Transgender rights in the United States

In Obergefell v. Hodges, the Court ruled that people have a right to marry without regard to sex. While this is commonly understood as a ruling allowing same-sex marriage, it also meant that a person's sex, whether assigned at birth or recognized following transitioning, cannot be used to determine their eligibility to marry. Prior to this ruling, the right of transgender people to marry was often subject to legal challenge—as was the status of their marriages after transitioning, particularly in cases where an individual's birth sex was interpreted to mean a same-sex marriage had taken place.{{cite news|author1=J. Courtney Sullivan|title=What Marriage Equality Means for Transgender Rights|url=https://www.nytimes.com/2015/07/16/opinion/what-marriage-equality-means-for-transgender-rights.html|access-date=August 28, 2015|work=The New York Times|date=July 16, 2015|url-status=live|archive-url=https://web.archive.org/web/20150906082508/http://www.nytimes.com/2015/07/16/opinion/what-marriage-equality-means-for-transgender-rights.html|archive-date=September 6, 2015|df=mdy-all}}

In 1959, Christine Jorgensen, a trans woman, was denied a marriage license by a clerk in New York City, on the basis that her birth certificate listed her as male;(April 4, 1959). [https://timesmachine.nytimes.com/timesmachine/1959/04/04/91419258.pdf Bars Marriage Permit; Clerk Rejects Proof of Sex of Christine Jorgensen] {{subscription required}}. The New York Times{{cite news|url=https://news.google.com/newspapers?id=3m4xAAAAIBAJ&pg=6305,3225316&dq=christine+jorgensen&hl=en|title=Christine Denied Marriage License|date=April 4, 1959|work=Toledo Blade|access-date=November 18, 2012}} Jorgensen did not pursue the matter in court. Later that year, Charlotte McLeod, another trans woman who underwent gender-affirming surgery in Denmark, married her husband Ralph H. Heidel in Miami. She did not mention her birth sex, however, or the fact she was still legally male, since Florida's marriage law did not require a birth certificate for the issuance of a marriage license to an individual over the age of 21.{{Cite journal |last1=Bowman |first1=Karl M. |last2=Engle |first2=Bernice |year=1960 |title=Sex Offenses: The Medical and Legal Implications of Sex Variations |url=https://www.jstor.org/stable/1190379 |journal=Law and Contemporary Problems |volume=25 |issue=2 |pages=292–308 |doi=10.2307/1190379 |jstor=1190379 |issn=0023-9186}} In 1976, the New Jersey case M.T. v. J.T. held that trans people who had undergone gender-affirming surgery could marry as the legal sex matching their gender identity, the first ruling of its kind. Here the court expressly considered the English Corbett v. Corbett decision but rejected its reasoning.

In Littleton v. Prange, (1999),{{cite web |title=Case # 04-99-00010-CV |publisher=Texas Fourth Court of Appeals |year=2000 |url=http://www.4thcoa.courts.state.tx.us/opinions/case.asp?FilingID=8739 |access-date=May 7, 2009 |archive-url=https://web.archive.org/web/20100503003853/http://www.4thcoa.courts.state.tx.us/opinions/case.asp?FilingID=8739 |archive-date=May 3, 2010 |df=mdy-all }} Christie Lee Littleton, a trans woman who had undergone gender-affirming surgery, argued to the Texas 4th Court of Appeals that her marriage to her genetically male husband (deceased) was legally binding and hence she was entitled to his estate. The court decided that plaintiff's sex is equal to her chromosomes, which were XY (male). The court subsequently invalidated her revision to her birth certificate, as well as her Kentucky marriage license, ruling "We hold, as a matter of law, that Christie Littleton is a male. As a male, Christie cannot be married to another male. Her marriage to Jonathon was invalid, and she cannot bring a cause of action as his surviving spouse." She appealed to the Supreme Court but it denied certiorari in 2000.

The Kansas Appellate Court ruling in In re Estate of Gardiner (2001){{cite web |title=85030 – In re Estate of Gardiner |publisher=Court of Appeals of the State of Kansas |year=2000 |url=http://www.kscourts.org/Cases-and-Opinions/opinions/ctapp/2001/20010511/85030.htm |access-date=May 7, 2009 |url-status=live |archive-url=https://web.archive.org/web/20081011051448/http://www.kscourts.org/Cases-and-Opinions/opinions/ctapp/2001/20010511/85030.htm |archive-date=October 11, 2008 |df=mdy-all }} considered and rejected Littleton, preferring M.T. v. J.T. instead. In this case, the Kansas Appellate Court concluded that "[A] trial court must consider and decide whether an individual was male or female at the time the individual's marriage license was issued and the individual was married, not simply what the individual's chromosomes were or were not at the moment of birth. The court may use chromosome makeup as one factor, but not the exclusive factor, in arriving at a decision. Aside from chromosomes, we adopt the criteria set forth by Professor Greenberg. On remand, the trial court is directed to consider factors in addition to chromosome makeup, including: gonadal sex, internal morphologic sex, external morphologic sex, hormonal sex, phenotypic sex, assigned sex and gender of rearing, and sexual identity." In 2002, the Kansas Supreme Court reversed the Appellate court decision in part, following Littleton.{{citation needed|date=May 2016}}{{cite web|url=http://www.lambdalegal.org/know-your-rights/transgender/trans-marriage-law-faq|title=FAQ About Transgender People and Marriage Law|website=lambdalegal.org|url-status=live|archive-url=https://web.archive.org/web/20161003104407/http://www.lambdalegal.org/know-your-rights/transgender/trans-marriage-law-faq|archive-date=October 3, 2016|df=mdy-all}}

The custody case of Michael Kantaras made national news.{{cite news|last=Canedy |first= Dana |date=February 18, 2002 |url=https://query.nytimes.com/gst/fullpage.html?res=9805E7DD1E3FF93BA25751C0A9649C8B63 |title= Sex Change Complicates Battle Over Child Custody |work=The New York Times}} Kantaras met a woman and filed for divorce in 1998, requesting primary custody of the children. Though he won that case in 2002, it was reversed on appeal in 2004 by the Florida Second District Court of Appeal,Kantaras v. Kantaras, 884 So. 2d 155 (Fla. Ct. App. 2004) upholding Forsythe's claim that the marriage was null and void because her ex-husband was still a woman and same-sex marriages were illegal in Florida.Michael J Kantaras v Linda Kantaras [2003] Case No. 98-5375CA. 511998DR005375xxxWS, 6th Circuit Review was denied by the Florida Supreme Court.Kantaras v. Kantaras, 898 So. 2d 80 (Fla. 2005)

In re Jose Mauricio LOVO-Lara (2005),{{cite web |url=http://www.usdoj.gov/eoir/vll/intdec/vol23/3512%20.pdf |title=In re Jose Mauricio LOVO-Lara, Beneficiary of a visa petition filed by Gia Teresa LOVO-Ciccone, Petitioner |publisher=Usdoj.gov |access-date=August 28, 2015 |url-status=live |archive-url=https://web.archive.org/web/20090725064001/http://www.usdoj.gov/eoir/vll/intdec/vol23/3512%20.pdf |archive-date=July 25, 2009 |df=mdy-all }} the Board of Immigration Appeals ruled that for purposes of an immigration visa, "A marriage between a postoperative transsexual and a person of the opposite sex may be the basis for benefits under ..., where the State in which the marriage occurred recognizes the change in sex of the postoperative transsexual and considers the marriage a valid heterosexual marriage."

In Fields v. Smith (2006), three transgender women filed a lawsuit against this state of Wisconsin for passing a law banning hormone treatment or gender-affirming surgery for inmates. The courts of appeal struck down the law issuing that transgender people have a right to medical access in prison.{{citation needed|date=October 2015}}{{cite web|url=https://caselaw.findlaw.com/us-7th-circuit/1576923.html|title=FindLaw's United States Seventh Circuit case and opinions|url-status=live|archive-url=https://web.archive.org/web/20160607215754/https://caselaw.findlaw.com/us-7th-circuit/1576923.html|archive-date=June 7, 2016|df=mdy-all}}

Courts are generally allowed to base custody or visitation rulings only on factors that directly affect the best interests of the child. According to this principle, if a transgender parent's gender identity cannot be shown to hurt the child, contact should not be limited, and other custody and visitation orders should not be changed for this reason. Many courts have upheld this principle and have treated transgender custody cases like any other child custody determination—by focusing on standard factors such as parental skills. In Mayfield v. Mayfield, for instance, the court upheld a transgender parent's shared parenting plan because there was no evidence in the record that the parent would not be a "fit, loving and capable parent".{{cite web| url=http://www.lambdalegal.org/know-your-rights/transgender/trans-parenting-faq| title=FAQ About Transgender Parenting| work=Lambda Legal| url-status=live| archive-url=https://web.archive.org/web/20150907132020/http://www.lambdalegal.org/know-your-rights/transgender/trans-parenting-faq| archive-date=September 7, 2015| df=mdy-all}}

Other times, courts claiming to consider a child's interests have ruled against the transgender parent, leading to the parent losing access to their children on the basis of their gender identity. For example, in 1982 in Ohio, in Cisek v. Cisek, the court terminated a transgender parent's visitation rights. The court asked whether the parent's gender transition was "simply an indulgence of some fantasy". It held that there was a risk of both mental and "social harm" to the children, who might be emotionally confused upon seeing "their father as a woman".{{cite court |litigants=Cisek v. Cisek |vol= 80 |opinion=113 |pinpoint=401 |court=Court of Appeals |date=July 20, 1982| quote=Judgment reversed.}} {{subscription required|via = lexisnexis.com}}

Many U.S. jurisdictions require gender-affirming surgery before the person's legal sex can be changed. This has been criticized as forced sterilization.{{cite news |url= http://www.salon.com/2011/11/02/sweden_transgender_sterilization/ |title= Sweden's shameful transgender sterilization rule |date= November 2, 2011 |work=Salon.com |first= Ann |last= Tornkvist |url-status= live |archive-url= https://web.archive.org/web/20150924224618/http://www.salon.com/2011/11/02/sweden_transgender_sterilization/ |archive-date= September 24, 2015 |df= mdy-all }} Some trans people wish to retain their ability to procreate. Others do not medically require hysterectomy, phalloplasty, metoidioplasty, penectomy, orchiectomy, or vaginoplasty to treat their gender dysphoria. In these cases, surgery is considered medically unnecessary and, for that reason, medically unethical. Additionally, surgery is generally the final series of medical procedures in a complete sex transition, and is financially prohibitive for many people.{{cite journal |last1=Nixon |first1=Laura |title=The Right to (Trans) Parent: A Reproductive Justice Approach to Reproductive Rights, Fertility, and Family-Building Issues Facing Transgender People |journal=William & Mary Journal of Race, Gender, and Social Justice |date=December 2013 |volume=20 |issue=1 |pages=73 |url=https://scholarship.law.wm.edu/wmjowl/vol20/iss1/5/ }}

Some transgender people use assisted reproduction technology services and preservation of reproductive tissue prior to having surgery that would render them infertile. Depending on what type of gametes the person's body naturally produces, this would include cryopreservation of semen in a sperm bank or preservation of oocytes or ovum. For such individuals, access to surrogacy and in vitro fertilization services is necessary to have children. Some people advocate specifically for transgender people to have a legal right to these services.{{cite web |url=http://ncbio.org/nordisk/arkiv/sex-id-Sunde-pres.pdf |title=Reproductive rights of transgender adolescents |access-date=2015-08-30 |archive-url=https://web.archive.org/web/20160319200335/http://ncbio.org/nordisk/arkiv/sex-id-Sunde-pres.pdf |archive-date=March 19, 2016 |df=mdy-all }}

Identity documents are a major area of legal concern for transgender people. Different procedures and requirements for legal name changes and gender marker changes on birth certificates, drivers licenses, social security identification and passports exist and can be inconsistent. Many states have historically required gender-affirming surgery to change their name and gender marker; however, there are increasingly few states where this is the case, with Alabama being one of the last.{{Cite web|title=Corbitt v. Taylor|url=https://www.aclu.org/cases/corbitt-v-taylor|access-date=2022-02-22|website=American Civil Liberties Union|language=en}} Also, documents which do not match each other can present difficulties in conducting personal affairs—particularly those which require multiple, matching forms of identification. Furthermore, having documents which do not match a person's gender presentation has been reported to lead to harassment and discrimination.{{cite web|url=http://www.lambdalegal.org/know-your-rights/transgender/anands-story|title=Introduction and Anand's Story|work=Lambda Legal|url-status=live|archive-url=https://web.archive.org/web/20150828090521/http://www.lambdalegal.org/know-your-rights/transgender/anands-story|archive-date=August 28, 2015|df=mdy-all}}{{cite web|url=http://transequality.org/issues/identity-documents-privacy|title=Identity Documents & Privacy|work=National Center for Transgender Equality|url-status=live|archive-url=https://web.archive.org/web/20150905065644/http://www.transequality.org/issues/identity-documents-privacy|archive-date=September 5, 2015|df=mdy-all}} Federal documents, including passports and social security cards, do not currently issue passports with a gender marker that does not match the assigned sex at birth; passports issued prior to January 2025 with changed markers remain valid until their expiration.

Transgender people often seek legal recognition for a name change during a gender transition. Laws regarding name changes vary state-by-state. In some states, transgender people can change their name, provided that the change does not perpetrate fraud or enable criminal intent. In other states, the process requires a court order or statute and can be more difficult. An applicant may be required to post legal notices in newspapers to announce the name change—rules that have been criticized on grounds of privacy rights and potentially endangering transgender people to targeted hate crimes.{{cite web|url=http://transgenderlawcenter.org/archives/9027|title=California Governor Signs Bill to Remove Barriers for Transgender People to Change Name and Identity Documents|work=transgenderlawcenter.org|date=September 6, 2013|url-status=live|archive-url=https://web.archive.org/web/20150618005621/http://transgenderlawcenter.org/archives/9027|archive-date=June 18, 2015|df=mdy-all}} Some courts require medical or psychiatric documentation to justify a name change, despite having no similar requirement for individuals changing names for reasons other than gender transitioning.{{cite news|title=Name Change Ruling|url=http://cityroom.blogs.nytimes.com/2009/10/21/ruling-eases-transgender-name-change-petitions/|access-date=August 25, 2015|work=The New York Times|date=October 21, 2009|url-status=live|archive-url=https://web.archive.org/web/20151027021043/http://cityroom.blogs.nytimes.com/2009/10/21/ruling-eases-transgender-name-change-petitions/|archive-date=October 27, 2015|df=mdy-all}}

In April 2025, the Mississippi Supreme Court ruled that a transgender teen could not legally change his name, despite having the support of both his parents, until he turned 21 citing a "lack of maturity". The court also misgendered the teen throughout in the ruling. The legal age of majority in Mississippi is 21, however, minors are legally allowed to change their name in other circumstances in Mississippi as long as they have parental permission.{{cite news|title=Transgender teen can't legally change name until age 21, Mississippi Supreme Court rules |url=https://www.advocate.com/law/mississippi-transgender-teen-name-change|access-date=August 25, 2015|work=The Advocate|date=April 18, 2025}}

[[File:Requirements for altering birth certificate sex in the US.svg|alt=|thumb|261x261px|Legal requirements each state has for altering the sex on one's birth certificate.

{{legend|#006400|State updates birth certificates using an administrative process and does not require provider documentation (14 states)}}

{{legend|#228B22|State updates birth certificates using an administrative process and requires provider documentation of "appropriate treatment" (11 states , 1 territory + D.C.)}}

{{legend|#3CB371|State has unclear process and/or unclear medical requirements left to the discretion of individual judges (see citations for more information) (7 states, 3 territories)}}

{{legend|#90EE90|State updates birth certificates using an administrative process but requires proof of surgery (3 states)}}

{{legend|#98FB98|State updates birth certificates but requires both a court order and proof of surgery (8 states, 1 territory)}}

{{legend|Red|State does not allow for amending the gender marker on the birth certificate (7 states)}}]]

[[File:Birth Certificate Sex Altering Regulations in the United States.svg|right|261px|thumb|The procedure each state uses to alter the sex on one's birth certificate as of September 2021

{{legend|Purple|New birth certificate is issued with correct sex designation}}

{{legend|Fuchsia|Old birth certificate is amended to correct sex designation}}

{{legend|#ff0000|State does not alter sex on birth certificates for transgender people}}]]

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U.S. states make their own laws about birth certificates, and state courts have issued varied rulings about transgender people.{{cite web|url=http://writ.news.findlaw.com/grossman/20050308.html|title=FindLaw's Writ – Grossman: When Parentage Turns on Anatomical Sex An Illinois Court Denies a Female-to-Male Transsexual's Claim of Fatherhood|work=findlaw.com|url-status=live|archive-url=https://web.archive.org/web/20110510080250/http://writ.news.findlaw.com/grossman/20050308.html|archive-date=May 10, 2011|df=mdy-all}}{{Cite book |last=Grenberg |first=Julie |publication-date=2006 |contribution=The Roads Less Travelled: The Problem with Binary Sex Categories |editor-last=Currah |editor-first=Paisley |editor2-last=Juang |editor2-first=Richard |editor3-last=Minter|editor3-first=Minter |title=Transgender Rights |location=Minneapolis |publisher=Minnesota University Press|pages=51–73|isbn=0-8166-4312-1|year=2006}}

Most states permit the name and sex to be changed on a birth certificate, either by amending the existing birth certificate or by issuing a new one, although some require medical proof of gender-affirming surgery to do so. These include:

