011
California	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
Colorado	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
Connecticut	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity	2021
Delaware
District of Columbia	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
Florida
Georgia			2011
Guam	State has law that only covers sexual orientation
Hawaii		State has law that covers sexual orientation and gender identity
Idaho
Illinois	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
Indiana
Iowa	State has law that covers sexual orientation and gender identity	State has law that only covers sexual orientation
Kansas
Kentucky
Louisiana
Maine	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
Maryland	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
Massachusetts	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
Michigan		State has law that covers sexual orientation and gender identity
Minnesota	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
Mississippi
Missouri	State does not have this law	State does not have this law	2006
Montana
Nebraska
Nevada	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
New Hampshire	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
New Jersey	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
New Mexico	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
New York	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
North Carolina	State has law that covers sexual orientation and gender identity
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
Pennsylvania
Puerto Rico		State has law that covers sexual orientation and gender identity
Rhode Island	State has law that covers sexual orientation and gender identity
South Carolina
South Dakota	State does not have this law	State does not have this law	2012
Tennessee
Texas
U.S. Virgin Islands	State has law that only covers sexual orientation
Utah
Vermont	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
Virginia		State has law that covers sexual orientation and gender identity
Washington	State has law that covers sexual orientation and gender identity	State has law that covers sexual orientation and gender identity
West Virginia
Wisconsin		State has law that only covers sexual orientation
Wyoming

	Sexual Orientation Tally	Gender Identity Tally	Overall Tally
High (75-100% of total points possible)	17.25+	19.5+	36.75+
Medium (50-74.9% of total points possible)	11.5 to 17	13 to 19.25	24.5 to 36.5
Fair (25-49.9% of total points possible)	5.75 to 11.25	6 to 12.75	12.25 to 24.25
Low (0-24.9% of total points possible)	0 to 5.5	0 to 5.75	0 to 12
Negative (<0 points)	<0	<0	<0
Total points possible	23	26	49

