Tracking the regions in the United States where gender identity care is limited versus where it's safeguarded
In the United States, the legal landscape for transgender individuals, particularly minors, is undergoing significant changes. The US Supreme Court's recent decision in United States v. Skrmetti (June 18, 2025) has set a precedent that is likely to impact similar bans in other states.
The Court upheld Tennessee’s ban on gender-affirming care for minors, including puberty blockers, hormone therapy, and surgeries. Applying a rational basis standard, the Court accepted the state’s stated interests in preventing minors from making irreversible medical decisions and protecting safety, thus rejecting heightened scrutiny for transgender status or sex discrimination claims.
This ruling effectively allows Tennessee’s law to take effect and signals that similar bans in other states are likely to withstand legal challenges. The Court’s approach limits protections for transgender minors under federal anti-discrimination laws regarding medical care access.
As a result, numerous states have passed or are proposing laws targeting minors’ access to gender-affirming care, with potential criminal penalties for providers. These laws frequently exempt similar medical interventions for cisgender or intersex youth, highlighting the targeted nature of these restrictions.
In addition, proposed federal policies could reduce insurance coverage for gender-affirming care, potentially increasing costs for transgender patients.
The situation is not limited to healthcare. Hundreds of anti-LGBTQ bills have been introduced in 2025, affecting healthcare, identity documents, and public expression. These bills cover various aspects of everyday life, including bathroom access, school sports, and identification documents.
Every state, except for Vermont, has filed at least one anti-LGBTQ bill in 2025, according to a CNN analysis. Texas, in particular, has introduced 88 anti-LGBTQ bills this year, more than double the number of bills being considered in any other state.
Despite these challenges, ongoing legal, legislative, and advocacy efforts are influencing future developments. The US Supreme Court will take on more cases dealing with trans rights in its next session starting in October.
Here's a summary of the current status and trends:
| Aspect | Current Status/Trend | |----------------------------|--------------------------------------------------| | Supreme Court rulings | Upheld bans on gender-affirming care for minors (e.g., Tennessee) applying rational basis review[1][4] | | State laws | Numerous states passing or proposing bans targeting minors’ access with potential criminal penalties[3] | | Federal policies | Proposed rule changes to ACA coverage could increase costs and limit insurance coverage access[2] | | Legal challenges | Similar bans likely to survive challenges post-Skrmetti[1] | | Broader legislative attacks| Hundreds of anti-LGBTQ bills affecting healthcare, IDs, and expression in 2025[3] |
This reflects a growing nationwide trend of restricting gender-affirming care access for transgender minors through state laws and supportive judicial decisions, compounded by federal policies that could reduce insurance coverage protections.
Sources: [1] CNN, July 2025 [2] ACLU, July 2025 [3] Human Rights Campaign, July 2025 [4] SCOTUSblog, July 2025
- The ruling in United States v. Skrmetti by the US Supreme Court has set a precedent that may influence future policy-and-legislation regarding mental-health and health-and-wellness issues, particularly for transgender minors.
- In addition to the changes in the legal landscape for transgender individuals, there has been widespread, ongoing efforts to enact anti-LGBTQ bills in various aspects, including general-news, identity documents, and public expression across most states in the country, with Texas leading with the highest number of bills introduced this year.
- The legal and legislative landscape for science and mental-health related policies has been affected, with significant focus on limiting access to gender-affirming care for transgender minors, potentially impacting future mental-health outcomes for affected individuals.