• Texas, by opinion of the local clerk's office, will make a court-ordered change of sex.
• New York State and New York City both passed legislation in 2014 to ease the process for changing sex on the birth certificate, eliminating the requirement for proof of surgery.{{cite web |title=New York Name & Gender Change Information |url=https://transequality.org/documents/state/new-york |website=National Center for Transgender Equality |access-date=January 9, 2022 |language=en}}{{cite news|url=https://www.nytimes.com/2014/12/11/nyregion/in-new-york-insurance-must-cover-sex-changes-cuomo-says.html|first=Anemona|last=Hartocollis|title=Insurers in New York Must Cover Gender Reassignment Surgery, Cuomo Says|newspaper=The New York Times |date=December 11, 2014 |url-status=live|archive-url=https://web.archive.org/web/20150317114116/http://www.nytimes.com/2014/12/11/nyregion/in-new-york-insurance-must-cover-sex-changes-cuomo-says.html?_r=0|archive-date=March 17, 2015|df=mdy-all}} A subsequent 2021 bill also removed the newspaper publication requirement.{{Cite web |last=Brandon |date=2021-10-05 |title=The Gender Recognition Act: Progress for Transgender and Nonbinary New Yorkers |url=https://nysba.org/the-gender-recognition-act-progress-for-transgender-and-nonbinary-new-yorkers/ |access-date=2024-12-14 |website=New York State Bar Association |language=en-US}}
• Nevada eliminated the surgery requirement in November 2016. It requires an affidavit from the person making the change and an affidavit who can attest that the information is accurate.{{cite web|title=Victory: Nevada passes the most progressive birth certificate gender change policy in the nation!|url=http://www.transequality.org/blog/victory-nevada-passes-the-most-progressive-birth-certificate-gender-change-policy-in-the-nation|website=National Center for Transgender Equality|access-date=April 6, 2017|url-status=live|archive-url=https://web.archive.org/web/20170407143502/http://www.transequality.org/blog/victory-nevada-passes-the-most-progressive-birth-certificate-gender-change-policy-in-the-nation|archive-date=April 7, 2017|df=mdy-all|date=November 21, 2016}}
• Colorado (February 2019) and New Mexico (November 2019) eliminated the surgery requirement and made the gender marker "X" available.{{Cite web|url = https://www.colorado.gov/pacific/cdphe/sex-changes|title = Sex Changes|date = June 16, 2014|access-date = May 29, 2019|archive-date = May 29, 2019|archive-url = https://web.archive.org/web/20190529221420/https://www.colorado.gov/pacific/cdphe/sex-changes|url-status = dead}}{{cite web |url=https://www.ladailypost.com/content/nmdoh-new-mexico-fourth-state-allow-gender-neutral-sex-designation-birth-certificates |title=New Mexico is Fourth State to allow Gender-Neutral Sex Designation on Birth Certificates |last=Clark |first=Carol |date=November 14, 2019 |website=LA Daily Post |access-date=July 9, 2021 |archive-url=https://web.archive.org/web/20191115020700/https://www.ladailypost.com/content/nmdoh-new-mexico-fourth-state-allow-gender-neutral-sex-designation-birth-certificates |archive-date=November 15, 2019}}{{Cite web | url=https://transequality.org/documents/state/new-mexico | title=New Mexico}}
• Kansas began allowing changes to the gender marker in June 2019. The person must sign an affidavit. If they do not already have documentation (driver's license or passport) with their preferred gender marker, they must bring a letter from a doctor or psychotherapist affirming their gender, but they do not need proof of surgery.{{Cite web|url=https://transequality.org/documents/state/kansas|title=Kansas|website=National Center for Transgender Equality|language=en|access-date=2020-02-28}} Regulations were set up under a signed executive order for the Kansas Department of Health and Environment (KDHE) by the Governor of Kansas. In 2023, SB 180 was passed by the Kansas Legislature, which changed the laws regarding changing a person's gender markers on their birth certificate and state identity documents. The KDHE announced it would no longer issue new birth certificates with amended gender markers due to recently passed state law, and any previously issued birth certificates with a changed gender marker would be reverted to the original gender at birth if reissued.{{Cite web |title=SB 180 Impacts on Birth Certificates |url=https://www.kdhe.ks.gov/DocumentCenter/View/30719/SB-180-Impacts-on-Birth-Certificates?bidId= |access-date=March 30, 2024 |website=Kansas Department of Health and Environment}} Additionally, the Kansas Department of Revenue (KDOR) announced after a temporary restraining order that any credentials issued after July 10, 2023 would be required to reflect the gender of the person at birth, if known to the department.{{Cite web |title=Kansas Department of Revenue Division of Vehicles - Gender Change |url=https://www.ksrevenue.gov/dovgender.html |access-date=2024-11-17 |website=ksrevenue.gov}}
• Virginia removed the requirement for surgery to change the gender marker in September 2020.{{Cite web|title=LIS > Bill Tracking > HB1041 > 2020 session|url=https://lis.virginia.gov/cgi-bin/legp604.exe?201+sum+HB1041|access-date=2020-10-03|website=lis.virginia.gov}}

Tennessee will not change the sex on a birth certificate under any circumstances.{{Cite web |last=Loller |first=Travis |date=2023-06-23 |title=Judge Won't Let Tennessee Transgender Plaintiffs' Change Their Birth Certificates |url=https://www.huffpost.com/entry/bc-us-transgender-birth-certificates_n_64960a50e4b0c0ed59b28fca |access-date=2023-06-24 |website=HuffPost |language=en}}{{Cite web|url=https://www.nbcnews.com/feature/nbc-out/kansas-allow-trans-residents-change-birth-certificates-n1021411|title=Kansas to allow trans residents to change birth certificates|publisher=NBC News|date=June 25, 2019 }}{{cite web|url=http://www.lambdalegal.org/publications/changing-birth-certificate-sex-designations-state-by-state-guidelines|title=Changing Birth Certificate Sex Designations: State-By-State Guidelines|work=Lambda Legal|url-status=live|archive-url=https://web.archive.org/web/20140618233117/http://www.lambdalegal.org/publications/changing-birth-certificate-sex-designations-state-by-state-guidelines|archive-date=June 18, 2014|df=mdy-all}} In December 2020, a federal judge invalidated an unconstitutional departmental rule banning sex changes on an individual's birth certificate within Ohio.{{cite web |url=https://www.huffpost.com/entry/ohio-allow-gender-changes-birth-certificate_n_5fda94adc5b6aa861e5b5617 |title=Court Rules Ohio Must Allow Gender Changes on Birth Certificates |last=Smyth |first=Julie Carr |date=December 16, 2020 |website=HuffPost |access-date=July 9, 2021}} In 2022, Oklahoma became the second state to ban legal gender marker change on birth certificates. This followed an executive order issued by the governor the previous year.{{Cite web |last=Stitt |first=Kevin |date=November 8, 2021 |title=Executive Order 2021-24 |url=https://www.sos.ok.gov/documents/executive/2014.pdf |access-date=November 3, 2022 |website=Oklahoma Secretary of State}}{{cite web |title=Oklahoma governor signs transgender bathroom bill |url=https://abcnews.go.com/US/wireStory/oklahoma-governor-signs-transgender-bathroom-bill-84998910 |website=ABC News |access-date=28 July 2022}} Oklahoma Senate Bill 1100 also banned non-binary gender markers on birth certificates.{{cite web |first1=Sean |last1=Murphy |date=27 April 2022 |title=Oklahoma governor signs ban on nonbinary birth certificates |url=https://abcnews.go.com/Health/wireStory/oklahoma-governor-signs-ban-nonbinary-birth-certificates-84328875 |archive-url=https://web.archive.org/web/20220505175139/https://abcnews.go.com/Health/wireStory/oklahoma-governor-signs-ban-nonbinary-birth-certificates-84328875 |archive-date=5 May 2022 |access-date=5 May 2022 |website=ABC News}} During the same year, Montana also issued a rule that banned legal gender change on birth certificates.{{Cite web |date=2022-09-09 |title=Montana permanently blocks transgender people from changing their birth certificates |url=https://www.pbs.org/newshour/politics/montana-permanently-blocks-transgender-people-from-changing-their-birth-certificates |access-date=2022-11-05 |website=PBS NewsHour |language=en-us}} In 2024, District Judge Mike Menahan issued an injunction blocking Montana's rule.{{Cite web |date=2024-12-17 |title=Montana judge blocks rule that prevented transgender people from changing their sex on documents |url=https://apnews.com/article/montana-transgender-sex-documents-bf2a09d005ca3e6750e428d79a2969e9 |access-date=2025-03-19 |website=AP News |language=en-us}}

The first case to consider legal gender change in the U.S. was Mtr. of Anonymous v. Weiner (1966), in which a transgender woman wished to change her name and sex on her birth certificate in New York City after having undergone gender-affirming surgery. The New York City Health Department denied the request. She took the case to court, but the court ruled that the New York City Health Code did not permit the request, which only permitted a change of sex on the birth certificate if an error was made recording it at birth.{{cite book|last1=Turkington|first1=Richard C.|last2=Allen|first2=Anita L.|title=Privacy law: cases and materials|url=https://books.google.com/books?id=xRY9AQAAIAAJ|access-date=November 18, 2012|date=2002|publisher=West Group|isbn=978-0314262042|pages=861–|url-status=live|archive-url=https://web.archive.org/web/20140626181419/http://books.google.com/books?id=xRY9AQAAIAAJ|archive-date=June 26, 2014|df=mdy-all}}{{cite journal|last=Markowitz|first=Stephanie |title=Change of Sex Determination on Transsexuals' Birth Certificates: Public Policy and Equal Protection|journal=Cardozo Journal of Law & Gender|volume=14|pages=705–|url=http://cardozolawandgender.com/uploads/2/7/7/6/2776881/14-3_markowitz.pdf|url-status=live|archive-url=https://web.archive.org/web/20121222042226/http://cardozolawandgender.com/uploads/2/7/7/6/2776881/14-3_markowitz.pdf|archive-date=December 22, 2012|df=mdy-all}}

The decision of the court in Weiner was again affirmed in Mtr. of Hartin v. Dir. of Bur. of Recs. (1973) and Anonymous v. Mellon (1977). Despite this, there can be noted as time progressed an increasing support expressed in judgments by New York courts for permitting changes in birth certificates, even though they still held to do so would require legislative action. Classification of characteristic sex is a public health matter in New York; and New York City has its own health department which operates separately and autonomously from the New York State health department.{{citation needed|date=August 2015}}

An important case in Connecticut was Darnell v. Lloyd (1975),{{cite web|title=Diana M. Darnell v. Douglas Lloyd, Commissioner of Health, State of Connecticut.|url=https://scholar.google.com/scholar_case?case=4608588674573608973&q=Darnell+v.+Lloyd,+395+F.+Supp.+1210&hl=en&as_sdt=2,47&as_vis=1|access-date=June 28, 2012}} where the court found that substantial state interest must be demonstrated to justify refusing to grant a change in sex recorded on a birth certificate.{{cite web|url=http://www.leagle.com/decision/19751605395FSupp1210_11444.xml/DARNELL%20v.%20LLOYD|title=Darnell v. Lloyd|url-status=live|archive-url=https://web.archive.org/web/20161003121837/http://www.leagle.com/decision/19751605395FSupp1210_11444.xml/DARNELL%20v.%20LLOYD|archive-date=October 3, 2016|df=mdy-all}}

In K. v. Health Division (1977),{{cite web|title=Annotations to ORS Chapter 432|url=http://www.leg.state.or.us/ors/annos/432ano.htm|publisher=Oregon State Legislature|access-date=June 28, 2012|archive-url=https://web.archive.org/web/20130106220640/http://www.leg.state.or.us/ors/annos/432ano.htm|archive-date=January 6, 2013|df=mdy-all}} the Oregon Supreme Court rejected an application for a change of name or sex on the birth certificate of a transgender man who had undergone gender-affirming surgery, on the grounds that there was no legislative authority for such a change to be made.{{citation needed|date=August 2015}}

As of February 2024, all U.S. States except for Kansas and Florida allow the gender marker to be changed on a driver's license, although the requirements for doing so vary by state. Often, the requirements for changing one's driver's license are less stringent than those for changing the marker on the birth certificate. For example, until August 1, 2015, the state of Massachusetts required gender-affirming surgery for a birth certificate change,{{cite web|publisher=Commonwealth of Massachusetts|title=General Laws|url=http://www.malegislature.gov/Laws/GeneralLaws/PartI/TitleVII/Chapter46/Section13|access-date=June 20, 2012|url-status=live|archive-url=https://web.archive.org/web/20120702053455/http://www.malegislature.gov/Laws/GeneralLaws/PartI/TitleVII/Chapter46/Section13|archive-date=July 2, 2012|df=mdy-all}}{{cite web|work=Massachusetts Law Updates |publisher=Commonwealth of Massachusetts|title=Transgender People and Amended Birth Certificates|date=August 26, 2015|url=https://blog.mass.gov/masslawlib/new-laws/transgender-people-and-amended-birth-certificates|access-date=March 18, 2021|url-status=live|archive-url=https://web.archive.org/web/20210127094117/https://blog.mass.gov/masslawlib/new-laws/transgender-people-and-amended-birth-certificates|archive-date=January 27, 2021|df=mdy-all}} but only a form including a sworn statement from a physician that the applicant is in fact the new gender to correct the sex designation on a driver's license.{{cite web|publisher=Massachusetts Registry of Motor Vehicles|title=Change of Gender|url=https://secure.rmv.state.ma.us/PolicyBrowserPublic/PB/default.htm?turl=WordDocuments%2FTransactions%2Fchangeofgender44.htm|access-date=June 20, 2012|url-status=live|archive-url=https://web.archive.org/web/20140201140746/https://secure.rmv.state.ma.us/PolicyBrowserPublic/PB/default.htm?turl=WordDocuments%2FTransactions%2Fchangeofgender44.htm|archive-date=February 1, 2014|df=mdy-all}}

As of November 2019, the Commonwealth of Massachusetts no longer requires any documentation or a sworn statement from a medical doctor in order to change one's gender marker on their drivers license/state ID. In order to change the gender marker, one only needs to fill out a new drivers license/ID card application reflecting the correct information.{{cite web|publisher=Commonwealth of Massachusetts|title=Massachusetts Allows Nonbinary Marker on Licenses, IDs|url=https://www.mass.gov/news/massachusetts-allows-nonbinary-marker-on-licenses-ids|access-date=March 18, 2021|url-status=live|archive-url=https://web.archive.org/web/20210203143515/https://www.mass.gov/news/massachusetts-allows-nonbinary-marker-on-licenses-ids|archive-date=February 3, 2021|df=mdy-all}}

The state of Virginia had policies similar to those of Massachusetts, requiring gender-affirming surgery (GAS) for a birth certificate change, but not for a driver's license change.{{cite news|title=Sources of Authority to Amend Sex Designation on Birth Certificates|url=http://www.lambdalegal.org/publications/sources-of-authority-to-amend|newspaper=Lambda Legal|access-date=June 20, 2012|url-status=live|archive-url=https://web.archive.org/web/20120716231645/http://www.lambdalegal.org/publications/sources-of-authority-to-amend|archive-date=July 16, 2012|df=mdy-all}}{{cite web|url=http://www.dmv.state.va.us/webdoc/pdf/dl17.pdf|title=Gender Change Request|publisher=Virginia Department of Motor Vehicles|access-date=June 20, 2012|url-status=live|archive-url=https://web.archive.org/web/20130514080328/http://www.dmv.state.va.us/webdoc/pdf/dl17.pdf|archive-date=May 14, 2013|df=mdy-all}} Virginia removed the requirement for surgery to change the gender marker in September 2020.

Sometimes, the states' requirements and laws conflict with and are dependent on each other; for example, a transgender woman who was born in Tennessee but living in Kentucky will be unable to have the gender marker changed on her Kentucky driver's license. This is due to the fact that Kentucky requires an amended birth certificate reflecting the person's accurate gender, but the state of Tennessee does not change gender markers on birth certificates at all.{{cite web|title=Driver's License Policies by State|url=http://transequality.org/Resources/DL/DL_policies.html|publisher=National Center for Transgender Equality|access-date=June 21, 2012|url-status=live|archive-url=https://web.archive.org/web/20120701163135/http://transequality.org/Resources/DL/DL_policies.html|archive-date=July 1, 2012|df=mdy-all}}

On July 1, 2023, Kansas Senate Bill 180 went into effect, mandating that gender markers on birth certificates and driver's licenses reflect a person's sex at birth – reversing a 2019 federal equal protection lawsuit settlement which allowed birth certificates to be changed to reflect a person's gender identity.{{cite web|last=Ebrahimji|first=Alisha|url=https://www.cnn.com/2023/07/11/us/kansas-transgender-drivers-license-law/index.html|title=A state judge ordered Kansas to stop letting transgender people change their gender marker on their driver's licenses |publisher=CNN|access-date=10 February 2024|date=11 July 2023}}

In January 2024, Florida banned changing the gender marker on driver's licenses. Additionally, any person "misrepresenting" their gender would be subject to criminal and civil penalties.{{cite web|last=Migdon|first=Brooke|url=https://thehill.com/homenews/state-watch/4438514-florida-bars-transgender-residents-from-changing-gender-on-drivers-licenses/|title=Florida bars transgender residents from changing gender on driver's licenses|website=The Hill|date=30 January 2024}}{{cite web|last1=Crowley|first1=Kinsey|last2=Soule|first2=Douglas|url=https://www.usatoday.com/story/news/politics/2024/01/30/florida-transgender-drivers-license-change/72409088007/|title=Florida barring gender changes on driver's license puts trans residents at risk, critics say|website=USA Today|date=30 January 2024}}

In August 2024, the Texas Department of Public Safety (DPS) issued a statement saying they would no longer accept court orders as a basis to change a person's sex on their drivers license, effectively banning trans people from changing their sex on their drivers license. The statement also "directs drivers license employees to send the names and identification numbers of people seeking to change their sex on their license to a particular email address" with the subject line "Sex Change Court Order." Drivers license employees are also ordered to "scan into the record" court orders or other documents associated with any sex change requests. The DPS refused to say how this information will be used. However two years prior, Attorney General Ken Paxton ordered workers at DPS to gather a list of people who had changed their sex on their Texas driver's licenses and other department records.{{cite web|last=Salhotra|first=Pooja|url=https://www.texastribune.org/2024/08/21/transgender-texans-drivers-license-DPS/|title=Transgender Texans blocked from changing their sex on their driver's license|website=The Texas Tribune|access-date=22 August 2024|date=21 August 2024}}

In addition, a number of states and city jurisdictions have passed legislation to allow a third gender marker on official identification documents (see below).

In May 2015, six Michigan transgender people filed Love v. Johnson in the United States District Court for the Eastern District of Michigan, challenging the state's policy requiring the information on a person's driver's license match the information on their birth certificate.{{cite web |url=https://www.aclu.org/news/aclu-lawsuit-michigan-id-policy-exposes-transgender-men-and-women-risk-harassment-violence |title=ACLU Lawsuit: Michigan ID Policy Exposes Transgender Men and Women to Risk of Harassment, Violence |date=May 21, 2015 |website=American Civil Liberties Union |access-date=July 9, 2021 |archive-url=https://web.archive.org/web/20160525092512/https://www.aclu.org/news/aclu-lawsuit-michigan-id-policy-exposes-transgender-men-and-women-risk-harassment-violence |archive-date=May 25, 2016}} This policy requires transgender people to change the information on their birth certificates in order to change their driver's licenses, which at the time of filing was not possible in Tennessee, Nebraska and Ohio, where three of the plaintiffs were born, and requires a court order in South Carolina, where a fourth was born. The remaining two residents were born in Michigan, and would be required to undergo surgery to change their birth certificates.{{cite web |first=Khalil |last=AlHajal |url=http://www.mlive.com/news/detroit/index.ssf/2015/11/judge_refuses_to_dismiss_chall.html |title=Judge refuses to dismiss challenge to Michigan policy on transgender drivers |date=November 16, 2015 |access-date=July 9, 2021 |archive-url=https://web.archive.org/web/20151222153455/http://www.mlive.com/news/detroit/index.ssf/2015/11/judge_refuses_to_dismiss_chall.html |archive-date=December 22, 2015}} The plaintiffs in the case are represented by the American Civil Liberties Union.