Marriage Recognition	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
As a result of the 2015 U.S. Supreme Court decision in Obergefell, same-sex couples can marry nationwide and states must extend all the rights and benefits of marriage to same-sex couples. As a result, the following benefits are available to all married same-sex couples on the same basis they are available to married different-sex couples: Marriage for Same-Sex Couples Medical Decision-Making Authority for Married Same-Sex Couples Stepparent Adoption for Married Same-Sex Couples Joint Adoption for Married Same-Sex Couples		1
Second-Parent Adoption for Unmarried Couples	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Second-parent adoption laws permit a parent in a relationship to adopt their partner's child and become a legal parent of that child, giving the child two legal parents and giving both parents legal rights. LGBTQ people often create families in diverse ways, including outside of legal marriage, so these laws help protect LGBTQ parents’ rights without requiring legal marriage.	Only parents in legally recognized relationships can petition to adopt their partner’s child.	0	These laws permit adoption of a child by a second parent who is not married to the child’s parent, irrespective of one’s gender identity. Therefore, enumerating gender identity is outside of the scope of these laws.
	Parents can petition for second-parent or stepparent adoption statewide irrespective of parents' marital status or legal recognition of their relationship.	1
Confirmatory Adoption	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
A confirmatory adoption is a streamlined process established by law to confirm a parent’s existing legal relationship to a child. The parent may have established parentage through other means, but completing the confirmatory adoption process results in a formal adoption decree. Other means of establishing parentage can include the marital presumption (the presumption that married parents are the parents of a child born during their marriage), the holding out presumption (the presumption that if a person acted as a parent to a child, such as by providing a home and raising them, then they are a parent), or as someone who intended to parent a child born through assisted reproduction. In the streamlined confirmatory adoption process, the home study or background check requirements associated with other types of adoptions are not required.	Confirmatory adoption is not available.	0
	Confirmatory adoption is available.	1
Voluntary Acknowledgment of Parentage	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
For most children born to unmarried parents, legal recognition of parentage is established through the “voluntary acknowledgment of parentage” (VAP), a legal document typically completed at the hospital at the time of the child’s birth. There are no costs associated with it, and once it takes effect, it is the legal equivalent of a court decree of parentage and, under federal law, must be respected across state lines and in all jurisdictions. However, in many states, only men who are believed to be the genetic father of the child in question are permitted to sign VAPs. As a result, many LGBTQ families face obstacles to this pathway to parental recognition. Now, a growing number of states are updating their parenting laws to ensure that any parent—regardless of their gender, sexual orientation, or genetic relationship to the child—can sign a VAP and have their parental relationship legally recognized and protected.	State has not yet expanded access of Voluntary Acknowledgment of Parentage (VAP)	0
	State has Voluntary Acknowledgment of Parentage (VAP) that is explicitly available to non-genetic and LGBTQ parents	1
Family Services Nondiscrimination Protections for LGBTQ Parents: Adoption	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Adoption nondiscrimination policies protect LGBTQ parents from discrimination by adoption agencies and officials. In combination with foster care nondiscrimination, this creates a full point for family services nondiscrimination policy.	Adoption nondiscrimination protections do not enumerate sexual orientation.	0	Adoption nondiscrimination protections do not enumerate gender identity.	0
	State law, regulation, or agency policy prohibits discrimination in adoption based on sexual orientation of parent(s).	0.5	State law, regulation, or agency policy prohibits discrimination in adoption based on gender identity of parent(s).	0.5
