US Laws Restricting Medical Care for Transgender Minors: Statutory Inconsistencies Involving Intersex and Other Individuals.

Abstract

Since 2021, there have been growing calls in the US to prohibit gender-affirming medical care (GAMC) for transgender and gender-diverse (TGD) minors (ie, <18 years). Supporters of these bans have argued the restrictions are necessary to protect TGD minors from potentially risky or unproven medical interventions; however, the same bans include exceptions for similar procedures when performed on presumptively non-TGD minors: primarily, infants and children with variations in sex characteristics, or intersex traits. To comprehensively describe US legislation seeking to prohibit GAMC for TGD individuals and determine the extent to which such legislation contains exceptions for similar interventions performed on presumptively non-TGD minors. All US jurisdictions with statutes restricting GAMC across 4 full legislative sessions (January 1, 2021, to December 31, 2024) were searched. For each statute, the authors identified descriptions of sex, gender, and GAMC; restricted health care services; stated purpose(s) for which services are restricted; exceptions to restrictions; and penalties for statutory violations. All US states with legislation restricting voluntarily sought TGD-related health care contain statutory exceptions that allow for physically comparable, but typically nonvoluntary interventions to "normalize" the benign bodily attributes of children with intersex traits. Some statutes also explicitly permit medically unnecessary procedures like penile circumcision on presumptively non-TGD minors. Inconsistent statutory rules appear to be applied to TGD and presumptively non-TGD minors. Furthermore, these findings suggest such rules are shaped by definitions of sex and gender that conflict with current scientific understanding. Sound health policy ought to afford equal access to health care services affecting sexual anatomy, without discrimination based on sex traits or gender.