In November 2015, Judge Nancy Edmunds denied the State of Michigan's motion to dismiss the case.

The State Department determines what identifying biographical information is placed on passports. They currently do not allow gender markers that do not match the gender assigned at birth. Passports issued prior to January 2025 remain valid, regardless of whether the gender marker matches.

On June 30, 2021, the government announced that the State Department would begin offering an "X" gender marker and would also allow changing one's gender marker without proving any physical changes to one's sex.{{Cite web|date=30 June 2021|title=Biden administration adds gender marker X to passports|url=https://dallasvoice.com/biden-administration-adds-gender-marker-x-to-passports/|access-date=2021-06-30|website=Dallas Voice|language=en-US}} Previously, the policy had been amended on June 10, 2010 to allow permanent gender marker changes only if accompanied by a physician's statement that "the applicant has had appropriate clinical treatment for gender transition to the new gender."{{cite web |title=8 FAM 403.3 Gender Change |publisher=United States Department of State |date=June 27, 2018 |url=https://fam.state.gov/FAM/08FAM/08FAM040303.html |access-date=July 18, 2018 |df=mdy-all }} Before 2010, the required statement was more specific; it was required to be from a surgeon who said that gender reassignment surgery had been completed.{{cite web |title=8 FAM 1004.1 Passport Amendments |publisher=United States Department of State |date=June 27, 2018 |url=https://fam.state.gov/FAM/08FAM/08FAM100401.html |access-date=July 18, 2018 |df=mdy-all }}

From April 11, 2022, any individual who is a valid US passport holder could legally have F, M or X options listed as a sex/gender marker available and recognized by way of self determination.{{cite news |last1=Yurcaba |first1=Jo |title=Gender-neutral X passports will be available in April |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/gender-neutral-x-passports-will-available-april-rcna22292 |access-date=March 31, 2022 |publisher=NBC News |date=March 31, 2022|url-status=live|archive-url=https://web.archive.org/web/20220628145920/https://www.nbcnews.com/nbc-out/out-politics-and-policy/gender-neutral-x-passports-will-available-april-rcna22292|archive-date=June 28, 2022}} Starting in late 2023, X was also available for passport cards, emergency passports made by consulates and embassies, consular reports of birth abroad.{{Cite web|url=https://travel.state.gov/content/travel/en/passports/need-passport/selecting-your-gender-marker.html|title = Selecting your Gender Marker|url-status=live|archive-url=https://web.archive.org/web/20220810024451/https://travel.state.gov/content/travel/en/passports/need-passport/selecting-your-gender-marker.html|archive-date=August 10, 2022|access-date=August 19, 2022}}

Upon his inauguration on January 20, 2025, Donald Trump issued an executive order titled Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government which directed the US federal government to replace all uses of gender, including passports, with a new legal category of biological sex from the time of conception, and to only recognize two biological sexes based on size of gametes produced. On January 23, 2025, secretary of state Marco Rubio instructed staff to suspend all applications for passports that requested an "X" sex marker or a change to the existing sex marker.{{cite news |last1=Gedeon |first1=Joseph |title=Rubio instructs staff to freeze passport applications with 'X' sex markers |url=https://www.theguardian.com/us-news/2025/jan/23/trump-rubio-x-gender-passport |access-date=January 23, 2025 |work=The Guardian |date=January 23, 2025}}

In February 2025, the State Department issued new guidance stating that already-issued passports with an "X" or amended sex marker would remain valid until expired or replaced. In-progress passport applications, and applications received as of February 7, 2025, would be limited to male or female designations, as determined by "biological sex from the time of conception" as determined by the aforementioned executive order.{{cite news |last1=Yurcaba |first1=Jo |last2=Williams |first2=Abigail |title=Passports with 'X' sex markers will be valid until they expire or are renewed, State Department says |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/passports-x-sex-marker-guidance-valid-expire-state-department-rcna191539 |access-date=February 10, 2025 |publisher=NBC News |date=February 10, 2025}}

Persons not born in the United States and who hold status in the United States can change the gender marker on their USCIS-issued Certificate of Naturalization, Certificate of Citizenship, Permanent Resident Card, and their State Department-issued Consular Report of Birth Abroad; these serve as foundational identity documents that may be substituted for birth certificates.{{Cite web|date=2019-04-15|title=Chapter 2 – USCIS-Issued Secure Identity Documents |url=https://www.uscis.gov/policy-manual/volume-11-part-a-chapter-2|access-date=2020-07-22|website=uscis.gov|language=en}}{{Cite web|title=Passports|url=https://transequality.org/know-your-rights/passports|access-date=2020-07-22|website=National Center for Transgender Equality|language=en}}

Other options include obtaining a state court order affirming the change of legal gender as a linking document, such as California's Order Recognizing Change of Gender.{{cite web |url=https://www.courts.ca.gov/25797.htm?rdeLocaleAttr=en |title=How to Change Your Name AND Gender (Adult) |website=California Courts |access-date=July 9, 2021}}

[[File:Legal recognition of non-binary gender in the United States.svg|thumb|261x261px|Jurisdictions that legally recognize a non-binary gender on state documents as of January 2025

{{legend|#B3DE69|Recognition via statute or policy}}

{{legend|#FCE77C|Recognition via court order only, isolated instances}}

{{legend|#D3D3D3|No legal recognition}}

]]

{{main|Legal recognition of non-binary gender#United States}}

The United States does not currently recognize non-binary gender at a national level. Some states offer legal documentation of a third gender on birth certificates, driver's licenses, and/or state ID. Previously issued passports using the gender marker "X" remain valid until their expiration date.{{cite web |title=Sex Marker in Passports |url=https://travel.state.gov/content/travel/en/passports/passport-help/sex-marker.html#:~:text=All%20passports%20%2D%20including%20those%20with,Aviation%20Organization%20(ICAO)%20policy. |website=Travel.State.Gov |publisher=United States Department of State |access-date=23 February 2025 |date=February 11, 2025}}

From 2021 to 2025, the U.S. federal government recognized a third gender option on passports or other national identity documents, joining other countries including Australia, New Zealand, India, Nepal, Pakistan, Bangladesh, Germany, Malta, and Canada with similar recognition.{{cite web|url=http://www.dailysabah.com/asia/2015/08/10/nepal-issues-first-third-gender-passport-after-australia-and-n-zealand|title=Nepal issues first third-gender passport, after Australia and N. Zealand|date=August 10, 2015|work=DailySabah|url-status=live|archive-url=https://web.archive.org/web/20150817054554/http://www.dailysabah.com/asia/2015/08/10/nepal-issues-first-third-gender-passport-after-australia-and-n-zealand|archive-date=August 17, 2015|df=mdy-all}}{{cite web|url=https://www.theguardian.com/commentisfree/2013/nov/10/germany-third-gender-birth-certificate|title=Germany got it right by offering a third gender option on birth certificates|first=Jacinta|last=Nandi|work=The Guardian|date=November 10, 2013|url-status=live|archive-url=https://web.archive.org/web/20161222091105/https://www.theguardian.com/commentisfree/2013/nov/10/germany-third-gender-birth-certificate|archive-date=December 22, 2016|df=mdy-all}}{{cite magazine|url=https://time.com/3992104/nepal-passport-third-gender-transgender/|title=Nepal Is The Latest Country to Acknowledge A Third Gender on Passports|first=Joanna|last=Plucinska|date=August 11, 2015|magazine=Time|url-status=live|archive-url=https://web.archive.org/web/20150824165124/http://time.com/3992104/nepal-passport-third-gender-transgender/|archive-date=August 24, 2015|df=mdy-all}}{{cite news|last1=Busby|first1=Mattha|title=Canada introduces gender-neutral 'X' option on passports|url=https://www.theguardian.com/world/2017/aug/31/canada-introduces-gender-neutral-x-option-on-passports|access-date=August 31, 2017|newspaper=The Guardian|date=August 31, 2017|url-status=live|archive-url=https://web.archive.org/web/20170831045455/https://www.theguardian.com/world/2017/aug/31/canada-introduces-gender-neutral-x-option-on-passports|archive-date=August 31, 2017|df=mdy-all}} Third genders have traditionally been acknowledged in a number of Native American cultures as "two spirit" people, in traditional Hawaiian culture as the māhū, and as the fa'afafine in American Samoa.{{cite web|url=https://www.theguardian.com/music/2010/oct/11/two-spirit-people-north-america|title=The 'two-spirit' people of indigenous North Americans|work=The Guardian|date=October 11, 2010|url-status=live|archive-url=https://web.archive.org/web/20170128231853/https://www.theguardian.com/music/2010/oct/11/two-spirit-people-north-america|archive-date=January 28, 2017|df=mdy-all}}{{cite news|url=https://www.huffingtonpost.com/2015/04/28/hawaiian-culture-transgender_n_7158130.html|title=The Beautiful Way Hawaiian Culture Embraces A Particular Kind Of Transgender Identity|date=April 28, 2015|work=HuffPost|url-status=live|archive-url=https://web.archive.org/web/20170130060554/http://www.huffingtonpost.com/2015/04/28/hawaiian-culture-transgender_n_7158130.html|archive-date=January 30, 2017|df=mdy-all}}{{cite web|url=http://theculturetrip.com/pacific/samoa/articles/fa-afafines-the-third-gender/|title=Fa'afafines: The Third Gender|work=theculturetrip.com|date=September 15, 2011|url-status=live|archive-url=https://web.archive.org/web/20151127055906/http://www.theculturetrip.com/pacific/samoa/articles/fa-afafines-the-third-gender/|archive-date=November 27, 2015|df=mdy-all}}{{cite web|url=https://www.facebook.com/pages/Society-Of-Faafafine-In-American-Samoa-SOFIAS/168150006613160|title=Society Of Fa'afafine In American Samoa – S.O.F.I.A.S.|via=Facebook|url-status=live|archive-url=https://web.archive.org/web/20180104130543/https://www.facebook.com/pages/Society-Of-Faafafine-In-American-Samoa-SOFIAS/168150006613160|archive-date=January 4, 2018|df=mdy-all}} Similarly, immigrants from traditional cultures that acknowledge a third gender would benefit from such a reform, including the muxe gender in southern Mexico and the hijra of south Asian cultures.{{cite web|url=https://www.npr.org/sections/pictureshow/2012/05/30/153990125/in-mexico-mixed-genders-and-muxes|title=In Mexico, Mixed Genders And 'Muxes'|date=June 5, 2012|publisher=NPR|url-status=live|archive-url=https://web.archive.org/web/20150912093840/http://www.npr.org/sections/pictureshow/2012/05/30/153990125/in-mexico-mixed-genders-and-muxes|archive-date=September 12, 2015|df=mdy-all}}{{cite web|url=https://www.theguardian.com/society/2014/apr/16/india-third-gender-claims-place-in-law|title=Hijra: India's third gender claims its place in law|first=Homa|last=Khaleeli|work=The Guardian|date=April 16, 2014|url-status=live|archive-url=https://web.archive.org/web/20170415131009/https://www.theguardian.com/society/2014/apr/16/india-third-gender-claims-place-in-law|archive-date=April 15, 2017|df=mdy-all}}{{cite news|title=Third Gender|url=https://www.huffingtonpost.com/2014/03/19/non-binary-gender-petition_n_4994200.html|access-date=August 25, 2015|work=HuffPost|date=March 19, 2014|url-status=live|archive-url=https://web.archive.org/web/20150729090841/http://www.huffingtonpost.com/2014/03/19/non-binary-gender-petition_n_4994200.html|archive-date=July 29, 2015|df=mdy-all}}

On June 10, 2016, an Oregon circuit court ruled that a resident, Elisa Rae Shupe, could obtain a non-binary gender designation. The Transgender Law Center believes this to be "the first ruling of its kind in the U.S." On September 26, 2016, intersex California resident Sara Kelly Keenan became the second person in the United States to legally change her gender to 'non-binary', citing Shupe's case as inspiration.{{cite web|last1=O'Hara|first1=Mary Emily|title=Californian Becomes Second US Citizen Granted 'Non-Binary' Gender Status|url=https://www.nbcnews.com/feature/nbc-out/californian-becomes-second-us-citizen-granted-non-binary-gender-status-n654611|publisher=NBC News|access-date=September 26, 2016|date=September 26, 2016|url-status=live|archive-url=https://web.archive.org/web/20160926204210/https://www.nbcnews.com/feature/nbc-out/californian-becomes-second-us-citizen-granted-non-binary-gender-status-n654611|archive-date=September 26, 2016|df=mdy-all}} Keenan obtained a birth certificate with an intersex sex marker. Ohio had issued a 'hermaphrodite' sex marker in 2012.{{cite web| last = O'Hara| first = Mary Emily| title = Nation's First Known Intersex Birth Certificate Issued in NYC| publisher = NBC News| access-date = 2016-12-30| date = December 29, 2016| url = https://www.nbcnews.com/feature/nbc-out/nation-s-first-known-intersex-birth-certificate-issued-nyc-n701186| url-status = live| archive-url = https://web.archive.org/web/20161230121426/https://www.nbcnews.com/feature/nbc-out/nation-s-first-known-intersex-birth-certificate-issued-nyc-n701186| archive-date = December 30, 2016| df = mdy-all}}

The State Department issued the first passport with an "X" gender marker on October 27, 2021. In January 2025, Donald Trump signed Executive Order 14168 to revoke the recognition of a third gender, and on January 22, 2025, Secretary of State Marco Rubio directed the Department of State to suspend all applications seeking a sex marker change or a nonbinary "X" sex marker.{{cite news |last1=Yurcaba |first1=Jo |last2=Williams |first2=Abigail |title=State Department to suspend passport applications seeking sex-marker changes |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/rubio-passport-sex-marker-changes-paused-trump-order-rcna189222 |access-date=January 27, 2025 |publisher=NBC News |date=January 24, 2025 |archive-date=January 26, 2025 |archive-url=https://web.archive.org/web/20250126113415/https://www.nbcnews.com/nbc-out/out-politics-and-policy/rubio-passport-sex-marker-changes-paused-trump-order-rcna189222 |url-status=live }}

On June 15, 2017, Oregon became the first state in the U.S. to announce it will allow a non-binary "X" gender marker on state IDs and driver's licenses. The law took effect July 1. No doctor's note is required for the change.{{cite news|last1=Levin|first1=Sam|title='Huge validation': Oregon becomes first state to allow official third gender option|url=https://www.theguardian.com/us-news/2017/jun/15/oregon-third-gender-option-identity-law|access-date=June 15, 2017|newspaper=The Guardian|date=June 15, 2017|url-status=live|archive-url=https://web.archive.org/web/20170615232659/https://www.theguardian.com/us-news/2017/jun/15/oregon-third-gender-option-identity-law|archive-date=June 15, 2017|df=mdy-all}} The following week, Washington, D.C., announced that a non-binary "X" gender marker for district-issued ID cards and driver's licenses would very shortly be offered with no medical certification required.{{cite web|last1=Rook|first1=Erin|title=Washington, DC joins Oregon in offering third gender marker on drivers' licenses|url=https://www.lgbtqnation.com/2017/06/washington-dc-joins-oregon-offering-third-gender-marker-drivers-licenses/|website=LGBTQ Nation|access-date=June 22, 2017|date=June 22, 2017|url-status=live|archive-url=https://web.archive.org/web/20171021010540/https://www.lgbtqnation.com/2017/06/washington-dc-joins-oregon-offering-third-gender-marker-drivers-licenses/|archive-date=October 21, 2017|df=mdy-all}} The D.C. policy change went into effect on June 27, making the district the first place in the U.S. to offer gender-neutral driver's licenses and ID cards.{{cite news|last1=Grinberg|first1=Emanuella|title=You can now get a gender neutral driver's license in D.C.|url=http://www.cnn.com/2017/06/27/health/washington-gender-neutral-drivers-license/index.html|access-date=June 29, 2017|publisher=CNN|date=June 27, 2017|url-status=live|archive-url=https://web.archive.org/web/20170628235024/http://www.cnn.com/2017/06/27/health/washington-gender-neutral-drivers-license/index.html|archive-date=June 28, 2017|df=mdy-all}} The California State Senate introduced a bill in January 2017 to add a nonbinary marker to all IDs,{{cite web|title=TLC Backs CA Bill to Create New Gender Marker and Ease Process for Gender Change in Court Orders and on State Documents|url=https://transgenderlawcenter.org/archives/13524|website=Transgender Law Center|access-date=January 28, 2017|date=January 26, 2017|url-status=live|archive-url=https://web.archive.org/web/20170202043921/https://transgenderlawcenter.org/archives/13524|archive-date=February 2, 2017|df=mdy-all}} signed into law that October and formally available on January 1, 2019.{{cite web|title=SB-179 Gender identity: female, male, or nonbinary.|url=https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB179|website=California Legislative Information|access-date=17 October 2017|url-status=live|archive-url=https://web.archive.org/web/20170916185409/https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB179|archive-date=September 16, 2017|df=mdy-all}} Other states began offering a third gender marker in 2018, including Maine,{{cite news |last1=Bouchard |first1=Kelly |title=Maine begins putting 'non-binary' on driver's licenses for those not 'F' or 'M' |url=https://www.pressherald.com/2018/06/11/maine-bmv-will-offer-non-binary-gender-licenses/ |access-date=12 June 2018 |work=Press Herald |date=11 June 2018}} New Jersey,{{cite news |last1=Vagianos |first1=Alanna |title=New Jersey Gov. Signs Bills Giving Transgender Residents More Rights |url=https://www.huffingtonpost.com/entry/new-jersey-gov-signs-bills-transgender-rights_us_5b3cbee9e4b09e4a8b291569 |access-date=5 July 2018 |work=HuffPost |date=4 July 2018}} Minnesota,{{cite news |last1=Church |first1=Danielle |title=Minnesota Offers "X" Gender Option on Driver's Licenses |url=https://www.kvrr.com/2018/10/03/minnesota-offers-x-gender-option-on-drivers-licenses/ |access-date=5 October 2018 |publisher=KVRR |date=3 October 2018}} Colorado,{{Cite web|url=https://kdvr.com/2018/11/08/colorado-to-begin-offering-gender-x-on-drivers-licenses-id-cards/|title = Colorado to begin offering gender X on driver's licenses, ID cards| work=FOX31 Denver |date = November 8, 2018}} New York, and Massachusetts.{{cite news|last1=Holtzman|first1=Michael|title=Female, male or 'X': Haddad looks to make 3rd gender option on licenses, IDs|url=http://www.southcoasttoday.com/news/20180514/female-male-or-x-haddad-looks-to-make-3rd-gender-option-on-licenses-ids|access-date=17 May 2018|publisher=South Coast Today|date=14 May 2018}} New York City, which handles its own documents, began offering birth certificates with an "X" gender marker in January 2019.{{cite news |last1=Simko-Bednarski |first1=Evan |title=New York City birth certificates get gender-neutral option |url=https://www.cnn.com/2019/01/03/health/new-york-city-gender-neutral-birth-certificate-trnd/index.html |access-date=26 January 2019 |publisher=CNN|date=2 Jan 2019}}