Family Services Nondiscrimination Protections for LGBTQ Parents: Foster Care	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Foster care nondiscrimination policies protect LGBTQ foster parents from discrimination by foster care agencies and officials. In combination with adoption nondiscrimination, this creates a full point for family services nondiscrimination policy.	Foster care nondiscrimination protections do not enumerate sexual orientation.	0	Foster care nondiscrimination protections do not enumerate gender identity.	0
	State law, regulation, or agency policy prohibits discrimination in foster care based on sexual orientation of parent(s).	0.5	State law, regulation, or agency policy prohibits discrimination in foster care based on gender identity of parent(s).	0.5
Legal Recognition for Parents Using Assisted Reproduction	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
These laws apply when a child is conceived through donor insemination and other forms of assisted reproduction. These laws grant legal parenting rights to the non-gestational, non-genetic parent (just as a woman’s husband would be a legal parent of a child they have using donor insemination even though he is not the biological father). In some states, being a married is not a legal requirement for parental recognition of a non-gestational, non-genetic parent. The process of “consenting to inseminate” allows parents in some states a way to establish a legal relationship to the child irrespective of the parents’ marital status.	State lacks clear mechanisms to create legal ties between a non-gestational, non-genetic parent and a child born via donor insemination.	0	Historically, parents using donor insemination are not denied legal recognition because they are transgender, but because they are part of (or perceived to be part of) a same-sex couple. Therefore, enumerating gender identity is outside of the scope of these laws.
	State law recognizes the non-gestational parent as a legal parent, regardless of marital status, if the non-gestational parent consents to the process by which a child is conceived via donor insemination or other assisted reproduction.	1
State Family Leave Laws: Definitions of Spouse/Partner	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
State family leave laws allow a person to take leave from work to care for their family members, including a spouse or partner. Some laws allow the worker to take leave for a partner only if they are in a legally recognized relationship (i.e. marriage) to the person who needs care. Other family leave laws use broader definitions of spouse or partner that better reflect the varied ways that LGBTQ people create family, including outside of legal marriage.	State lacks a family leave law entirely.	0	Although transgender people may be (or be considered to be) in a same-sex relationship and benefit from family leave, historically these laws’ definitions of family have the effect of recognizing or not recognizing a same-sex partner or spouse because both parties are the same sex, not because one of the parties is transgender. Therefore, enumerating gender identity is outside of the scope of these laws.
	State law grants workers leave to care for a partner, but only if the couple is in a legally recognized relationship.	0.25
	State law grants workers leave to care for a partner, even if the couple is not in a legally recognized relationship.	0.5
State Family Leave Laws: Definitions of Child/Parent	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
State family leave laws allow a person to take leave from work to care for a child. Barriers to parental recognition for LGBTQ people raising children often mean that one parent lacks legal ties to the child or children they are raising. Additionally, LGBTQ people create families in many ways, and some LGBTQ workers may not have legal or biological relationships to their children. Parents who are not legal or biological parents may be denied this leave unless the state law uses broader definitions of children or parenting that recognizes these varied ways of family building.	State lacks a family leave law entirely.	0	In the domain of family leave laws, LGBTQ parents’ struggles to gain legal ties to the children they are raising, and thus be recognized under state family leave laws, stem from lack of recognition of parents who are part of a same-sex couple, rather than because a parent is transgender. Therefore, enumerating gender identity is outside the scope of these laws.
	State law grants workers leave to care for a child for whom the worker is parenting, but only if the worker has a legal or biological relationship to the child.	0.25
	State law grants workers leave to care for a child for whom the worker is parenting, even if the worker lacks a legal or biological relationship to the child.	0.5
Relationship and Parental Recognition Subtotals (Tallies for Sexual Orientation and Gender Identity)	7		1
Relationship and Parental Recognition Total	8

