Several state legislatures, led by Republicans, are discussing a fresh set of measures that would limit medical treatment for transgender minors and, in certain instances, adults. This revisits the topic from last year when a number of prominent bills were passed and resulted in legal challenges.

As lawmakers commence their duties for the new term, there have been proposals in multiple states to implement or enhance limitations on puberty-blocking medications and hormone therapies for minors. Additionally, bills addressing which pronouns students can use in school, which sports teams they can join, and which restrooms they can access have resurfaced. There are also attempts to restrict drag performances, as well as certain books and school curriculums.

Many LGBTQ+ supporters claim that the majority of states that are considering bans on gender-affirming care have already implemented them, and they anticipate these states to further restrict and extend the bans to include adults. As legislatures in numerous states face upcoming elections, transgender minors and their loved ones fear being targeted once again by conservative politicians who use this as a divisive tactic.

Mandy Wong, a mother from Santa Barbara, California, expressed frustration with conservative politicians who exploit transgender children for political gain. Although she does not anticipate such a policy to be enacted in her state, which is led by Democrats, Wong’s child and their friends are feeling emotionally exhausted.

She expressed her sadness when telling him that the issue would not be resolved quickly. The constant negative focus on transgender students, including parents, due to these proposals does not seem to be decreasing.

The House Republicans in Ohio voted on Wednesday to overturn the veto of Republican Governor Mike DeWine on a bill that prohibits all types of gender-affirming treatments for minors. It is anticipated that the Senate will also do the same this month. Despite vetoing the bill, DeWine signed an order prohibiting gender-transition surgeries for minors. Additionally, he suggested implementing regulations that would require a care team for both children and adults, which critics argue could greatly limit accessibility for all patients.

The state of South Carolina, which is one of the few Southern states that does not currently have a ban on gender-affirming care for minors, had a House committee vote to send a ban to the House floor on Wednesday. The proposed bill, introduced by the state’s Republican House speaker, would also prohibit Medicaid from covering gender-affirming treatments for individuals under the age of 26. Additionally, the House in New Hampshire voted last week to ban gender-transition surgeries for minors.

At least 22 states have enacted bans on gender-affirming care for children, with most of them approved in the past year. Those who support the bans say they want to protect children and have concerns about the treatments themselves. Major medical groups, including the American Medical Association and the American Academy of Pediatrics, oppose the bans and have endorsed such care, saying it’s safe when administered properly.

The previous year’s restrictions included a Florida statute that has greatly hindered the ability of numerous transgender individuals in the state to obtain gender-affirming treatment. Governor Ron DeSantis of Florida has touted this prohibition as one of his achievements while vying for the Republican nomination for president.

Katy Erker-Lynch, executive director of PROMO, an advocacy organization in Missouri, stated that “They will not hesitate to take action, leaving us uncertain of what to expect (in 2024).” This comes as lawmakers in the state have put forth over 20 bills aimed at the LGBTQ+ community.

Proposed laws in Missouri aim to eliminate two aspects that played a crucial role in defeating a Democratic filibuster against the state’s prohibition on gender-affirming treatment for minors. The newly formed Missouri Freedom Caucus is giving priority to a bill that would permanently enforce the ban on gender-affirming care for minors, removing the clause that permits it to end in 2027. The bill would also eliminate a provision that allows minors who started the treatment before the law was implemented to continue receiving it.

Republican lawmaker Mike Moon, who is supporting legislation to remove the expiration date on medical restrictions and to mandate that schools inform parents if a student wishes to use a different name or pronoun than what was used for school registration, drew parallels between transgender medical limitations for minors and age limits for activities like smoking, drinking, and driving.

According to Moon, children, particularly younger ones, struggle with decision-making and may not always have a clear understanding of reality.

LGBTQ+ advocates refer to legislation mandating schools to disclose a student’s desire to change their name or pronouns to their parents as “forced outing,” arguing that schools may serve as the only secure environment for transgender or nonbinary individuals to express their gender identity.

Activists have taken notice of the high volume of bills filed in Missouri, but Republican leaders in the legislature do not believe there is much interest in revisiting restrictions and do not intend to make them a priority.

Caleb Rowden, the Missouri Senate President Pro Tem, stated that last year, a robust and comprehensive bill, in his opinion, was approved, referring to the medical prohibition.

In Oklahoma, there are currently two active bills from last year that aim to restrict access to gender-affirming care for adults. One bill seeks to ban insurance coverage for these procedures, while the other would prevent public funds from being used for any providers offering such care.

Last year, the Republican-controlled Legislature did not make any progress on both measures. However, they may be revisited during the legislative session in February.

DeWine’s recent proposal in Ohio imposes stricter regulations on adults, which advocates believe will hinder access to necessary treatment for certain individuals. These regulations include the requirement for a designated team of professionals, including an endocrinologist, bioethicist, and psychiatrist, for each individual. Additionally, the rules call for medical providers to submit data on gender dysphoria and treatment.

Multiple proposals have been submitted in Florida, one of which would mandate that employees at state agencies or organizations receiving state funds use the pronouns that align with their designated gender at birth.

A bill proposed on Wednesday in West Virginia aims to forbid individuals under the age of 21 from receiving gender-affirming treatment and would prevent mental health experts from validating what legislators refer to as a transgender individual’s “false belief” about their gender identity.

Conservatives in California are attempting to place a measure on the ballot next year that would restrict the rights of transgender minors, despite the state’s acceptance of these individuals and their families from states with medical restrictions.

Kathleen Kauth, a senator from Nebraska, was responsible for the state’s ban on gender-affirming care for minors last year. She denies that her efforts to pass laws targeting the LGBTQ+ community are motivated by political partisanship. She is currently advocating for a bill that would place restrictions on transgender students’ involvement in sports and access to bathrooms and locker rooms, which she first introduced last year.

The medical ban imposed by Kauth prompted progressive legislators to engage in filibustering for almost every bill during last year’s session.

Kauth stated that he does not believe his actions are motivated by a desire for reelection. He mentioned that his district has an equal split between conservative and liberal views, with a slight majority leaning conservative. Kauth’s main focus is on resisting federal government interference and safeguarding children.

Throughout the country, legal challenges to existing laws are progressing towards the U.S. Supreme Court. The American Civil Liberties Union has requested that the court intervene and prevent limitations on services for minors in Kentucky and Tennessee.

The 8th U.S. Circuit Court of Appeals is reviewing Arkansas’ appeal to overturn a decision that invalidated the state’s pioneering ban on gender-affirming treatment for minors.

Judges appointed by both Democratic and Republican presidents have issued federal rulings against the bans.

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DeMillo provided coverage from Little Rock, Arkansas, while Schoenbaum reported from Salt Lake City. Additional contributors to this article include Associated Press journalists David Lieb and Summer Ballentine in Jefferson City, Missouri; Margery Beck in Omaha, Nebraska; Sean Murphy in Oklahoma City; and Sophie Austin in Sacramento, California.