Jurisdictions that currently offer third gender markers on driver's licenses and/or birth certificates{{Cite web |title=Movement Advancement Project {{!}} Identity Document Laws and Policies |url=https://www.lgbtmap.org/equality-maps/identity_document_laws |access-date=2022-11-03 |website=www.lgbtmap.org |language=en}} include California, Colorado, Connecticut,{{Cite web |title=Connecticut |url=https://transequality.org/documents/state/connecticut |access-date=2022-11-03 |website=National Center for Transgender Equality |language=en}} Delaware, Washington D.C., Hawai'i, IIlinois,{{Cite web |title=Gender-affirming identification basics |url=https://www.illinoislegalaid.org/legal-information/can-i-change-gender-my-id-and-other-records |access-date=2025-06-03 |website=www.illinoislegalaid.org |language=en}} Massachusetts,{{Cite news |date=November 13, 2019 |title=Non-binary gender designation is now available on Mass. Licenses |newspaper=The Boston Globe |url=https://www.boston.com/news/local-news/2019/11/13/non-binary-gender-designation-is-now-available-on-mass-licenses/amp}}{{cite web |author=GLAD |date=November 13, 2019 |title=Non-binary gender designation is now available on Mass. licenses. |url=https://mobile.twitter.com/GLADLaw/status/1194622173039775744 |access-date=September 17, 2021 |via=Twitter}} Maine, Maryland, Michigan,{{cite web |title=Benson, community members celebrate nonbinary ID option |url=https://www.michigan.gov/sos/0,4670,7-127--572249--,00.html |access-date=22 November 2021 |website=Michigan Secretary of State}}{{cite web |title=How to correct Sex Designation on Driver's License or ID |url=https://www.michigan.gov/sos/0,4670,7-127-1627_109198---,00.html |access-date=22 November 2021 |website=Michigan Secretary of State}} Minnesota, Nevada, New Hampshire,{{cite news |last1=Williams |first1=Pete |date=January 1, 2020 |title=2020's new laws: Gender-neutral 'X' licenses, stronger ID, wear your hair the way you want |publisher=NBC News |url=https://www.nbcnews.com/politics/supreme-court/2020-s-new-laws-gender-neutral-x-licenses-stronger-id-n1106326 |access-date=June 10, 2021}} New Jersey,{{Cite web |date=April 20, 2021 |title=New Jersey adds 'X' gender marker on driver's licenses and other state identification |url=https://www.cnn.com/2021/04/20/us/x-gender-drivers-license-new-jersey-trnd/index.html |publisher=CNN}} New York,{{Cite web |last=Campbell |first=Jon |title=New York to offer gender-neutral 'X' designation for driver's licenses with new law |url=https://www.usatoday.com/story/news/nation/2021/06/25/ny-gender-recognition-act-drivers-license-x/5343975001/ |access-date=2022-04-04 |website=USA Today |language=en-US}} Ohio, Oregon, Puerto Rico,{{Cite web |date=2025-06-03 |title=Puerto Rico Supreme Court allows 'X' as a third gender choice on birth certificates |url=https://www.nbcnews.com/nbc-out/out-news/puerto-rico-supreme-court-allows-x-third-gender-choice-birth-certifica-rcna210572 |access-date=2025-06-03 |website=NBC News |language=en}} Pennsylvania,{{Cite web |last=Herreria |first=Carla |date=2019-06-27 |title=Hawaii Adds Third Gender Option For State-Issued IDs |url=https://www.huffpost.com/entry/hawaii-adds-third-gender-option_n_5d15240fe4b03d611638c748 |access-date=2019-06-28 |website=HuffPost |language=en}}{{Cite web |last=Goodin-Smith |first=Oona |date=July 31, 2019 |title=Pennsylvania to offer gender-neutral option on state IDs |url=https://www.inquirer.com/news/pennsylvania/pennsylvania-nonbinary-state-id-drivers-license-gender-20190731.html |access-date=September 17, 2021 |website=The Philadelphia Inquirer}} Rhode Island,{{Cite web |date=August 8, 2019 |title=Rhode Island to add gender-neutral option 'X' for licenses |url=https://wsbt.com/news/nation-world/rhode-island-to-add-gender-neutral-option-for-licenses |access-date=September 17, 2021 |publisher=WSBT}} Utah, Virginia,{{Cite web |last=Van Slooten |first=Philip |date=April 7, 2020 |title=Northam signs Va. Non-binary driver's license bill into law |url=https://www.washingtonblade.com/2020/04/07/northam-signs-va-non-binary-drivers-license-bill-into-law/ |access-date=September 17, 2021 |website=The Washington Blade}}{{Cite web |title=LIS > Bill Tracking > SB246 > 2020 session |url=https://lis.virginia.gov/cgi-bin/legp604.exe?201+sum+SB246 |access-date=2022-11-03 |website=lis.virginia.gov}} Vermont, and Washington.

A study conducted by Oregon epidemiologists found that within the area of Portland, Oregon, more than half of dead trans people were recorded as their assigned sex at birth on their death certificates.{{Cite web |url=https://www.oregonlive.com/health/2022/10/transgender-and-nonbinary-peoples-gender-identities-erased-after-death-portland-area-officials-find.html |last1=Zarkhin |first1=Fedor |title=Transgender and nonbinary people's gender identities erased after death, Portland area officials find|date=October 5, 2022 }}

Transgender individuals in the United States face severe challenges in securing safe, stable housing. Research from the 2015 U.S. Transgender Health Survey indicates that nearly 30% of transgender people have experienced homelessness at some point in their lives, with rates rising to 41% among Black transgender individuals.{{Cite web |last1=O'Neill |first1=Kathryn |last2=Wilson |first2=Bianca |last3=Herman |first3=Jody |title=Homeless Shelter Access Among Transgender Adults |url=https://williamsinstitute.law.ucla.edu/publications/trans-homeless-shelter-access/}}{{Cite web |last1=Sonoma |first1=Serena |date=May 19, 2021 |title=Kayla Gore, a Black Trans Woman on the Lead to End Homelessness and HIV Prevalence for Black Trans Women |url=https://www.glaad.org/blog/kayla-gore-black-trans-woman-lead-end-homelessness-and-hiv-prevalence-black-trans-women}} These figures reflect not only a lack of affordable and inclusive housing options but also systemic barriers, including discrimination in employment, limited access to supportive services, and social stigma, that compound housing instability for trans communities.

In shelters and crisis centers, transgender people often encounter environments that are far from safe. Studies by the Vera Institute have documented routine verbal and physical abuse directed toward trans individuals in these facilities, further exacerbating their vulnerability and negatively impacting their mental and physical health.{{Cite web |last1=Zavidow |first1=Evan |title=Transgender people at higher risk for justice system involvement |url=https://www.vera.org/news/gender-and-justice-in-america/transgender-people-at-higher-risk-for-justice-system-involvement}} In many cases, shelter staff are ill-prepared to address the unique needs of transgender clients, which can lead to misgendering, exclusion, or even violent encounters.

Policy shifts over the past decade have also played a significant role in shaping housing access for transgender people. In 2020, the Trump Administration rolled back several Obama-era protections intended to ensure equal access to homeless shelters for transgender individuals. One controversial action was the issuance of guidelines instructing shelter staff on how to identify transgender women, a move widely criticized for legitimizing discriminatory practices and undermining the dignity and safety of trans people.{{Cite web |last1=Burns |first1=Katelyn |date=July 17, 2020 |title=The Trump administration's proposed homeless shelter rule spells out how to spot a trans woman |url=https://www.vox.com/identities/2020/7/17/21328708/proposed-anti-trans-rule-homeless-shelters-judge-women}}{{Cite web |last1=Bollinger |first1=Alex |date=July 20, 2020 |title=Trump administration memo explains how to spot a transgender woman |url=https://www.lgbtqnation.com/2020/07/trump-administration-memo-explains-spot-transgender-woman/}}

However, there has been progress as well. In 2021, a memo from the U.S. Department of Housing and Urban Development (HUD) expanded the scope of the 2012 Equal Access Rule. This revised guidance declared that all individuals, regardless of their actual or perceived sexual orientation, gender identity, or marital status, must have equal access to HUD programs and affiliated shelters.{{Cite web | author1=Rose, K. | author2=Gombos, B. | author3=John, L. | author4=Ivaturi, A. | year=2023 | title=TRANSforming Fair Housing in St. Louis: New Protections, New Partnerships, and New Possibilities for the LGBTQ Community | location=St. Louis, MO | publisher=Metropolitan St. Louis Equal Housing and Opportunity Council | url=https://www.transforminghousingstl.org/}} This policy aimed to reverse some of the previous setbacks by reinforcing nondiscrimination in federal housing programs.

Housing instability is a pervasive issue for transgender and gender nonconforming youth in the United States. While roughly 28% of LGBTQ+ youth experience homelessness or housing instability, trans and gender nonconforming youth often face even greater risks due to unique challenges related to their gender identity.{{Cite web |date=2022-02-03 |title=Homelessness and Housing Instability Among LGBTQ Youth |url=https://www.thetrevorproject.org/research-briefs/homelessness-and-housing-instability-among-lgbtq-youth-feb-2022/ |access-date=2025-02-24 |website=The Trevor Project |language=en-US}}{{Cite web | publisher=Consumer Financial Protection Bureau | year=2021 | title=Housing insecurity and the COVID-19 pandemic | page=21 | url=https://files.consumerfinance.gov/f/documents/cfpb_Housing_insecurity_and_the_COVID-19_pandemic.pdf}}{{Cite web |title=LGBT Youth Shelter and Services |url=https://www.aliforneycenter.org/ |access-date=2025-04-15 |website=Ali Forney Center |language=en}}{{Cite web |last=CDC |date=2025-02-12 |title=Youth Risk Behavior Surveillance System (YRBSS) |url=https://www.cdc.gov/yrbs/index.html |access-date=2025-02-24 |website=Youth Risk Behavior Surveillance System (YRBSS) |language=en-us}} Many of these young people are forced to leave home or run away because of family rejection and mistreatment. Studies reveal that while only 23% of cisgender boys/men and 23% of cisgender girls/women report past or current housing instability, rates among trans girls/women and trans boys/men rise to 38% and 39% respectively, with nonbinary youth at 35% and gender-questioning youth at 24%. These figures underscore the disproportionate vulnerability of trans and gender nonconforming youth to unstable living conditions.

The consequences of such instability extend far beyond the absence of a permanent home. Trans and gender nonconforming youth experiencing housing instability are two to four times more likely to report severe mental health challenges (including depression, anxiety, self-harm, and suicidal ideation) compared to their stably housed peers. For instance, among LGBTQ+ youth with stable housing, 35% have seriously considered suicide and 10% have attempted it. In contrast, those who have experienced past housing instability report rates of 58% for suicidal ideation and 28% for suicide attempts, while youth who are currently homeless report rates as high as 62% and 35%, respectively. Similarly, the risk of victimization also increases with housing instability: youth with stable housing report threat rates due to sexual orientation and gender identity at 10% and 14%, respectively; these numbers climb to 26% and 34% for those with past instability, and further to 30% and 39% among youth who are currently homeless. These statistics indicate a stepwise escalation in mental health and safety risks correlated with the degree of housing instability.

An analysis of the data reveals that housing instability is strongly associated with elevated mental health risks among LGBTQ+ youth. The transition from a stable housing situation, where 35% report considering suicide and 10% report suicide attempts, to a state of past instability, with figures of 58% and 28%. Among those currently homeless, the rates further increase to 62% and 35%, which illustrates a clear gradient of risk corresponding to housing conditions. Similarly, when examining victimization, the baseline threat due to gender identity at 14% in stable conditions rises to 34% with past instability and 39% when currently homeless. These figures suggest that as housing stability decreases, the likelihood of encountering threats and abusive behaviors increases significantly, indicating a strong correlation between housing status and personal safety.

Further dissection of the data by gender identity highlights distinct disparities among subgroups within the LGBTQ+ community. Cisgender youth, both boys/men and girls/women, report housing instability at a rate of 23%, whereas the rates for trans girls/women and trans boys/men are substantially higher, at 38% and 39% respectively. Nonbinary youth also face a high rate of instability at 35%, with gender-questioning youth reporting slightly lower rates at 24%. These disparities suggest that transgender and gender nonconforming youth experience a roughly 1.5 to 1.7 times higher prevalence of housing instability compared to their cisgender peers. The data, when combined with the elevated rates of suicidal ideation, suicide attempts, and victimization, underscore the compounded challenges that these youth face.

In response to this crisis, several efforts have emerged at the policy and institutional level to address LGBTQ+ youth homelessness. Experts have emphasized the need for stronger anti-discrimination protections, such as those proposed in the federal Equality Act, which would add sexual orientation and gender identity as protected classes under the Civil Rights Act.{{Cite report |url=https://www.urban.org/urban-wire/how-can-we-reduce-housing-instability-among-lgbtq-americans |title=How Can We Reduce Housing Instability among LGBTQ Americans? |last=Abare |first=Robert |date=2019-06-18 |publisher=Urban Institute |language=en}} Researchers and advocates also call for increased investment in equitable housing, better inclusion of LGBTQ+ data in federal surveys, and the development of targeted resources, including LGBTQ-affirming shelters and transitional housing programs.

{{Main|Transgender genocide}}

Some critics, including journalists Emily St. James and Saeed Jones and civil rights lawyer Chase Strangio, have described US laws as fitting the United Nations' definition of genocide, such as those laws which ban proper transgender healthcare ("causing serious bodily or mental harm to members of the group; deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part"), and those mandating that trans children be taken away by the state ("forcibly transferring children of the group to another group").{{Cite web |url=https://www.vox.com/first-person/22977970/anti-trans-legislation-texas-idaho |last=St. James |first=Emily |title=The time to panic about anti-trans legislation is now |work=Vox |date=March 24, 2022}}{{Cite web |url=https://www.msnbc.com/opinion/msnbc-opinion/texas-twisted-attack-trans-kids-just-got-worse-n1290792 |title=Greg Abbott's death wish for trans kids is on full display |last=Burns |first=Katelyn |publisher=MSNBC |date=March 4, 2022}}{{Cite web |url=https://www.gq.com/story/chase-strangio-on-anti-trans-laws |last=Jones |first=Saeed |title=The Republican War Against Trans Kids |work=GQ |date=May 5, 2021}}

On March 3, 2023, at the Conservative Political Action Conference, political commentator Michael Knowles declared that "If it is false, then for the good of society, and especially for the good of the poor people who have fallen prey to this confusion, transgenderism must be eradicated from public life entirely—the whole preposterous ideology, at every level." This statement, and other parts of his speech, led the Lemkin Institute for Genocide Prevention to raise a 'Red Flag Alert' in the US, stating "Now that ideologues of hate can openly call for the elimination of transgender identity – in the very country that has been most open to the transgender community over the last decade – we are at a new stage in the global threat against transgender people."{{Cite web |url=https://www.lemkininstitute.com/red-flag-alerts-1/red-flag-alert-for-genocide---usa |title=Red Flag Alert for Genocide - USA |date=April 14, 2023 |publisher=Lemkin Institute for Genocide Prevention |access-date=April 15, 2023 |archive-date=April 15, 2023 |archive-url=https://web.archive.org/web/20230415052530/https://www.lemkininstitute.com/red-flag-alerts-1/red-flag-alert-for-genocide---usa |url-status=dead }}

Transgender healthcare bans have been described as dire by members of the medical community. A medical report which was published by Yale in response to bans on gender-affirming care argued that the bans were no more ethical than a prohibition on healthcare for any other life-threatening medical condition.{{cite web |last1=Boulware |first1=Susan |last2=Kamody |first2=Rebecca |last3=Kuper |first3=Laura |title=Biased Science: The Texas and Alabama Measures Criminalizing Medical Treatment for Transgender Children and Adolescents Rely on Inaccurate and Misleading Scientific Claims |url=https://medicine.yale.edu/lgbtqi/research/gender-affirming-care/report%20on%20the%20science%20of%20gender-affirming%20care%20final%20april%2028%202022_442952_55174_v1.pdf |publisher=Yale Medicine |access-date=17 July 2023}} The president of the World Professional Association of Transgender Health (WPATH) wrote an opinion article in the New York Times stating her view that these laws constituted an effort to "rid the world of transgender people."{{cite news |last1=Bowers |first1=Marci |title=What Decades of Providing Trans Health Care Have Taught Me |url=https://www.nytimes.com/2023/04/01/opinion/trans-healthcare-law.html |work=The New York Times |date=April 2023 |access-date=17 July 2023}} Similar sentiments were expressed in a WPATH public communique: "Anti-transgender health care legislation is not about protections for children but about eliminating transgender persons on a micro and macro scale."{{cite web |title=Statement of Opposition to Legislation Banning Access to Gender-Affirming Health Care in the US |url=https://www.wpath.org/media/cms/Documents/Public%20Policies/2023/USPATH_WPATH%20Statement%20re_%20GAHC%20march%208%202023.pdf |publisher=World Professional Association of Transgender Health |access-date=17 July 2023}}

According to the legal definition of crimes against humanity which is propagated at the Hague by the International Criminal Court, "'extermination' includes the intentional infliction of conditions of life, inter alia the deprivation of

access to food and medicine, calculated to bring about the destruction of part of a population" when "pursuant to or in

furtherance of a State or organizational policy to commit such attack."{{cite web |title=Rome Statute of the International Criminal Court |url=https://www.icc-cpi.int/sites/default/files/RS-Eng.pdf |publisher=International Criminal Court}}

The compiling of lists of transgender citizens by governments, such as the list which was compiled by the state of Texas in 2022,{{Cite news |last=Hennessy-Fiske |first=Molly |date=2022-12-14 |title=Texas attorney general's office sought state data on transgender Texans |language=en-US |newspaper=The Washington Post |url=https://www.washingtonpost.com/nation/2022/12/14/texas-transgender-data-paxton/ |access-date=2022-12-21 |issn=0190-8286}} has been criticized by trans advocates who feared the state would "use the information to further persecute the already vulnerable trans community."{{Cite web |last=Villarreal |first=Daniel |title=GOP Texas attorney general's office allegedly demanded a list of trans people in the state |url=https://www.lgbtqnation.com/2022/12/gop-texas-attorney-generals-office-allegedly-demanded-list-trans-people-state/ |access-date=2022-12-21 |website=LGBTQ Nation|date=December 14, 2022 }} In August 2024, the Texas Department of Public Safety (DPS) issued a statement saying they would no longer accept court orders as a basis to change a person's sex on their drivers license, effectively banning trans people from changing their sex on their drivers license. The statement also "directs drivers license employees to send the names and identification numbers of people seeking to change their sex on their license to a particular email address" with the subject line "Sex Change Court Order." Drivers license employees are also ordered to "scan into the record" court orders or other documents associated with any sex change requests. The DPS refused to say how this information will be used.