Employment Nondiscrimination Laws	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Employment nondiscrimination laws protect LGBTQ people from being unfairly fired, not hired, or discriminated against in the workplace by private employers. If state lacks a statewide law, this tally looks at local nondiscrimination ordinances and provides partial points based on the percent of the state's LGBTQ population covered by local laws that protect LGBTQ people from discrimination by private employers. No points are awarded for state policies or local laws that only protect government/public employees.	No state law prohibiting employment discrimination based on sexual orientation, and <25% of state population is protected from discrimination based on sexual orientation through local ordinances.	0	No state law prohibiting employment discrimination based on gender identity, and <25% of state population is protected from discrimination based on gender identity through local ordinances.	0
	No state law prohibiting employment discrimination based on sexual orientation, but 25-49% of state population is protected from discrimination based on sexual orientation through local ordinances.	0.25	No state law prohibiting employment discrimination based on gender identity, but 25-49% of state population is protected from discrimination based on gender identity through local ordinances.	0.25
	No state law prohibiting employment discrimination based on sexual orientation, but 50-99% of state population is protected from discrimination based on sexual orientation through local ordinances.	0.5	No state law prohibiting employment discrimination based on gender identity, but 50-99% of state population is protected from discrimination based on gender identity through local ordinances.	0.5
	State employment nondiscrimination law does not explicitly enumerate sexual orientation, but state explicitly interprets existing state prohibition on sex discrimination to include sexual orientation.	0.75	State employment nondiscrimination law does not explicitly enumerate gender identity, but state explicitly interprets existing state prohibition on sex discrimination to include gender identity.	0.75
	State law explicitly prohibits employment discrimination based on sexual orientation.	1	State law explicitly prohibits employment discrimination based on gender identity.	1
Housing Nondiscrimination Laws	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Housing nondiscrimination laws protect LGBTQ people from being unfairly evicted, denied housing, or refused the ability to rent or buy housing. If state lacks a statewide law, this tally looks at local nondiscrimination ordinances and provides partial points based on the percent of the state's LGBTQ population covered by local laws that protect LGBTQ people from housing discrimination.	No state law prohibiting housing discrimination based on sexual orientation, and <25% of state population is protected from housing discrimination based on sexual orientation through local ordinances.	0	No state law prohibiting housing discrimination based on gender identity, and <25% of state population is protected from housing discrimination based on gender identity through local ordinances.	0
	No state law prohibiting housing discrimination based on sexual orientation, but 25-49% of state population is protected from housing discrimination based on sexual orientation through local ordinances.	0.25	No state law prohibiting housing discrimination based on gender identity, but 25-49% of state population is protected from housing discrimination based on gender identity through local ordinances.	0.25
	No state law prohibiting housing discrimination based on sexual orientation, but 50-99% of state population is protected from housing discrimination based on sexual orientation through local ordinances.	0.5	No state law prohibiting housing discrimination based on gender identity, but 50-99% of state population is protected from housing discrimination based on gender identity through local ordinances.	0.5
	State housing nondiscrimination law does not explicitly enumerate sexual orientation, but state explicitly interprets existing state prohibition on sex discrimination to include sexual orientation.	0.75	State housing nondiscrimination law does not explicitly enumerate gender identity, but state explicitly interprets existing state prohibition on sex discrimination to include gender identity.	0.75
	State law explicitly prohibits housing discrimination based on sexual orientation.	1	State law explicitly prohibits housing discrimination based on gender identity.	1
Public Accommodations Nondiscrimination Laws	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Public accommodation nondiscrimination laws protect LGBTQ people from being unfairly refused service from or entry to places accessible to the general public. Public accommodations laws generally cover anywhere someone is when they are not at home, work, or school, including retail stores, restaurants, parks, hotels, doctors' offices, and banks. If state lacks a statewide law, this tally looks at local nondiscrimination ordinances and provides partial points based on the percent of the state's LGBTQ population covered by local laws that protect LGBTQ people from public accommodation discrimination.	No state law prohibiting public accommodation discrimination based on sexual orientation, and <25% of state population is protected from public accommodation discrimination based on sexual orientation through local ordinances.	0	No state law prohibiting public accommodation discrimination based on gender identity, and <25% of state population is protected from public accommodation discrimination based on gender identity through local ordinances.	0
	No state law prohibiting public accommodation discrimination based on sexual orientation, but 25-49% of state population is protected from public accommodation discrimination based on sexual orientation through local ordinances.	0.25	No state law prohibiting public accommodation discrimination based on gender identity, but 25-49% of state population is protected from public accommodation discrimination based on gender identity through local ordinances.	0.25