In June 2023, the Attorney General's office for the state of Tennessee mandated the Vanderbilt University Medical Center to turn over the medical records of all of its transgender patients. The VUMC complied.{{cite web | url=https://www.tennessean.com/story/news/health/2023/06/20/vanderbilt-university-m-turns-over-transgender-patient-medical-records-to-tennessee-attorney-general/70338356007/ | title=Vanderbilt turns over transgender patient records to state in attorney general probe | website=The Tennessean }}

As part of his 2024 presidential campaign, Donald Trump stated that if elected, he would sign an executive order instructing every federal agency to cease the promotion of sex or gender transition at any age as well as ask Congress to pass a bill stating that the United States will only recognize two genders as determined at birth, and promised to crackdown on gender-affirming care for all ages. Additionally, Trump stated that he would make hospitals and health care providers that provide transitional hormones or surgery no longer qualify for federal funding, including Medicare and Medicaid funding. Trump has also stated he will push to prohibit hormonal and surgical intervention for minors in all 50 states.{{cite web|last=Colvin|first=Jill|url=https://apnews.com/article/trump-policies-agenda-election-2024-second-term-d656d8f08629a8da14a65c4075545e0f|title=Trump's plans if he returns to the White House include deportation raids, tariffs and mass firings|agency=Associated Press|date=November 12, 2023|access-date=2024-02-05}}{{cite web|last=Weigel|first=David|url=https://www.semafor.com/article/02/03/2023/at-any-age-donald-trump-pushes-the-gop-towards-targeting-transgender-adults|title='At any age': Donald Trump pushes the GOP towards targeting transgender adults|website=Semafor|date=February 3, 2023|access-date=2024-02-05}}{{cite web|last1=Weill|first1=Kate|last2=Briquelet|first2=Kelly|url=https://www.miamiherald.com/news/politics-government/article277322158.html|title=Trump Says He'll Ban Federal Government From Promoting Transgender Care at Any Age|website=The Daily Beast|date=June 30, 2023|access-date=2024-02-05}}{{cite web|last=Roarty|first=Alex|url=https://www.semafor.com/article/02/03/2023/at-any-age-donald-trump-pushes-the-gop-towards-targeting-transgender-adults|title=It's trans adults, too: GOP candidates now back trans medical restrictions for all ages|website=Miami Herald|date=July 14, 2023|access-date=2024-02-05}}

{{Main|Executive Order 14168}}

On the January 20, 2025, shortly after being inaugurated, President Donald Trump signed an Executive Order,{{cite web |title=Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government |url=https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/ |url-status=live |archive-url=https://web.archive.org/web/20250121214116/https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/ |archive-date=21 January 2025 |website=White House|date=January 21, 2025 }}{{Cite web |date=2025-01-20 |title=Trump to try to remove 'nonbinary' and 'other' genders |url=https://www.politico.com/live-updates/2025/01/20/donald-trump-inauguration-day-news-updates-analysis/trump-removes-nonbinary-gender-00199264 |access-date=2025-01-23 |website=Politico |language=en}} which defined sex in the eyes of the federal government as a male-female binary, with "female" and "male" defined as "a person belonging, at conception to the sex that produces the large reproductive cell" and a "person belonging, at conception, to the sex that produces the small reproductive cell" respectively. The order also mandated that:

• Federal agencies should use "sex" instead of "gender", remove materials that "promote gender ideology", and halt "funding of gender ideology"{{R|name=wh2|location=§ 3(a), 3(e)}}
• Official government documents such as passports and visas stop allowing self-selection of gender{{R|name=wh2|location=§ 3(d)}}
• Transgender people be barred from government-funded single-sex facilities congruent with their gender identity{{R|name=wh2|location=§ 4}}
• The Bureau of Prisons halt any federal funding for gender-affirming care.{{R|name=wh2|location=§ 4(c)}}
• That federal funding no longer go to gender-affirming care{{Cite news |last=Demopoulos |first=Alaina |date=2025-01-22 |title='A twist of the knife': trans Americans respond to Trump's executive order |url=https://www.theguardian.com/world/2025/jan/22/trump-executive-order-trans-reaction |access-date=2025-01-22 |work=The Guardian |language=en-GB |issn=0261-3077}}
• The attorney general provide guidance "to correct the misapplication of the Supreme Court’s decision in Bostock v. Clayton County (2020) to sex-based distinctions" in federal agency activities.{{R|name=wh2|location=§ 3(f)}}
• Prior policies and federal government documents that are inconsistent with this order be rescinded, including policies that require the use of names and pronouns consistent with a person's gender identity in federal workplaces.

Provisions of the order have faced legal challenges, with temporary restraining orders having been issued to suspend the withholding of federal funding to programs that fund gender-affirming care and promote "gender ideology", the forced transfers of transgender inmates to facilities congruent with their sex assigned at birth, and the mass removal of documents published by the Centers for Disease Control and Prevention, Food and Drug Administration, Department of Health and Human Services that mention topics related to "gender ideology".{{Cite web |agency=Associated Press |date=2025-02-11 |title=Judge tells agencies to restore webpages and data removed after Trump's executive order |url=https://www.statnews.com/2025/02/11/cdc-fda-hhs-restore-webpages-data-trump-executive-order-judge-ruling/ |access-date=2025-02-14 |website=STAT |language=en-US}}

{{Main|Executive Order 14183}}

On January 27, 2025, Trump signed an executive order declaring that a soldier being trans “conflicts with a soldier's commitment to an honorable, truthful, and disciplined lifestyle, even in one's personal life” and that trans people “cannot satisfy the rigorous standards necessary for military service”.{{Cite web |last1=Watson |first1=Kathryn |last2=Watson |first2=Eleanor |last3=Cook |first3=Sara |date=2025-01-28 |title=Trump signs executive orders for military, focusing on transgender service members, COVID, diversity - CBS News |url=https://www.cbsnews.com/news/trump-executive-orders-military/ |access-date=2025-01-28 |publisher=CBS News |language=en-US}}

On March 18, 2025, Judge Ana C. Reyes blocked the executive order, ruling that banning trans people from the military likely violated their constitutional rights.{{cite news |title=US judge blocks Trump's ban on trans people serving in the military |url=https://www.theguardian.com/us-news/2025/mar/18/judge-blocks-trump-executive-order-trans-military-ban |access-date=March 18, 2025 |work=The Guardian |agency=Associated Press |date=March 18, 2025}}

{{Main|Executive Order 14187}}

On January 28, 2025, Trump signed an executive order to "Protect Children from Chemical and Surgical Mutilation". The order described gender-affirming care for minors as "chemical and surgical mutilation of children" as well as "maiming" and "sterilizing".{{cite web | agency=Associated Press | title=Some hospitals pause gender-affirming care to evaluate Trump's executive order | publisher=NBC News | date=2025-01-31 | url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/hospitals-pause-gender-affirming-care-trump-transgender-order-rcna190164 | access-date=2025-02-01}} It stated "countless children" who received such care would regret a "horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding."{{cite web | last=Montague | first=Zach | title=Trump Signs Order Restricting Gender-Affirming Treatments for Minors | website=The New York Times | date=2025-01-29 | url=https://www.nytimes.com/2025/01/28/us/politics/trump-trans-gender-affirming-care.html | access-date=2025-02-01}} The order also described the World Professional Association for Transgender Health's (WPATH) guidance as "junk science".

The order states that the US Federal Government will not "fund, sponsor, promote, assist, or support the so-called 'transition' of a child from one sex to another." The provisions include:

• Directing the United States Department of Health and Human Services to review the terms of insurance under Medicare, Medicaid, and the Affordable Care Act to end certain gender affirming care;
• Told federal agencies providing federal grants to medical institutions to make sure those institutions were not carrying out any gender-related procedures;
• Protects whistleblowers who report on institutions that provide gender affirming care in violation of the executive order.{{cite web|url=https://www.nationalreview.com/news/trump-signs-executive-order-protecting-children-from-chemical-and-surgical-gender-mutilation/|title=Trump Signs Executive Order Protecting Children from Chemical and Surgical Gender Mutilation|first=Haley|last=Strack|work=National Review|date=January 28, 2025}}

In response, some hospitals paused providing gender-affirming care for minors, while others continued. Attorneys general from 15 states said their states are committed to continuing to provide gender-affirming care to minors. Multiple groups filed lawsuits challenging the legality of the executive order. In response to one of the lawsuits, several federal judges issued injunctions blocking the government from withholding federal funds from hospitals that provide gender affirming care to minors.{{Cite news |last1=Harmon |first1=Amy |last2=Macur |first2=Juliet |date=2025-02-13 |title=Judge Temporarily Stops Trump's Plan to End Funds for Trans Youths' Health Providers |url=https://www.nytimes.com/2025/02/13/us/trump-trans-youth-health-providers.html |access-date=2025-02-14 |work=The New York Times |language=en-US |issn=0362-4331}}{{Cite news |date=March 1, 2025 |title=Judge blocks Trump's orders to curb youth gender transition care |newspaper=The Washington Post |url=https://www.washingtonpost.com/nation/2025/03/01/judge-blocks-trumps-orders-curb-youth-gender-transition-care/ |access-date=March 8, 2025 |language=en}} Following the injunction, some hospitals that initially paused gender-affirming care for minors resumed the care.{{cite news |url=https://www.cbs19news.com/news/uva-health-set-to-resume-transgender-care-services/article_e5058c94-ea6d-11ef-9a11-67133ace5cc0.html |title=UVA Health set to resume transgender care services |publisher=CBS News |date=February 13, 2025 |access-date=February 16, 2025}}{{cite news |url=https://www.azcentral.com/story/news/local/arizona-health/2025/02/15/az-clinic-to-resume-gender-affirming-care-transgender-people-under-19/78625587007/# |title=Phoenix clinic to resume gender-affirming care for children paused by Trump order |newspaper=The Arizona Republic |date=February 15, 2025 |access-date=February 16, 2025}}

On January 28, 2025, Trump ordered a freeze on all federal funding grants, loans, and aid while those receiving them were assessed to make sure they weren't promoting "advance Marxist equity, transgenderism, and green new deal social engineering policies".{{Cite web |last1=Cordes |first1=Nancy |last2=Watson |first2=Kathryn |last3=Linton |first3=Caroline |last4=Hubbard |first4=Kaia |last5=Quinn |first5=Melissa |last6=Brown |first6=Kristin |last7=Escobedo |first7=Richard |date=2025-01-28 |title=Trump administration orders federal funding freeze on all public loans, grants and more aid - CBS News |url=https://www.cbsnews.com/news/trump-freeze-federal-loans-grants-white-house-memo/ |access-date=2025-01-28 |publisher=CBS News |language=en-US}}

{{Main|Executive Order 14190}}

On January 29, 2025, Trump signed an executive order "Ending Radical Indoctrination in K-12 Schooling".{{Cite news |last=Office of the Press Secretary |date=January 29, 2025 |title=Ending Radical Indoctrination in K-12 Schooling |url=https://www.whitehouse.gov/presidential-actions/2025/01/ending-radical-indoctrination-in-k-12-schooling/ |publisher=White House |via=National Archives}}

{{Main|Executive Order 14201}}

On February 5, 2025, Trump signed an executive order titled "Keeping Men Out of Women's Sports", which directs federal agencies and state attorneys general to immediately enforce a prohibition of transgender girls and women from participating in women's sports.{{cite news |last1=Dunbar |first1=Marina |title=Trump signs executive order banning trans athletes from women's sports |url=https://www.theguardian.com/us-news/2025/feb/05/trump-trans-athletes-ban |access-date=February 5, 2025 |work=The Guardian |date=February 5, 2025}}{{cite web |title=Keeping Men Out of Women's Sports |url=https://www.whitehouse.gov/presidential-actions/2025/02/keeping-men-out-of-womens-sports/ |website=The White House |access-date=February 5, 2025 |date=February 5, 2025}} The order does not ban transgender men athletes from playing on male sports teams.{{Cite web |date=February 11, 2025 |title=Education Dept. urges NCAA to reverse transgender athletes' records, titles and awards |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/education-ncaa-transgender-athletes-records-reversal-rcna191742 |access-date=February 13, 2025|publisher=NBC News |first=Jo |last=Yurcaba |archive-date=February 11, 2025|archive-url=https://web.archive.org/web/20250211223339/https://www.nbcnews.com/nbc-out/out-politics-and-policy/education-ncaa-transgender-athletes-records-reversal-rcna191742 |url-status=live }} As part of this order's implementation, the Department of Education urged high school and college athletics organizations NCAA and NFHS to revoke female transgender athletes' records and restore cisgender athletes' ones.{{Cite web |last=Yurcaba |first=Jo |date=February 11, 2025 |title=Education Dept. urges NCAA to reverse transgender athletes' records, titles and awards |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/education-ncaa-transgender-athletes-records-reversal-rcna191742 |url-status=live |archive-url=https://web.archive.org/web/20250211223339/https://www.nbcnews.com/nbc-out/out-politics-and-policy/education-ncaa-transgender-athletes-records-reversal-rcna191742 |archive-date=February 11, 2025 |access-date=February 13, 2025 |publisher=NBC News}}{{Cite news |last=Walsh |first=Sheri |date=February 11, 2025 |title=Education Department urges NCAA to erase records set by transgender athletes |url=https://www.upi.com/Top_News/US/2025/02/11/education-department-ncaa-erase-records-transgender-athletes/9871739317069/ |access-date=February 13, 2025 |agency=United Press International }} The State Department also announced a ban on transgender athletes from entering the United States if they attempt to compete in women's sports, and that visa applicants suspected of such would have their file marked with the letters 'SWS25' for the purposes of tracking.{{Cite news |last=Gedeon |first=Joseph |date=February 25, 2025 |title=US threatens permanent visa bans on trans athletes based on sex markers |url=https://www.theguardian.com/us-news/2025/feb/25/visa-ban-transgender-athletes |access-date=February 25, 2025 |work=The Guardian |issn=0261-3077}}

A 2014 report by the Department of Justice found that 2% of trans people report being physically attacked upon visiting a doctor's office, with 3% reporting being forcibly subjected to unwanted medical procedures.{{Cite web|url=https://ovc.ojp.gov/sites/g/files/xyckuh226/files/pubs/forge/tips_pro.html|title=Victim Issues: Mistrust of Professionals | Responding to Transgender Victims of Sexual Assault|website=ovc.ojp.gov}}

According to a study published by the UCLA Williams Institute, transgender people are the victims of violent crimes at over four times the rate of cisgender people. The study found that from 2017 to 2018, trans people experienced violent victimizations at a rate of 86.2 per 1000 people, compared to 21.7 among cis people. Trans women suffered at a rate of 86.1 per 1000, compared to cis women's 23.7, and trans men suffered at a rate of 107.5 per 1000 compared to cis men's 19.8.{{Cite web|url=https://williamsinstitute.law.ucla.edu/press/ncvs-trans-press-release/|title=Transgender people over four times more likely than cisgender people to be victims of violent crime|website=Williams Institute}}

According to the Department of Justice in 2022, 50% of people who die in anti-LGBT hate crimes are trans women, with sexual assault being a frequent occurrence after their murders. Additionally, 50% of transgender people are physically abused after coming out as trans to a significant other.{{Cite web |url=https://ovc.ojp.gov/sites/g/files/xyckuh226/files/pubs/forge/sexual_numbers.html |archive-date=2022-06-25 |url-status=live |archive-url=https://web.archive.org/web/20220625220709/https://ovc.ojp.gov/sites/g/files/xyckuh226/files/pubs/forge/sexual_numbers.html |title=Responding to Transgender Victims of Sexual Assault}}

In June 2022, NBC reported "Events for transgender rights (…) have become frequent targets of extremists, militias, and far-right personalities".{{Cite web |url=https://www.nbcnews.com/tech/tech-news/anti-lgbtq-threats-orchestrated-on-internet-shut-down-events-rcna33955 |title=Anti-LGBTQ threats, fueled by internet's far right 'machine,' shut down trans rights and drag events |last1=Madani |first1=Doha |last2=Collins |first2=Ben|publisher=NBC News |date=June 18, 2022 }}

In August 2022, a draft report from the California Attorney General's Office found that trans people were four times more likely to be stopped by police for "reasonable suspicion" than cis people.{{Cite web |url=https://www.lgbtqnation.com/2022/08/police-four-times-likely-stop-transgender-people-reasonable-suspicion/ |last1=Owen |first1=Greg |title=Police are four times more likely to stop transgender people for 'reasonable suspicion'|date=August 2022 }}

According to the Department of Justice in 2022, 66% of trans people experience sexual assault at some point in their lives. 15% of trans people report being sexually assaulted by police or prison staff (32% for African-American trans people), while another 10% report being sexually assaulted by healthcare professionals.{{Cite web |archive-url=https://web.archive.org/web/20220625220709/https://ovc.ojp.gov/sites/g/files/xyckuh226/files/pubs/forge/sexual_numbers.html |title=Responding to Transgender Victims of Sexual Assault|url=https://ovc.ojp.gov/sites/g/files/xyckuh226/files/pubs/forge/sexual_numbers.html |archive-date=June 25, 2022 }} An older study conducted by the DOJ in 2014 also found that it was not uncommon for psychiatric professionals to mandate that trans patients of theirs perform sexual favors for them in exchange for continued access to gender affirming healthcare.

The Trafficking in Persons report by the State Department found that trans people are significantly overrepresented in sex trafficking victims, and a study by Loyola University Chicago found that trans people in the US are 5.6x more likely to engage in survival sex—where sex is traded for money, food, shelter, or other essential items such as phones or clothing—than their cis peers.{{Cite news |url=https://www.reuters.com/article/trafficking-conference-transgender/transgender-sex-trafficking-survivor-hopes-her-story-will-help-others-idUSL8N1HQ4IM |title=Transgender sex trafficking survivor hopes her story will help others |last1=Goldsmith |first1=Belinda|website=Reuters |date=April 25, 2017 }}{{Cite web |url=https://ecommons.luc.edu/cgi/viewcontent.cgi?article=1017&context=chrc |last1=Tomasiewicz |first1=Meaghan |title=Sex Traffifficking of Transgender and Gender Nonconforming Youth in the United States}}{{Cite web |url=https://delta87.org/2021/12/gendered-understandings-forced-sexual-exploitation/ |title=Gendered Understandings of Forced Sexual Exploitation |last1=Newman-Granger |first1=Ellie |date=December 8, 2021 |access-date=July 28, 2022 |archive-date=September 28, 2022 |archive-url=https://web.archive.org/web/20220928212244/https://delta87.org/2021/12/gendered-understandings-forced-sexual-exploitation/ |url-status=dead }}

According to the 2015 US Transgender survey, 13% of K-12 students who were out as or perceived as transgender were sexually assaulted specifically for being transgender.{{Cite web |url=https://transequality.org/sites/default/files/docs/usts/USTS-Executive-Summary-Dec17.pdf |title=The Report of the 2015 US Transgender Survey Executive Summary |date=December 2016}}

It's considered relatively common for transgender people to be subjected to pat downs and secondary searches while going through airport security, due to their body types deviating from the presets expected by the body scanners. These searches can range from being groped in the groin area, to being forced to strip entirely.{{Cite news |url= https://edition.cnn.com/travel/article/tsa-body-scanners-transgender-travelers/index.html |title= The trauma of TSA for transgender travelers |publisher= CNN |access-date= March 27, 2023 |archive-date= March 27, 2023 |archive-url= https://web.archive.org/web/20230327050818/https://amp.cnn.com/cnn/travel/article/tsa-body-scanners-transgender-travelers/index.html |url-status= dead }}{{Cite news |url= https://www.washingtonpost.com/travel/2021/06/16/trans-travel-tsa-lgbtq/ |title=#TravelingWhileTrans: The trauma of returning to 'normal' |work=WaPo}}

Anti-trans legislation in numerous conservative states has caused some trans people and their families to flee their homes, whether to another state or another country, including the families of those who actively advocated against anti-trans laws in their states.{{Cite web |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/texas-families-trans-kids-plan-flee-state-rcna23633 |title=More Texas families with trans kids plan to flee the state |last1=Yurcaba |first1=Jo|publisher=NBC News |date=April 11, 2022 }}{{Cite web |url=https://www.motherjones.com/politics/2022/03/trans-teens-texas-medical-care-abbott-paxton-bigotry/ |last1=Michaels |first1=Samantha |title=Transgender Teens and Their Families Prepare to Flee Texas |work=Mother Jones}}{{Cite web |url=https://www.nbcnews.com/nbc-out/out-community-voices/texas-trans-activist-kai-shappley-flees-state-years-advocacy-rcna37000 |title=Texas trans activist, 11, flees the state after years of advocacy |last1=Yurcaba |first1=Jo|publisher=NBC News |date=July 7, 2022 }}

A number of states have passed laws protecting trans people and their families, as well as their healthcare providers, fleeing anti-trans states, from extradition. In 2022, Connecticut became the first state to implement such a law, alongside similar protections for reproductive healthcare providers and recipients.{{Cite act |type=House Bill |index=5506 |date=May 24, 2022 |article=Sec 484, 485, 486, 487, 488 |article-type= Section |legislature= The Connecticut General Assembly |page=681-686 |url=https://legiscan.com/CT/text/HB05506/2022 |archive-url=https://web.archive.org/web/20220812193552/https://legiscan.com/CT/text/HB05506/2022 |archive-date=August 12, 2022}} Since then, Massachusetts, California, Illinois, Minnesota, New Jersey, New Mexico, Vermont, Colorado, Washington, New York, Arizona, Maine, Rhode Island, Oregon, Maryland, and the District of Columbia have passed similar laws.{{Cite web |url=https://thehill.com/changing-america/respect/equality/3579987-massachusetts-governor-signs-bill-safeguarding-reproductive-gender-affirming-health-care-into-law/ |title=Massachusetts governor signs bill safeguarding reproductive, gender-affirming health care into law |last1=Migdon |first1=Brooke |date=July 29, 2022 |work=The Hill |access-date=August 12, 2022 |archive-date=April 6, 2023 |archive-url=https://web.archive.org/web/20230406021447/https://thehill.com/changing-america/respect/equality/3579987-massachusetts-governor-signs-bill-safeguarding-reproductive-gender-affirming-health-care-into-law/ |url-status=dead }}{{Cite web |url=https://www.wbur.org/news/2022/05/27/massachusetts-senate-roe-transgender-legal-protections |last1=Bebinger |first1=Martha |title=Mass. Senate moves to protect abortion providers from out-of-state court judgments and investigations|date=May 27, 2022 |publisher=WBUR}}{{Cite web |url=https://www.sacbee.com/news/politics-government/capitol-alert/article266601076.html |title= California to become sanctuary state for transgender children under new law |last1=Holden |first1=Lindsey |last2=Sheeler |first2=Andrew |website=sacbee.com}}{{Cite act |url=https://legiscan.com/DC/text/B24-0808/2021 |legislature=Washington DC Council |type=Council Bill |index=240808 |date=October 18, 2022}}{{Cite web |url=https://xtramagazine.com/power/trans-rights-blue-states-243885 |title=As Republican-led statehouses continue to attack trans rights, some blue states are fighting back |last1=Wells |first1=VS|date=January 16, 2023 |website=xtramagazine.com}}{{Cite web |last=Lee |first=Nicole |date=2023-03-10 |title=Minnesota becomes refuge state in US for gender-affirming care |url=https://gcn.ie/minnesota-refuge-state-gender-affirming-care/ |access-date=2023-03-24 |website=GCN |language=en}}{{Cite web |last=Walz |first=Tim |author-link=Tim Walz |date=March 8, 2023 |title=Executive Order 23-03 |url=https://mn.gov/governor/assets/EO%2023-03%20Signed%20and%20filed_tcm1055-568332.pdf |access-date=March 23, 2023 |publisher=State of Minnesota Executive Department}}{{Cite web |last1=Nieto-Munoz |first1=Sophie |date=April 4, 2023 |title=Governor Murphy declares N.J. 'safe haven' for transgender, nonbinary people |url=https://newjerseymonitor.com/briefs/governor-murphy-declares-n-j-safe-haven-for-transgender-nonbinary-people/ |access-date=2023-04-16 |website=New Jersey Monitor |language=en-US}}{{Cite web |last=Murphy |first=Philip |author-link=Phil Murphy |date=April 4, 2023 |title=State of New Jersey Executive Order No. 326 |url=https://www.nj.gov/infobank/eo/056murphy/pdf/EO-326.pdf |url-status=live |archive-url=https://web.archive.org/web/20230413013500/https://www.nj.gov/infobank/eo/056murphy/pdf/EO-326.pdf |archive-date=April 13, 2023 |access-date=April 16, 2023}}{{Cite web |publisher=State of Maryland Executive Department |date=June 5, 2023 |title=State of Maryland Executive Order 01.01.2023.08 |url=https://governor.maryland.gov/Lists/ExecutiveOrders/Attachments/11/EO_01.01.2023.08_accessible.pdf |url-status=live |archive-url=https://web.archive.org/web/20230609174705/https://governor.maryland.gov/Lists/ExecutiveOrders/Attachments/11/EO_01.01.2023.08_accessible.pdf |archive-date=June 9, 2023 |access-date=June 9, 2023}}{{Cite web |last=Migdon |first=Brooke |date=2023-06-08 |title=Maryland governor signs executive order protecting access to gender-affirming care |url=https://thehill.com/homenews/state-watch/4040993-maryland-governor-signs-executive-order-protecting-access-to-gender-affirming-care/ |access-date=2023-06-09 |website=The Hill |language=en-US |archive-date=June 14, 2023 |archive-url=https://web.archive.org/web/20230614205309/https://thehill.com/homenews/state-watch/4040993-maryland-governor-signs-executive-order-protecting-access-to-gender-affirming-care/ |url-status=dead }}

In June 2023, polling from Data for Progress found that 8% of transgender adults in the US have been displaced from their community or state by hostile legislation.{{Cite web |url=https://www.dataforprogress.org/blog/2023/6/8/lgbtq-adults-do-not-feel-safe-and-do-not-think-the-democratic-party-is-doing-enough-to-protect-their-rights |title=LGBTQ+ Adults Do Not Feel Safe and Do Not Think the Democratic Party Is Doing Enough to Protect Their Rights |date=June 8, 2023 |website=dataforprogress.org}}

File:Transgender Employment rights in the United States prior to the ruling in R.G. & G.R. Harris Funeral Homes Inc. v. Equal Employment Opportunity Commission.svg.

{{legend|#800080|Discrimination prohibited in public and private employment}}

{{legend|#BA75FF|Discrimination prohibited in public employment only}}

{{legend|#d3d3d3|No enumerated protections}}]]

In June 2020, the U.S. Supreme Court ruled for the first time on a case directly regarding Transgender rights. In the case R.G. & G.R. Harris Funeral Homes Inc. v. Equal Employment Opportunity Commission, the Supreme Court held that Title VII of the Civil Rights Act 1964 extends protections to individuals who are transgender in Employment. This is based on discrimination on the grounds of transgender status is a form of discrimination based on sex. Prior to the rulings that Title VII protections covered transgender status, four states (Alaska, Arizona, Wisconsin, and Missouri) had not enacted specific protections based on transgender status in any employment, and 22 states had extended protections to public employment only.{{cite news|url= https://www.nytimes.com/2020/06/15/us/gay-transgender-workers-supreme-court.html |title=Civil Rights Law Protects Gay and Transgender Workers, Supreme Court Rules|website=The New York Times|date=June 15, 2020|last1=Liptak|first1=Adam|url-status=live|archive-url=https://web.archive.org/web/20220814013015/https://www.nytimes.com/2020/06/15/us/gay-transgender-workers-supreme-court.html| archive-date=August 14, 2022|access-date=August 19, 2022}}

File:US Transgender housing discrimination.svg. HUD regulations require all housing providers that receive HUD funding not to discriminate against an individual's gender identity as of June 2020{{Update inline|date=October 2024|reason=Not updated in 4 years}}

{{legend|#0072b2|Prohibits housing discrimination based on gender identity}}

{{legend|#d3d3d3|No enumerated protections}}]]

There is no federal law designating transgender as a protected class, or specifically requiring equal treatment for transgender people. Some versions of the Employment Non-Discrimination Act introduced in the U.S. Congress have included protections against discrimination for transgender people, but as of 2021 no version of ENDA has passed. Whether or not to include such language has been a controversial part of the debate over the bill. In 2016 and again in 2017, Rep. Pete Olson [R-TX] introduced legislation to strictly interpret gender identity according to biology, which would end federal civil rights protection of gender identity. It remains legal at the federal level for parents to subject transgender children to conversion therapy.

On October 4, 2017, Attorney General Jeff Sessions released a Department of Justice memo stating that Title VII of the 1964 Civil Rights Act prohibits discrimination based on sex, which he stated "is ordinarily defined to mean biologically male or female," but the law "does not prohibit discrimination based on gender identity per se."{{cite news|last1=Moreau|first1=Julie|title=Federal Civil Rights Law Doesn't Protect Transgender Workers, Justice Department Says|url=https://www.nbcnews.com/feature/nbc-out/federal-civil-rights-law-doesn-t-protect-transgender-workers-justice-n808126|access-date=October 5, 2017|publisher=NBC News|date=October 5, 2017|url-status=live|archive-url=https://web.archive.org/web/20171005214758/https://www.nbcnews.com/feature/nbc-out/federal-civil-rights-law-doesn-t-protect-transgender-workers-justice-n808126|archive-date=October 5, 2017|df=mdy-all}}

On January 30, 2012, HUD Secretary Shaun Donovan announced new regulations that would require all housing providers that receive HUD funding to prevent housing discrimination based on sexual orientation or gender identity.{{cite press release|url=http://portal.hud.gov/hudportal/HUD?src=/press/press_releases_media_advisories/2012/HUDNo.12-014|title=HUD Secretary Shaun Donovan announces new regulations to ensure equal access to housing for all Americans regardless of sexual orientation or gender identity|publisher=United States Department of Housing and Urban Development|date=January 30, 2012|access-date=March 6, 2012|archive-url=https://web.archive.org/web/20120306214348/http://portal.hud.gov/hudportal/HUD?src=%2Fpress%2Fpress_releases_media_advisories%2F2012%2FHUDNo.12-014|archive-date=March 6, 2012|df=mdy-all}} These regulations went into effect on March 5, 2012.{{cite web|url=http://portal.hud.gov/hudportal/documents/huddoc?id=12lgbtfinalrule.pdf|title=Equal Access to Housing in HUD Programs Regardless of Sexual Orientation or Gender Identity|publisher=Federal Register|date=February 3, 2012|access-date=March 6, 2012|url-status=live|archive-url=https://web.archive.org/web/20120604005715/http://portal.hud.gov/hudportal/documents/huddoc?id=12lgbtfinalrule.pdf|archive-date=June 4, 2012|df=mdy-all}}

Over 225 jurisdictions including the District of Columbia (as of 2016){{cite web|url=http://www.hrc.org/resources/entry/cities-and-counties-with-non-discrimination-ordinances-that-include-gender|title=Cities and Counties with Non-Discrimination Ordinances that Include Gender Identity|work=Human Rights Campaign|url-status=live|archive-url=https://web.archive.org/web/20130530124705/http://www.hrc.org/resources/entry/cities-and-counties-with-non-discrimination-ordinances-that-include-gender|archive-date=May 30, 2013|df=mdy-all}} and 22 states (as of 2018) feature legislation that prohibit discrimination based on gender identity in either employment, housing, and/or public accommodations. In Anchorage, Alaska, voters chose in April 2018 to keep the existing protections for transgender people.{{cite news |last1=Thiessen |first1=Mark |title=Anchorage voters are 1st in nation to defeat transgender 'bathroom bill' referendum |url=http://www.chicagotribune.com/news/nationworld/ct-anchorage-transgender-bathroom-bill-defeated-20180412-story.html |access-date=10 June 2018 |newspaper=Chicago Tribune |date=12 April 2018}} In Massachusetts, a state law prohibited discrimination in public accommodations on the basis of gender identity; in October 2016, anti-transgender activists submitted the minimum number of signatures necessary to the Secretary of the Commonwealth of within Massachusetts to put the law up for repeal on a statewide ballot measure,{{cite web |title=Learn More |url=https://www.freedommassachusetts.org/learn-more/ |website=Freedom for All Massachusetts |access-date=10 June 2018}} Massachusetts voters chose on November 6, 2018 to retain the state law, with 68% in favor of upholding law, and 32% opposed. The Massachusetts Gender Identity Anti-Discrimination Initiative was the first-ever statewide ballot question of its kind in the United States.

Some states and cities have banned conversion therapy for minors.

In 2000, a court ruling in Connecticut determined that conventional sex discrimination laws protected transgender persons. However, in 2011, to clarify and codify this ruling, a separate law was passed defining legal anti-discrimination protections on the basis of gender identity.Declaratory Ruling on Behalf of John/Jane Doe (Connecticut Human Rights Commission 2000)

On October 16, 1976, the Court rejected plaintiff's appeal in sex discrimination case involving termination from teaching job after gender-affirming surgery from a New Jersey school system.{{cite web |url=http://tvnews.vanderbilt.edu/program.pl?ID=485785 |title=Supreme Court / Sex Discrimination Case / New Jersey Teacher – Oct 18, 1976 – NBC–TV news|publisher=Tvnews.vanderbilt.edu |date=October 18, 1976 |access-date=August 28, 2015 |url-status=live |archive-url=https://web.archive.org/web/20151230073830/http://tvnews.vanderbilt.edu/program.pl?ID=485785 |archive-date=December 30, 2015 |df=mdy-all }}

Carroll v. Talman Fed. Savs. & Loan Association, 604 F.2d 1028, 1032 (7th Cir.) 1979, held that dress codes are permissible. "So long as [dress codes] and some justification in commonly accepted social norms and are reasonably related to the employer's business needs, such regulations are not necessarily violations of Title VII even though the standards prescribed differ somewhat for men and women."{{cite web|title=Ca 79-3151 Carroll v. Talman Federal Savings and Loan Association of Chicago|date=December 6, 1978|volume=F2d|issue=604|page=1028|url=http://openjurist.org/604/f2d/1028/ca-79-3151-carroll-v-talman-federal-savings-and-loan-association-of-chicago|publisher=United States Court of Appeals, Seventh Circuit|access-date=June 23, 2012|url-status=live|archive-url=https://web.archive.org/web/20131029165906/http://openjurist.org/604/f2d/1028/ca-79-3151-carroll-v-talman-federal-savings-and-loan-association-of-chicago|archive-date=October 29, 2013|df=mdy-all}}

In Ulane v. Eastern Airlines Inc. 742 F.2d 1081 (7th Cir. 1984) Karen Ulane, a pilot who was assigned male at birth, underwent gender-affirming surgery to attain typically female characteristics. The Seventh Circuit denied Title VII sex discrimination protection by narrowly interpreting "sex" discrimination as discrimination "against women" [and denying Ulane's womanhood].{{cite web|title=Ulane v. Eastern Airlines, Inc., 742 F. 2d 1081 – Court of Appeals, 7th Circuit 1984|url=https://scholar.google.com/scholar_case?case=2720815591438522387&hl=en&as_sdt=2&as_vis=1&oi=scholarr|publisher=United States Court of Appeals, Seventh Circuit|access-date=June 23, 2012}}

The case of Price Waterhouse v. Hopkins 490 U.S. 228 (1989), expanded the protection of Title VII by prohibiting gender discrimination, which includes sex stereotyping. In that case, a woman who was discriminated against by her employer for being too "masculine" was granted Title VII relief.{{cite web|title=Price Waterhouse v. Hopkins|url=http://www.apa.org/about/offices/ogc/amicus/hopkins.aspx|publisher=American Psychological Association|access-date=June 23, 2012|url-status=live|archive-url=https://web.archive.org/web/20120630025920/http://www.apa.org/about/offices/ogc/amicus/hopkins.aspx|archive-date=June 30, 2012|df=mdy-all}}

Oncale v. Sundowner Offshore Services, Inc. 523 U.S. 75 (1998), found that same-sex sexual harassment is actionable under Title VII.{{cite web |last=Minter |first=Shannon |title=Representing Transsexual Clients: Selected Legal Issues |publisher=National Center for Lesbian Rights |year=2003 |url=http://www.transgenderlaw.org/resources/translaw.htm |access-date=October 3, 2007 |url-status=live |archive-url=https://web.archive.org/web/20071030225647/http://www.transgenderlaw.org/resources/translaw.htm |archive-date=October 30, 2007 |df=mdy-all }}

A gender stereotype is an assumption about how a person should dress which could encompass a significant range of transgender behavior. This potentially significant change in the law was not tested until Smith v. City of Salem 378 F.3d 566, 568 (6th Cir. 2004). Smith, a trans woman, had been employed as a lieutenant in the fire department without incident for seven years. After doctors diagnosed Smith with Gender Identity Disorder ("GID"), she began to experience harassment and retaliation following complaint. She filed Title VII claims of sex discrimination and retaliation, equal protection and due process claims under 42 U.S.C. § 1983, and state law claims of invasion of privacy and civil conspiracy. On appeal, the Price Waterhouse precedent was applied at p. 574: "[i]t follows that employers who discriminate against men because they do wear dresses and makeup, or otherwise act femininely, are also engaging in sex discrimination, because the discrimination would not occur but for the victim's sex."{{cite web|title=Smith v. City of Salem Ohio|url=https://caselaw.findlaw.com/us-6th-circuit/1380020.html|publisher=United States Court of Appeals, Sixth Circuit|access-date=June 23, 2012|url-status=live|archive-url=https://web.archive.org/web/20120719085632/https://caselaw.findlaw.com/us-6th-circuit/1380020.html|archive-date=July 19, 2012|df=mdy-all}} Chow (2005 at p214) comments that the Sixth Circuit's holding and reasoning represents a significant victory for transgender people. By reiterating that discrimination based on both sex and gender expression is forbidden under Title VII, the court steers transgender jurisprudence in a more expansive direction. But dress codes, which frequently have separate rules based solely on gender, continue. Carroll v. Talman Fed. Savs. & Loan Association, 604 F.2d 1028, 1032 (7th Cir.) 1979, has not been overruled.