	No state law prohibiting public accommodation discrimination based on sexual orientation, but 50-99% of state population is protected from public accommodation discrimination based on sexual orientation through local ordinances.	0.5	No state law prohibiting public accommodation discrimination based on gender identity, but 50-99% of state population is protected from public accommodation discrimination based on gender identity through local ordinances.	0.5
	State public accommodations nondiscrimination law does not explicitly enumerate sexual orientation, but state explicitly interprets existing state prohibition on sex discrimination to include sexual orientation.	0.75	State public accommodations nondiscrimination law does not explicitly enumerate gender identity, but state explicitly interprets existing state prohibition on sex discrimination to include gender identity.	0.75
	State law explicitly prohibits public accommodation discrimination based on sexual orientation.	1	State law explicitly prohibits public accommodation discrimination based on gender identity.	1
Credit and Lending Nondiscrimination Laws	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Credit and lending nondiscrimination laws protect LGBTQ people from being unfairly denied credit and lending services. Local nondiscrimination ordinances typically do not apply to credit and lending practices, so the 0.25 and 0.5 scoring options seen in the employment, housing, or public accommodations nondiscrimination policies are not applicable here.	No state law prohibiting credit and lending discrimination based on sexual orientation.	0	No state law prohibiting credit and lending discrimination based on gender identity.	0
	State credit nondiscrimination law does not explicitly enumerate sexual orientation, but state explicitly interprets existing state prohibition on sex discrimination to include sexual orientation.	0.75	State credit nondiscrimination law does not explicitly enumerate gender identity, but state explicitly interprets existing state prohibition on sex discrimination to include gender identity.	0.75
	State law explicitly prohibits credit and lending discrimination based on sexual orientation.	1	State law explicitly prohibits credit and lending discrimination based on gender identity.	1
Nondiscrimination Policies for State Employees	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Nondiscrimination policies for state employees prohibit discrimination against state employees on the basis of sexual orientation and/or gender identity.	No state policy prohibiting discrimination in public employment based on sexual orientation.	0	No state policy prohibiting discrimination in public employment based on gender identity.	0
	State law or policy explicitly prohibits discrimination against public employees based on sexual orientation.	0.5	State law or policy explicitly prohibits discrimination against public employees based on gender identity.	0.5
Negative Law: State Bans Cities and Counties from Passing Nondiscrimination Laws	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
So-called "Commerce Protection Acts," or preemption laws, prohibit cities and counties from extending local nondiscrimination protections to classes not included in state law. They also render existing local nondiscrimination ordinances unenforceable if they extend protection to these classes. These laws have been used to prevent cities and counties from protecting LGBTQ people from discrimination, and to nullify local ordinances which extend these protections.	State does not ban cities and counties from passing nondiscrimination protections based on sexual orientation.	0	State does not ban cities and counties from passing nondiscrimination protections based on gender identity.	0
	State law bans cities and counties from passing nondiscrimination protections based on sexual orientation.	-1	State law bans cities and counties from passing nondiscrimination protections based on gender identity.	-1
Negative Law: State Bans Transgender People from Using Publicly-Owned Bathrooms and Facilities According to their Gender Identity	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
These laws prohibit transgender people from using bathrooms and facilities—such as locker rooms, shower rooms, changing rooms, and other sex-segregated spaces—according to their gender identity in certain circumstances or places. All of these policies apply to K-12 school settings, and some apply even more broadly to other government-owned buildings and spaces. This can include bathrooms and facilities in government buildings (e.g., city hall, courthouses, state legislative buildings, and more), colleges or universities, jails or prisons, and even in some cases airports, public parks, and much more. Please note that these bans do not apply to, for example, private businesses or other non-government-owned spaces, though these spaces may have their own discriminatory policies.			No bathroom ban, or no bathroom ban applying beyond K-12 settings. Note that a K-12 bathroom ban may still apply; see LGBTQ youth category.	0
			State bans transgender people from using bathrooms and facilities consistent with their gender identity in K-12 schools and at least some government-owned buildings (e.g., public colleges/universities, prisons or jails, etc).	-0.5
			State bans transgender people from using bathrooms and facilities consistent with their gender identity in all government-owned buildings and spaces, including K-12 schools, colleges, and more.	-1
Negative Law: State Explicitly Regulates Gender by Defining "Sex" Throughout State Law	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
These laws explicitly regulate gender by defining "sex" throughout all state law to effectively allow discrimination against transgender and nonbinary people. These laws regulate gender and define sex as only male or female, typically based on a person's presumed reproductive anatomy, chromosomes, hormones, or other physical characteristics at birth. These laws also define sex as a permanent category, implying that transgender people's gender identity would never be legally recognized under state law. They may also have dangerous implications for transgender people when it comes to bathrooms, identity documents, and other areas of law or policy.			State has no law or executive order regulating gender by defining "sex" throughout state law	0
			State law regulates gender by defining "sex" throughout state law	-1
Nondiscrimination Subtotals (Tallies for Sexual Orientation and Gender Identity)	4.5		4.5
Nondiscrimination Total	9

Negative Law: Broad "RFRA" Religious Exemption Law	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Broad "RFRAs", or Religious Freedom Restoration Acts, are religious exemption laws that permit people, churches, non-profit organizations, and sometimes corporations to seek exemptions from state laws if they argue the laws burden their religious beliefs. The individual or organization must proactively seek out this exemption, such as through a court proceeding.	State has no broad RFRA religious exemption law.	0	State has no broad RFRA religious exemption law.	0
	State has broad RFRA religious exemption law.	-0.5	State has broad RFRA religious exemption law.	-0.5
Negative Law: Targeted Religious Exemption for Child Welfare Services	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Targeted religious exemptions for child welfare service providers permit state-licensed child welfare agencies to refuse to place and provide services to children and families, if doing so would conflict with their religious beliefs. These laws can harm many communities, as they can allow agencies to refuse to work with people from different or minority faith backgrounds, interracial or unmarried couples, single women, and LGBTQ people and same-sex couples, among others.	State has no targeted religious exemption law for child welfare providers.	0	State has no targeted religious exemption law for child welfare providers.	0
	State has targeted religious exemption law that permits state-licensed child welfare agencies to refuse to place and provide services to children and families, including LGBTQ people and same-sex couples, if doing so conflicts with their religious beliefs.	-1	State has targeted religious exemption law that permits state-licensed child welfare agencies to refuse to place and provide services to children and families, including LGBTQ people and same-sex couples, if doing so conflicts with their religious beliefs.	-1
Negative Law: Targeted Religious Exemption for Medical Professionals	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Targeted religious exemptions for medical professionals allow healthcare providers (such as doctors, nurses, pharmacists, and other medical professionals) to refuse to provide medical care to or otherwise serve LGBTQ clients.	State has no targeted religious exemption law for medical professionals.	0	State has no targeted religious exemption law for medical professionals.	0
	State has targeted religious exemption law allowing medical professionals to refuse to serve LGBTQ clients.	-1	State has targeted religious exemption law allowing medical professionals to refuse to serve LGBTQ clients.	-1
Negative Law: Targeted Religious Exemption for Private Wedding Services	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Targeted religious exemptions for private wedding services permit private for-profit businesses to deny services to married same-sex couples.	State has no targeted religious exemption law for private wedding services.	0	Although transgender people may often be (or be considered to be) in a same-sex relationship and would be harmed by laws denying services to same-sex couples, these laws have the effect of recognizing or not recognizing a same-sex partner or spouse because both parties are the same sex, not because one of the parties is transgender. Therefore, enumerating “gender identity” is outside of the scope of these laws.
	State permits services permits private for-profit businesses to deny wedding-related services to LGBTQ people/couples.	-0.5
Negative Law: Targeted Religious Exemption for Public Officials Providing Marriage Licenses	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Targeted religious exemptions for public officials (i.e., state and local government employees) permit those officials to decline to marry couples of whose marriage they disapprove, including same-sex couples.	State has no targeted religious exemption law for state and local officials providing marriage licenses.	0	Although transgender people may often be (or be considered to be) in a same-sex relationship and would be harmed by laws denying marriage licenses to same-sex couples, these laws have the effect of recognizing or not recognizing a same-sex partner or spouse because both parties are the same sex, not because one of the parties is transgender. Therefore, enumerating “gender identity” is outside of the scope of these laws.
	State permits state and local officials to decline to marry couples of whose marriage they disapprove.	-0.5
Religious Exemptions Subtotals (Tallies for Sexual Orientation and Gender Identity)	-3.5		-2.5
Religious Exemptions Total	-6