Harrah's implemented a policy named "Personal Best", in which it dictated a general dress code for its male and female employees. Females were required to wear makeup, and there were similar rules for males. One female employee, Darlene Jesperson, objected and sued under Title VII. In Jespersen v. Harrah's Operating Co., No. 03-15045 (9th Cir. April 14, 2006), plaintiff conceded that dress codes could be legitimate but that certain aspects could nevertheless be demeaning; plaintiff also cited Price Waterhouse. The Ninth Circuit disagreed, upholding the practice of business-related gender-specific dress codes. When such a dress code is in force, an employee amid transition could find it impossible to obey the rules.{{citation needed|date=November 2012}}

In Glenn v. Brumby, the 11th Circuit Court of Appeals held that the Equal Protection Clause prevented the state of Georgia from discriminating against an employee for being transgender.{{cite news|url=http://sdgln.com/news/2011/12/06/video-eleventh-circuit-upholds-victory-transgender-employee-fired-georgia-legislatur|title=Eleventh Circuit upholds victory for transgender employee fired by Georgia Legislature|work=San Diego Gay & Lesbian News|format=video|date=December 6, 2011|access-date=June 26, 2012|url-status=live|archive-url=https://web.archive.org/web/20120204161550/http://sdgln.com/news/2011/12/06/video-eleventh-circuit-upholds-victory-transgender-employee-fired-georgia-legislatur|archive-date=February 4, 2012|df=mdy-all}}{{cite web|url=http://www.thegavoice.com/index.php/news/atlanta-news/3870-vandy-beth-glenn-may-soon-return-to-work-at-ga-general-assembly|title=Vandy Beth Glenn may soon return to work at Ga. General Assembly|work=The GA Voice|first=Dyana|last=Bagby|date=December 9, 2011|access-date=June 26, 2012|archive-url=https://web.archive.org/web/20120712112529/http://www.thegavoice.com/index.php/news/atlanta-news/3870-vandy-beth-glenn-may-soon-return-to-work-at-ga-general-assembly|archive-date=July 12, 2012|df=mdy-all}}

On March 2, 2023, Tennessee governor Bill Lee signed the Adult Entertainment Act, which prohibits drag performances for children.{{Cite news |title=Tennessee governor signs first-of-its-kind bill restricting drag shows |url=https://www.nbcnews.com/feature/nbc-out/tennessee-governor-signs-first-its-kind-bill-restricting-drag-shows-n1303262 |access-date=March 3, 2023 |publisher=NBC News |date=March 3, 2023 |language=en |archive-date=March 3, 2023 |archive-url=https://web.archive.org/web/20230303042552/https://www.nbcnews.com/feature/nbc-out/tennessee-governor-signs-first-its-kind-bill-restricting-drag-shows-n1303262 |url-status=live}}{{cite news |last1=Fiscus |first1=Kirsten |title=Tennessee drag show bill: Will drag performances be banned? What we know. |url=https://www.tennessean.com/story/news/politics/2023/03/01/tennessee-drag-bill-will-drag-shows-and-performances-be-banned/69949236007/ |access-date=July 22, 2023 |work=The Tennessean |date=March 1, 2023 |archive-date=August 21, 2023 |archive-url=https://web.archive.org/web/20230821070628/https://www.tennessean.com/story/news/politics/2023/03/01/tennessee-drag-bill-will-drag-shows-and-performances-be-banned/69949236007/ |url-status=live}} This bill sparked outrage from the LGBT community.{{cite news |last=Baker-Jordan |first=Skylar |date=March 2, 2023 |title=Why the Tennessee ban on drag shows should terrify us all |url=https://www.independent.co.uk/voices/tennessee-drag-show-ban-queens-b2289083.html |url-status=live |archive-url=https://web.archive.org/web/20230308023652/http://www.independent.co.uk/voices/tennessee-drag-show-ban-queens-b2289083.html |archive-date=March 8, 2023 |access-date=March 8, 2023 |work=The Independent}} On June 3, 2023, a federal judge ruled that the law is unconstitutional.{{Cite news |last=Bacallao |first=Marianna |date=2023-06-03 |title=Tennessee's drag ban is back after appeals court ruling |publisher=WPLN |url=https://wpln.org/post/tennessees-drag-ban-is-back-after-appeals-court-ruling/ |access-date=2024-07-20}} On July 18, 2024, a three judge panel on the Sixth Circuit reinstated the law by ruling that the plaintiffs had lacked the standing to sue. The ruling did not address whether the law was constitutional.{{Cite news |last=Bacallao |first=Marianna |date=2024-07-18 |title=Tennessee's law restricting drag has been ruled unconstitutional |publisher=WPLN |url=https://wpln.org/post/tennessees-law-restricting-drag-has-been-ruled-unconstitutional-but-its-only-been-struck-down-for-memphis/}}

The states of Florida, Montana, and Texas have also passed laws banning public drag performances.{{cite web |last1=Riley |first1=John |title=Texas Governor Signs Law Banning Drag Performances in Public Businesses |url=https://www.metroweekly.com/2023/06/texas-governor-signs-law-banning-drag-performances-in-public/ |website=Metro Weekly |date=June 23, 2023 |access-date=June 26, 2023 |archive-date=June 26, 2023 |archive-url=https://web.archive.org/web/20230626003837/https://www.metroweekly.com/2023/06/texas-governor-signs-law-banning-drag-performances-in-public/ |url-status=live}}{{cite news |last1=Mizelle |first1=Shawna |title=Montana governor signs bill banning drag performers from reading to children in public schools, libraries |url=https://www.cnn.com/2023/05/24/politics/montana-drag-story-hour-ban/index.html |publisher=CNN |date=May 24, 2023 |access-date=June 26, 2023 |archive-date=June 26, 2023 |archive-url=https://web.archive.org/web/20230626154342/https://www.cnn.com/2023/05/24/politics/montana-drag-story-hour-ban/index.html |url-status=live}} However, all three of these drag bans were blocked by courts from taking effect.{{cite news |last1=Kashiwagi |first1=Sydney |title=Trump-appointed federal judge rules Tennessee's anti-drag show law is 'unconstitutional' |url=https://www.cnn.com/2023/06/03/politics/tennessee-drag-ban-law-unconstitutional/index.html |publisher=CNN |date=June 3, 2023 |access-date=June 26, 2023 |archive-date=June 26, 2023 |archive-url=https://web.archive.org/web/20230626154342/https://www.cnn.com/2023/06/03/politics/tennessee-drag-ban-law-unconstitutional/index.html |url-status=live}}{{cite news |last1=Trotta |first1=Daniel |title=U.S. court blocks Florida law restricting drag performances |url=https://www.reuters.com/legal/us-court-blocks-florida-law-restricting-drag-performances-2023-06-23/ |website=Reuters |date=June 23, 2023 |access-date=June 26, 2023 |archive-date=June 26, 2023 |archive-url=https://web.archive.org/web/20230626154342/https://www.reuters.com/legal/us-court-blocks-florida-law-restricting-drag-performances-2023-06-23/ |url-status=live}}{{cite news |last=Lavietes |first=Matt |title=Federal judge declares Texas drag law unconstitutional |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/federal-judge-declares-texas-drag-law-unconstitutional-rcna117486 |publisher=NBC News |date=September 26, 2023 |access-date=February 10, 2024}}{{cite news |last=Hanson |first=Amy Beth |title=Montana judge keeps in place a ban on enforcement of law restricting drag shows, drag reading events |url=https://apnews.com/article/montana-drag-shows-ruling-ee8adb41c142718ec4b5047d0f3f36be |work=AP News |date=October 13, 2023 |access-date=February 10, 2024}}

{{main|Gender identity under Title IX}}

{{see also|Anti-LGBT curriculum laws in the United States}}

[[File:LGBT Curricular Laws in the United States.svg|thumb|261px|{{legend|#b2182b|State law prohibits LGBT inclusive instruction in the classroom as of May 2023}}

{{legend|#d6604d|State law prohibits LGBT inclusive instruction in the classroom up to a certain age and requires parental notification past that age.}}

{{legend|#f4a582|State law requires parental notification of LGBT inclusive instruction and allows parents to opt their children out.}}

{{legend|#2166ac|State law explicitly requires LGBT inclusion in state curricular standards.}}]]

The Obama administration took the position that Title IX's prohibition on discrimination on the basis of "sex" encompasses discrimination on the basis of gender identity and gender expression. In 2016, the Fourth Circuit became the first{{cite web |url=http://wtkr.com/2016/05/10/gov-mccrory-files-brief-to-reverse-gloucester-transgender-restroom-policy-case/ |title=Gov. McCrory files brief to reverse Gloucester transgender restroom policy case |date=May 10, 2016 |website=NewsChannel 3 |access-date=September 17, 2021 |archive-url=https://web.archive.org/web/20160528122258/http://wtkr.com/2016/05/10/gov-mccrory-files-brief-to-reverse-gloucester-transgender-restroom-policy-case/ |archive-date=May 28, 2016}} Court of Appeals to agree with the administration on the scope of Title IX as applied to transgender students, in the case of Virginia high school student Gavin Grimm (G.G. v. Gloucester County School Board).{{cite news |first=Richard |last=Fausset |url=https://www.nytimes.com/2016/04/20/us/appeals-court-favors-transgender-student-in-virginia-restroom-case.html |title=Appeals Court Favors Transgender Student in Virginia Restroom Case |work=The New York Times |date=April 19, 2016 |access-date=May 16, 2016 |url-status=live |archive-url=https://web.archive.org/web/20160514213718/http://www.nytimes.com/2016/04/20/us/appeals-court-favors-transgender-student-in-virginia-restroom-case.html |archive-date=May 14, 2016 |df=mdy-all }} The validity of the executive's position is being tested further in the federal courts. In 2017 the ACLU, representing Grimm, stated that they had stopped Grimm's "request for an immediate halt to the Gloucester County School Board's policy prohibiting him and other transgender students from using the common restrooms at school" but were "moving forward with his claim for damages and his demand to end the anti-trans policy permanently."{{cite news |url=http://www.dailypress.com/news/gloucester-county/dp-nws-gavin-grim-amends-complaint-pursues-damages-and-policy-change-20170812-story.html |title=Complaint amended in transgender lawsuit |newspaper=Daily Press |access-date=2017-08-18 |url-status=live |archive-url=https://web.archive.org/web/20170818091802/http://www.dailypress.com/news/gloucester-county/dp-nws-gavin-grim-amends-complaint-pursues-damages-and-policy-change-20170812-story.html |archive-date=August 18, 2017 |df=mdy-all }} Judge Allen of the U.S. District Court of the Eastern District of Virginia, in May 2018, ruled that Grimm's discrimination claim was valid based upon Title IX and the U.S. Constitution's equal protection clause.{{cite web|url=http://whtc.com/news/articles/2018/may/22/us-court-backs-transgender-student-at-center-of-bathroom-dispute/|last=Hurley|first=Lawrence|title=U.S. court backs transgender student at center of bathroom dispute|access-date=January 27, 2019|archive-date=January 28, 2019|archive-url=https://web.archive.org/web/20190128082827/https://whtc.com/news/articles/2018/may/22/us-court-backs-transgender-student-at-center-of-bathroom-dispute/}}{{cite web|url=http://wtvr.com/2018/05/22/federal-court-rules-in-favor-of-transgender-student-gavin-grimm/|last=Freeman|first=Vernon|title=Federal court rules in favor of transgender student Gavin Grimm|date=May 22, 2018}}

{{Main|Ending Radical Indoctrination in K-12 Schooling}}

In 2025, after Donald Trump signed an executive order prohibiting federal agencies from recognizing transgender identity, the U.S. Department of Education told all employees to end all programs, contracts, and policies that "fail to affirm the reality of biological sex" by affirming transgender people.{{cite news |last1=Smith Richards |first1=Jennifer |last2=Cohen |first2=Jodi S. |title=The Department of Education Told Employees to End Support for Transgender Students |url=https://www.propublica.org/article/department-of-education-transgender-students-email |access-date=14 February 2025 |work=Pro Publica |date=February 8, 2025}} Another executive order titled "Ending Radical Indoctrination in K-12 Schooling"{{cite web |last1=Trump |first1=Donald |title=Ending Radical Indoctrination in K-12 Schooling |url=https://www.whitehouse.gov/presidential-actions/2025/01/ending-radical-indoctrination-in-k-12-schooling/ |website=White House |access-date=14 February 2025 |date=January 29, 2025}} declares transgender ideas or concepts to be "anti-American" and "subversive",{{Cite web |date=2025-01-29 |title=Trump issues orders on K-12 'indoctrination,' school choice and campus protests |url=https://www.politico.com/news/2025/01/29/trump-k12-indoctrination-school-choice-campus-protests-education-00201235 |access-date=2025-02-23 |website=Politico |language=en}} and directs law enforcement to criminally prosecute any teacher who "unlawfully facilitates" the social transition of a transgender minor. Listed examples of unlawful facilitation include psychiatric counseling by a school counselor, referring to the student using their preferred name and/or pronouns, referring to a student as "nonbinary", and allowing the student to use segregated facilities or participate on segregated sports teams differing from those of their assigned sex. The order directs that educators in violation of this law be prosecuted as having committed sexual exploitation of a minor, and/or practicing medicine without a license.{{Cite web |date=2025-01-29 |title=Ending Radical Indoctrination in K-12 Schooling |url=https://www.whitehouse.gov/presidential-actions/2025/01/ending-radical-indoctrination-in-k-12-schooling/ |access-date=2025-02-23 |website=The White House |language=en-US}}{{Cite news |last=Cochran |first=Lexi Lonas |date=2025-01-29 |title=Trump signs executive order to defund schools teaching CRT, 'radical gender ideology' |url=https://thehill.com/homenews/education/5113202-trump-schools-executive-order-crt-gender-ideology/ |archive-url=http://web.archive.org/web/20250207045710/https://thehill.com/homenews/education/5113202-trump-schools-executive-order-crt-gender-ideology/ |archive-date=2025-02-07 |access-date=2025-02-23 |work=The Hill |language=en-US}} Additionally, schools found in violation would have their federal funding revoked.{{Cite web |last=Lang |first=Nico |date=2025-01-31 |title=How Trump's "Radical Indoctrination" Executive Order Targets Trans Youth in Schools |url=https://www.them.us/story/how-trump-radical-indoctrination-executive-order-targets-trans-youth-schools |access-date=2025-02-23 |website=Them |language=en-US}} The order conflicted with preexisting legal precedents, as federal courts had protected gender identity from discrimination in schooling, and the federal government had limited jurisdiction over curriculum.{{cite news |last1=Krejci |first1=Cleo |title=Wisconsin education leaders left confused about legality of Trump executive order on K-12 |url=https://www.jsonline.com/story/news/education/2025/02/12/trump-executive-order-on-k-12-indoctrination-raises-legal-questions-in-wisconsin/78188600007/ |access-date=14 February 2025 |work=Milwaukee Journal Sentinel |date=February 12, 2025}}

According to the Vera Institute in 2016, "transgender youth are more likely to leave school due to harassment, physical assault, and sexual violence". In 2016, guidance was issued by the Departments of Justice and Education stating that schools which receive federal money must treat a student's gender identity as their sex (for example, in regard to bathrooms).{{cite web|url=https://www.huffingtonpost.com/entry/donald-trump-transgender_us_58ac4fe8e4b0a855d1d9d278 |title=Trump Administration Rescinds Protections For Transgender Students |publisher=HuffPost |date=2017-02-22 |access-date=2018-01-18}} However, this policy was revoked in 2017.