Nondiscrimination Laws and Policies Covering LGBTQ Students	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
School nondiscrimination laws and statewide regulations protect LGBTQ students from discrimination in school, including being unfairly denied access to facilities, sports teams, or clubs.	No state law, regulation, or teacher code prohibits discrimination in schools based on sexual orientation.	0	No state law, regulation, or teacher code prohibits discrimination in schools based on gender identity.	0
	Statewide regulation or teacher code prohibits discrimination in schools based on sexual orientation.	0.5	Statewide regulation or teacher code prohibits discrimination in schools based on gender identity.	0.5
	State’s school nondiscrimination law does not explicitly enumerate sexual orientation, but state explicitly interprets existing prohibition on sex discrimination to include sexual orientation.	0.75	State’s school nondiscrimination law does not explicitly enumerate gender identity, but state explicitly interprets existing prohibition on sex discrimination to include gender identity.	0.75
	State law explicitly prohibits discrimination in schools based on sexual orientation.	1	State law explicitly prohibits discrimination in schools based on gender identity.	1
Anti-Bullying Laws and Policies Covering LGBTQ Students	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Anti-bullying laws and statewide regulations protect LGBTQ students from bullying by other students, teachers, and school staff.	No state law or regulation prohibits bullying in schools based on sexual orientation.	0	No state law or regulation prohibits bullying in schools based on gender identity.	0
	State regulation, but not law, prohibits bullying in schools based on sexual orientation.	0.5	State regulation, but not law, prohibits bullying in schools based on gender identity.	0.5
	State law prohibits bullying in schools based on sexual orientation.	1	State law prohibits bullying in schools based on gender identity.	1
Negative Law: Anti-Enumeration Laws Banning Local Schools and Districts from Passing LGBTQ-Inclusive Nondiscrimination and/or Anti-Bullying Policies	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
These "anti-enumeration" laws prohibit schools and districts from adding (enumerating) sexual orientation or gender identity protections in the school/district's own anti-bullying and anti-discrimination policies.	State does not ban schools and districts from passing nondiscrimination and/or anti-bullying protections that include sexual orientation.	0	State does not ban schools and districts from passing nondiscrimination and/or anti-bullying protections that include gender identity.	0
	State law prohibits schools and districts from passing nondiscrimination and/or anti-bullying protections that include sexual orientation.	-1	State law prohibits schools and districts from passing nondiscrimination and/or anti-bullying protections that include gender identity.	-1
LGBTQ Inclusive Curricular Standards	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
LGBTQ-inclusive curricular laws explicitly require the state’s curricular standards to include LGBTQ people and history, such as in subjects like history, civics, or social studies. Often, laws requiring LGBTQ-inclusive curricular standards also require inclusive representation of other communities like people of color, people with disabilities, and religious minorities.	No state law requiring state's curricular standards to be LGBTQ-inclusive.	0	No state law requiring state's curricular standards to be LGBTQ-inclusive.	0
	State law requires the state's department of education to create LGBTQ-inclusive curriculum, but does not require schools to adopt it.	0.5	State law requires the state's department of education to create LGBTQ-inclusive curriculum, but does not require schools to adopt it.	0.5
	State law requires state's curricular standards to be LGBTQ-inclusive.	1	State law requires state's curricular standards to be LGBTQ-inclusive.	1
Negative Law: “Don't Say Gay” Laws Explicitly Restricting Educators From Discussing LGBTQ People or Issues in Schools	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
“Don't Say Gay” laws restrict teachers and staff from talking about LGBTQ issues and people. Most of these laws are written to bar any discussion of same-sex relationships within sex education programming, but the laws are often vague and can be misapplied by schools to limit discussion and inclusion of LGBTQ people and issues in other parts of the curriculum, school events and programs, and even extracurricular activities (for example, by being seen as prohibiting Gay-Straight Alliances).	State does not prohibit or explicitly restrict teachers and staff from talking about LGBTQ issues and people.	0	State does not prohibit or explicitly restrict teachers and staff from talking about LGBTQ issues and people.	0
	State has "Don't Say Gay" regulation prohibiting or explicitly restricting teachers and staff from talking about LGBTQ issues and people.	-1	State has "Don't Say Gay" regulation prohibiting or explicitly restricting teachers and staff from talking about LGBTQ issues and people.	-1
Negative Law: Laws Requiring Parental Notification And Allowing Parents to Opt Children Out of LGBTQ-Inclusive Curricula	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Parental opt-out laws require parents to be notified in advance of LGBTQ-inclusive curricula, and allow parents to opt their children out of those classes. "LGBTQ-inclusive curricula" can refer to any curricula about sexual orientation, gender identity, and/or LGBTQ people in general. Some states' parental opt-out laws apply to sex education or human sexuality instruction, but they have defined these to inherently include anything about sexual orientation or gender identity.	State does not have this law.	0	State does not have this law.	0
	State has law requiring parental notification of LGBTQ-inclusive curricula and allowing parents to opt children out.	-1	State has law requiring parental notification of LGBTQ-inclusive curricula and allowing parents to opt children out.	-1
Negative Law: Restricting Discussions of "Homosexuality" in Specific School Subjects	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
In the late 1980s, amidst the HIV/AIDS crisis, states began to enact censorship laws restricting how schools could discuss "homosexuality" in specific subjects like sex or health education. In some states, these laws remain on the books. These laws are distinct from the more recent wave of “Don’t Say LGBTQ” laws that explicitly censor teachers and staff from discussing LGBTQ people and issues in general (not only homosexuality), and throughout all curricula (not only in specific subjects).	State has no older-style law censoring discussions of "homosexuality" in specific subjects	0
	State law censors discussions of "homosexuality" in specific subjects	-0.5
Negative Law: Laws Banning Transgender Youth from Participating in Sports	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
These laws explicitly prevent transgender student athletes from participating in sports according to their gender identity. Independent of state laws, state high school athletic associations may have developed their own policies, which also vary widely from state to state.	These laws explicitly target transgender youth only. While transgender people may be of any sexual orientation, these laws are focused on gender identity.		State has no law (though state high school athletic associations may have their own policies).	0
			State has law banning transgender youth from participating in sports according to their gender identity.	-1
Negative Law: Laws Banning Transgender Students From Using School Facilities	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
These laws explicitly prevent transgender students from using K-12 school facilities, such as bathrooms or locker rooms, according to their gender identity.	These laws explicitly target transgender youth only. While transgender people may be of any sexual orientation, these laws are focused on gender identity.		State has no law banning transgender students from using school facilities according to their gender identity.	0
			State law bans transgender students from using school facilities according to their gender identity.	-1
Negative Law: Forced Outing of Transgender Youth in Schools	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
These laws explicitly require school staff—and in some cases, any government or public employee—to out transgender youth to their families, often without regard for whether doing so might put the child at risk of harm. Importantly, however, these laws vary in their actual requirements.	While students can also be outed about their sexual orientation, these laws specifically address and refer to students' gender identity.		State has no forced outing or related law	0
			State law requires forced outing of transgender youth before school staff can use a student’s preferred name/pronouns, but a student’s mere request to use a different name or pronouns does not itself require forced outing	-0.25
			State law requires forced outing of transgender youth, but only if parents ask school staff for the information	-0.5
			State law forces the outing of transgender youth if they make specific disclosures or requests about their gender identity (such as asking to be addressed by different name or pronouns, to access different bathrooms, etc) to school staff	-1
Conversion "Therapy" Laws	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Protective versions of these laws prohibit licensed mental health practitioners from subjecting minors to harmful conversion "therapy" practices that attempt to change their sexual orientation or gender identity. More recently, new and harmful versions of conversion "therapy" related state laws instead attempt to prevent municipalities from being able to enact local-level protections against conversion "therapy."	State law explicitly prevents municipalities from enacting local-level protections against conversion "therapy"	-1	State law explicitly prevents municipalities from enacting local-level protections against conversion "therapy"	-1
	No state law protecting youth from conversion "therapy," and <25% of state population is protected from conversion "therapy" through local ordinances.	0	No state law protecting youth from conversion "therapy," and <25% of state population is protected from conversion "therapy" through local ordinances.	0
	No state law protecting youth from conversion "therapy," but 25-49% of state population is protected from conversion "therapy" through local ordinances.	0.25	No state law protecting youth from conversion "therapy," but 25-49% of state population is protected from conversion "therapy" through local ordinances.	0.25
	No state law protecting youth from conversion "therapy," but 50-99% of state population is protected from conversion "therapy" through local ordinances.	0.5	No state law protecting youth from conversion "therapy," but 50-99% of state population is protected from conversion "therapy" through local ordinances.	0.5
	State law or executive order partially restricts conversion "therapy" for minors, but does not fully prohibit the practice	0.75	State law or executive order partially restricts conversion "therapy" for minors, but does not fully prohibit the practice	0.75
	State law prohibits licensed mental health care providers from subjecting minors to conversion "therapy"	1	State law prohibits licensed mental health care providers from subjecting minors to conversion "therapy"	1
Protections for LGBTQ Youth in the Child Welfare System	Sexual Orientation		Gender Identity
Definition	Level of State Law	Corresponding Point Value	Level of State Law	Corresponding Point Value
Protections for LGBTQ youth in the child welfare system can stem from state laws, regulations, or agency policies that prohibit discrimination against youth based on sexual orientation and/or gender identity. Some states also require current and prospective foster parents and child welfare staff to receive training about LGBTQ youth in areas like cultural competency and legal requirements, and some states require that transgender youth be placed in accordance with their gender identity. These laws and regulations are designed to improve the safety of and outcomes for LGBTQ youth in the child welfare system.	No explicit state protections against discrimination based on sexual orientation for youth in the child welfare system, nor requirements of LGB cultural competency training.	0	No explicit state protections against discrimination based on gender identity for youth in the child welfare system, nor guidance about transgender youth being placed in accordance with their gender identity.	0
	State law, regulation, or agency policy prohibits discrimination against youth in the child welfare system based on sexual orientation.	1	State law, regulation, or agency policy prohibits discrimination against youth in the child welfare system based on gender identity.	1
LGBTQ Youth Laws and Policies Subtotals (Tallies for Sexual Orientation and Gender Identity)	5		5
LGBTQ Youth Laws and Policies Total	10

Bans on Best Practice Medical Care for Transgender Youth

State bans best practice medication and surgical care for transgender youth, though ban may not be in effect (see note)

State does not ban best practice medical care for transgender youth

State ban makes it a felony crime to provide certain forms of best practice medical care for transgender youth

State bans best practice surgical care for transgender youth

State has "shield" law protecting access to transgender health care

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Bans on Best Practice Medical Care for Transgender Youth

State bans best practice medication and surgical care for transgender youth, though ban may not be in effect (see note)

State does not ban best practice medical care for transgender youth

State ban makes it a felony crime to provide certain forms of best practice medical care for transgender youth

State bans best practice surgical care for transgender youth

State has "shield" law protecting access to transgender health care

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