The U.S. Department of Agriculture requires schools participating in federal food assistance programs to investigate allegations of discrimination due to sexual orientation or gender identity. In July 2022, Texas, along with more than 20 other states, sued to overturn this requirement.{{Cite web |url=https://www.texastribune.org/2022/07/26/texas-food-assistance-lgbtq-lawsuit/ |last1=Perez-Castells |first1=Ariana |title=Texas suing USDA over requirement to add LGBTQ protections to nutrition programs' nondiscrimination policies|date=July 27, 2022 }}{{Cite web |url= https://www.politico.com/news/2022/06/22/gop-senator-considering-blocking-school-meal-funding-deal-over-transgender-policy-fight-00041366 |last1=Lee |first1=Meredith |title=GOP senator considering blocking school meal funding deal over transgender policy fight|website=Politico |date=June 22, 2022 }}

In 2024, the U.S. House of Representatives considered the "Parental Rights Over The Education and Care of Their Kids Act" aka the "PROTECT Kids Act" (HR 736). Students up to Grade 8 would need "parental consent" to change their "gender markers, pronouns, or preferred name on any school form" or "sex-based accommodations, including locker rooms or bathrooms." Schools that ignore the requirement for parental consent would lose federal funding.{{Cite web |title=Text of H.R. 736: PROTECT Kids Act (Reported by House Committee version) |url=https://www.govtrack.us/congress/bills/118/hr736/text |access-date=2024-10-09 |website=GovTrack.us |language=en}} This bill was merged into the "Parental Bill of Rights Act" and passed the House in 2024.{{Cite web |date=2023-03-09 |title=Walberg's PROTECT Kids Act Advanced by Committee |url=http://walberg.house.gov/media/press-releases/walbergs-protect-kids-act-advanced-committee |access-date=2023-03-22 |website=Congressman Tim Walberg |language=en}}

Local K-12 school boards have adopted a variety of policies regarding trans students, ranging from allowing fully equal rights and non-discrimination for trans students, to requiring trans students to submit to a criminal background check to be allowed to use the bathroom consistent with their gender identity, to implementing full bans on expressing one's self-declared gender at all, including bans on chosen pronouns and pride flags, to even bans on mentioning the very existence of trans people.{{Cite web |url=https://iowatorch.com/2022/04/29/linn-mar-school-board-approves-controversial-transgender-policy/ |title=Linn-Mar School Board approves controversial transgender policy |last1=Vander Hart |first1=Shane|date=April 29, 2022 }}{{Cite web |url=https://www.wtvr.com/news/local-news/hanover-county-proposed-transgender-bathroom-lockerroom-policy-august-9-2022 |last1=Marshall |first1=Maggi |title=Parents, guardians had a lot to say about Hanover's proposed transgender bathroom policy|date=August 10, 2022 }}{{Cite web |url=https://www.advocate.com/news/2022/8/01/wisconsin-school-district-bans-preferred-pronouns-pride-symbols |last1=Wiggins |first1=Christopher |title=Wisconsin School District Bans Preferred Pronouns & Pride Symbols|date=August 2022 }}{{Cite web |url= https://www.texasobserver.org/gcisd-grapevine-coleyville-lgbtq-trans/ |last1=Monacelli |first1=Steven |title= 'Don't Say Trans' Policy Passes in North Texas School District|date=August 23, 2022 }}

States have similarly passed laws both protecting and restricting LGBT inclusion in classrooms. In 2014, the Maryland Senate passed a bill that "bans discrimination based on sexual orientation and sexual identity but includes an exemption for religious organizations, private clubs and educational institutions.{{cite news|url=https://www.washingtonpost.com/local/md-politics/maryland-senate-passes-bill-banning-discrimination-against-transgender-people/2014/03/04/56fbb722-a3c8-11e3-84d4-e59b1709222c_story.html|title=Maryland Senate Passes Bill Banning Discrimination Against Transgender People|last=Kunkle|first=Fredrick|date=March 4, 2014|newspaper=The Washington Post|url-status=live|archive-url=https://web.archive.org/web/20161012074728/https://www.washingtonpost.com/local/md-politics/maryland-senate-passes-bill-banning-discrimination-against-transgender-people/2014/03/04/56fbb722-a3c8-11e3-84d4-e59b1709222c_story.html|archive-date=October 12, 2016|df=mdy-all}}

In 2022, the state of Florida enacted the Parental Rights in Education Act, commonly known as the "Don't Say Gay Bill", banning any "classroom discussion about sexual orientation or gender identity" by school personnel or third parties, up through third grade.{{Cite web |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/floridas-dont-say-gay-bill-actually-says-rcna19929 |title=Here's what Florida's 'Don't Say Gay' bill would do and what it wouldn't do |last1=Lavietes |first1=Matt|publisher=NBC News |date=March 16, 2022 }} For older students, any discussion of such must be "age appropriate or developmentally appropriate", with the goal to, according to the text of the legislation, "reinforce the fundamental right of parents to make decisions regarding the upbringing and control of their children".{{Cite news |url=https://www.washingtonpost.com/politics/2022/04/01/what-is-florida-dont-say-gay-bill/ |title=Florida's law limiting LGBTQ discussion in schools, explained |last1=Phillips |first1=Amber|newspaper=The Washington Post }} As of July 2022, five more states have enacted similar laws.{{Cite web |archive-date=2022-07-26 |url=https://www.lgbtmap.org/equality-maps/curricular_laws |archive-url=https://web.archive.org/web/20220726075709/https://www.lgbtmap.org/equality-maps/curricular_laws |url-status=live |title=LGBTQ Curricular Laws}} In early 2023, a national proposal based on this Florida law was introduced as HR 5, "The Parents Bill of Rights Act."{{Cite web |last=Baptiste |first=Nathalie |date=2023-03-10 |title=House Republicans Are Taking Their Assault On Trans Rights To The Federal Level |url=https://www.huffpost.com/entry/republicans-congress-attack-trans_n_640a5bdbe4b09c5c6d6dca9b |access-date=2023-03-10 |website=HuffPost |language=en}} In July 2022, the Florida Department of Education issued a memo to all Florida schools referring to transgender non-discrimination policies regarding access to public facilities as "imposing a sexual ideology" on schools, saying that any school that did not sufficiently discriminate against transgender students could be acting in violation of state law.{{Cite web |url=https://www.tallahassee.com/story/news/education/2022/07/28/florida-education-commissioner-manny-diaz-jr-schools-ignore-biden-lgbtq-discrimination-rules/10173686002/ |title=Florida schools told they can ignore Biden administration on LGBTQ discrimination rules |last1=Goni-Lessan |first1=Ana}}

{{As of|2024|April}}, at least six states—Alabama, Arizona, Arkansas, Idaho, Indiana and North Carolina—have laws that, if a teacher believes a child is transgender, the teacher must notify the child's parents.{{Cite web |last=Mulvihill |first=Geoff |date=2024-04-23 |title=New federal rule bars transgender school bathroom bans, but it likely isn't the final word |url=https://apnews.com/article/title-ix-transgender-bathroom-bans-645b5564ce227a9efe2c05f883609ae8 |access-date=2024-04-23 |website=AP News |language=en}} Additionally, Virginia asked schools to write guidance on this matter.{{Cite web |date=2023-08-24 |title=Virginia school boards must adhere to Gov. Youngkin's new policies on transgender students, AG says |url=https://apnews.com/article/virginia-schools-transgender-students-e1889d4eea2520814c91c3cd6a367fc9 |access-date=2024-04-23 |website=AP News |language=en}} In 2025, the Utah legislature passed a bill banning transgender students of public universities from living in dorms consistent with their gender identity.{{cite news |last1=McKellar |first1=Katie |title=Bill to restrict transgender students in Utah college dorms heads to Gov. Cox |url=https://utahnewsdispatch.com/2025/02/10/bill-to-restrict-transgender-students-in-utah-college-dorms-heads-to-gov-cox/ |access-date=14 February 2025 |work=Utah News Dispatch |date=February 10, 2025}}

In a 2021 survey by the UCLA Williams Institute, 48.8% of trans people reported experiencing employment discrimination due to their trans status. 43.8% reported receiving verbal harassment in the workplace for being trans, and 22.4% reported being sexually harassed in the workplace in the preceding five years.{{Cite web |url=https://williamsinstitute.law.ucla.edu/publications/lgbt-workplace-discrimination/ |title=LGBT people's experience of workplace discrimination and harassment |last1=Sears |first1=Brad |last2=Mallory |first2=Christy |last3=Flores |first3=Andrew |last4=Conron |first4=Kerith}}

According to the Human Rights Campaign, in 2021 transgender women in the US were paid 60 cents for every dollar the average worker was paid.{{Cite web |archive-url=https://web.archive.org/web/20220119204725/https://www.hrc.org/resources/the-wage-gap-among-lgbtq-workers-in-the-united-states |title=The Wage Gap Among LGBTQ+ Workers in the United States|url=https://www.hrc.org/resources/the-wage-gap-among-lgbtq-workers-in-the-united-states |archive-date=January 19, 2022 }}

A study conducted by the Center for Public Integrity in July 2022 found that in preceding month, 30% of trans adults had lost their jobs or lived with someone who had, and that in that month trans people experienced hunger at more than twice the rate that cis people did.{{Cite web |url= https://publicintegrity.org/inside-publici/newsletters/watchdog-newsletter/transgender-adults-struggling/ |last1=Fernandez Campbell |first1=Alexia |title= Hunger, depression and unemployment: Trans adults are struggling|date=July 29, 2022 }}

According to Ross Wicks, director of LGBTQ+ Canadian non-profit Pflag, While more than 60% of Americans favor transgender rights in education and public employment, 41% support a ban on teaching about gender identity in elementary schools.{{cite news |last1=Yang |first1=Maya |title=Canada warning over US travel comes at 'concerning time', LGBTQ+ groups say |url=https://www.theguardian.com/world/2023/sep/01/canada-us-travel-warning-advisory-lgbtq |work=The Guardian |year=2023}}

According to the 2022 US Transgender Survey, 18% of all trans adults face unemployment, while the number living below the poverty line is 34%.{{Cite news |work=Teen Vogue |url=https://www.teenvogue.com/story/has-life-improved-for-transgender-americans-in-the-last-10-years-not-really |title=Has Life Improved for Transgender Americans in the Last 10 Years? Not Really.}}

In February 2025, the U.S. Equal Employment Opportunity Commission moved to dismiss six of its own pending cases alleging gender identity discrimination: One in Alabama, one in California, three in Illinois and one in New York.{{Cite web |last1=Savage |first1=Claire |last2=Olson |first2=Alexandra |date=2025-02-16 |title=EEOC Seeks To Drop Transgender Discrimination Cases, Citing Trump's Executive Order |url=https://www.huffpost.com/entry/eeoc-gender-discrimination-lawsuit-drop_n_67b12ecbe4b059dad8b38c2c |access-date=2025-02-16 |website=HuffPost |language=en}}{{cite news |last1=Helmore |first1=Edward |title=US civil rights agency seeks to dismiss gender-identity discrimination cases |url=https://www.theguardian.com/us-news/2025/feb/15/transgender-equal-employment-opportunity-commission |access-date=February 16, 2025 |work=The Guardian |date=February 15, 2025}} It cited Trump's January 20, 2025, executive order, "Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government", which defines sex as binary.{{Cite web |date=2025-01-21 |title=Defending Women From Gender Ideology Extremism And Restoring Biological Truth To The Federal Government |url=https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/ |access-date=2025-02-01 |website=The White House |language=en-US}}

Public support for transgender people has shifted in recent years.

According to the Public Religion Research Institute, support for mandating that trans people use the bathroom corresponding to their gender assigned at birth has risen among all religious groups, with white protestant evangelicals being the highest change, going from 41% in support to 72% in support between 2017 and 2021. 41% of total Americans hold this stance, with 31% disagreeing, and 28% not holding a position on the issue.{{Cite news |url= https://www.washingtonpost.com/opinions/2023/02/21/trump-gender-lgbtq-identity/ |title= Trump is exploiting an anti-trans turn in public opinion |work=WaPo |date=Feb 21, 2023}}

60% of American adults reported in the summer of 2022 that they opposed allowing nonbinary marker options on government documents, while 58% reported supporting mandating that trans athletes compete on teams matching their gender assigned at birth.

On the other hand, most Americans have more positive attitudes regarding transgender individuals in the workplace.{{Cite journal |doi = 10.1287/mnsc.2023.02567|title = Understanding Labor Market Discrimination Against Transgender People: Evidence from a Double List Experiment and a Survey |journal = Management Science|year = 2024|last1=Aksoy|first1=Billur|last2=Carpenter|first2=Christopher S.|last3=Sansone|first3 = Dario|doi-access=free|arxiv=2209.02335}} Although American adults overreport their support in surveys, over two-thirds of them would be comfortable with a transgender manager and support employment nondiscrimination protection for transgender people, even after correcting for this overreporting. However, stated labor market support for transgender people is lower than support for gay, lesbian, and bisexual people.

In 2019, a report analyzing 10 million US and UK social media posts over three and a half years found that of that 10 million social media posts, 15% (1.5 million) expressed transphobic sentiment.{{Cite web |url=https://time.com/5710466/transphobic-abuse-online-study/ |title=A Study Analyzed 10 Million Online Posts Over 3.5 Years. It Found a Torrent of Transphobic Abuse |last1=Haynes |first1=Suyin|date=October 25, 2019 }}

A study conducted by Media Matters between February 2019 and February 2020 found that the top five most-interacted sources on Facebook regarding transgender people were LifeSite News, the Daily Caller, the Daily Wire, Western Journal, and the Alliance Defending Freedom, with right wing sources on trans issues receiving 43.33 million interactions, compared to left wing sources receiving only 2.56 million.{{Cite web |url= https://www.nbcnews.com/feature/nbc-out/transgender-facebook-content-dominated-right-wing-sources-study-finds-n1234252 |last1=Fitzsimons |first1=Tim |title= Transgender Facebook content dominated by right-wing sources, study finds|date=July 20, 2020 |publisher=NBC News }}

In the wake of the Colorado Springs nightclub shooting, in which a man walked into an LGBTQ nightclub and opened fire, Twitter unbanned the accounts of several major anti-trans figures that had previously been suspended for breaking Twitter policies regarding the targeting of LGBTQ people,{{Cite web |url=https://www.vice.com/en/article/elon-musk-twitter-colorado-shooting-anti-trans-reinstated/ |last1=Lamoureux |first1=Mack |title=Elon Musk's Twitter Reinstates Anti-Trans Activists on Same Weekend as Club Q Attacked|date=November 21, 2022 }} while reformatting its hateful conduct policy so that a provision that banned "targeted misgendering or deadnaming of transgender individuals" was "now effectively dead", according to Vanity Fair.{{Cite web |url=https://www.vanityfair.com/news/2022/11/elon-musk-twitter-content-moderation |title=We're Officially in the Elon Musk Era of Content Moderation |last1=Ecarma |first1=Caleb|website=Vanity Fair |date=November 21, 2022 }}

In February 2022, United States Senate candidate J. D. Vance from Ohio falsely attributed the then looming Russian invasion of Ukraine to transgender rights, saying "We didn't serve in the Marine Corps to go and fight Vladimir Putin because he didn't believe in transgender rights"{{Cite web |url=https://www.politifact.com/factchecks/2022/feb/21/jd-vance/jd-vance-says-transgender-rights-drives-looming-co/ |title=JD Vance says transgender rights drives looming conflict in Ukraine |last1=Greenberg |first1=Jon}}

In May 2022, United States Representative Paul Gosar issued a statement via Twitter falsely claiming that the mass shooter in the Uvalde school shooting which killed 19 elementary school children, was a "transsexual leftist illegal alien".{{Cite web |url=https://www.nbcnews.com/nbc-out/out-news/trans-womans-photo-used-spread-baseless-online-theory-texas-shooter-rcna30511 |last1=Yurcaba |first1=Jo |last2=Goggin |first2=Ben |last3=Collins |first3=Ben |title=Trans woman's photo used to spread baseless online theory about Texas shooter|publisher=NBC News |date=May 25, 2022 }}

A joint report by the Human Rights Campaign and the Center for Countering Digital Hate found that the Twitter accounts of Representative Marjorie Taylor Greene and Representative Lauren Boebert were among the top three sources in the United States for the promotion and propagation of the grooming conspiracy theory.{{Cite web |url=https://counterhate.com/wp-content/uploads/2022/08/CCDH-HRC-Digital-Hate-Report-2022-single-pages.pdf |title=Digital Hate: Social Media's Role in Amplifying Dangerous Lies About LGBTQ+ people}} In response, Lauren Boebert stated via Twitter "My tweets about groomers are only third? Guess that means I have to tweet about these sick, demented groomers even more".{{Cite web|title=My tweets about groomers are only third? Guess that means I have to tweet about these sick, demented groomers even more. |archive-url=https://web.archive.org/web/20220815104908/https://twitter.com/laurenboebert/status/1559129870688452609 |url=https://twitter.com/laurenboebert/status/1559129870688452609 |archive-date=August 15, 2022 |access-date=August 19, 2022}}{{Cite web |url=https://www.newsweek.com/lauren-boebert-vows-even-more-groomer-tweets-after-coming-only-third-list-1734131?amp=1 |last1=Bickerton |first1=James |title=Boebert Vows 'Even More' Groomer Tweets After Coming 'Only Third' on List|website=Newsweek |date=August 16, 2022 }}

In September 2022, Senator Ted Cruz of Texas cast attention on a gender affirming healthcare doctor at University of Wisconsin, saying "She does this to children. Sterilizes & mutilates them".{{Cite web |title=She does this to children. Sterilizes & mutilates them. Before they are old enough to consent.|archive-url=https://web.archive.org/web/20220924120624/https://twitter.com/tedcruz/status/1573389007652016129 |url=https://twitter.com/tedcruz/status/1573389007652016129 |archive-date=September 24, 2022 |access-date=September 24, 2022}} Providing gender-affirming healthcare to trans minors is considered best practice by the American Medical Association, American Psychiatric Association, the Endocrine Society, American Academy of Pediatrics, and the World Professional Association for Transgender Health.{{Cite web|url=https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Transgender-Gender-Diverse-Youth.pdf|title=Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth}}{{Cite web |date=15 December 2020 |title=Transgender Health: An Endocrine Society Position Statement |url=https://www.endocrine.org/advocacy/position-statements/transgender-health |access-date=15 June 2022 |website=endocrine.org |publisher=The Endocrine Society |language=en}}{{Cite journal |title=Standards of Care for the Health of Transgender and Gender Diverse People, Version 8|year=2022 |doi=10.1080/26895269.2022.2100644 |last1=Coleman |first1=E. |last2=Radix |first2=A. E. |last3=Bouman |first3=W. P. |last4=Brown |first4=G. R. |last5=De Vries |first5=A. L. C. |last6=Deutsch |first6=M. B. |last7=Ettner |first7=R. |last8=Fraser |first8=L. |last9=Goodman |first9=M. |last10=Green |first10=J. |last11=Hancock |first11=A. B. |last12=Johnson |first12=T. W. |last13=Karasic |first13=D. H. |last14=Knudson |first14=G. A. |last15=Leibowitz |first15=S. F. |last16=Meyer-Bahlburg |first16=H. F. L. |last17=Monstrey |first17=S. J. |last18=Motmans |first18=J. |last19=Nahata |first19=L. |last20=Nieder |first20=T. O. |last21=Reisner |first21=S. L. |last22=Richards |first22=C. |last23=Schechter |first23=L. S. |last24=Tangpricha |first24=V. |last25=Tishelman |first25=A. C. |last26=Van Trotsenburg |first26=M. A. A. |last27=Winter |first27=S. |last28=Ducheny |first28=K. |last29=Adams |first29=N. J. |last30=Adrián |first30=T. M. |journal=International Journal of Transgender Health |volume=23 |issue=Suppl 1 |pages=S1–S259 |pmid=36238954 |pmc=9553112 |s2cid=252127302 |display-authors=1 }}{{Cite journal |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |last1=Rafferty |first1=Jason |display-authors=etal |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |doi=10.1542/peds.2018-2162 |doi-access=free |pmid=30224363 |s2cid=52288840}}{{Cite web|url=https://www.ama-assn.org/press-center/press-releases/ama-states-stop-interfering-health-care-transgender-children|title=AMA to states: Stop interfering in health care of transgender children|website=American Medical Association|date=April 26, 2021 }}

That same month, Republican Representative Bob Good from Virginia stated his belief that the high suicide rates among trans youth, widely believed to be due to systemic discrimination and lack of access to proper healthcare, were in fact due to sexual "grooming" into being transgender.{{Cite news |url=https://www.washingtonpost.com/dc-md-va/2022/09/22/exchange-over-trans-policy-gets-angry-spanberger-good/ |last1=Flynn |first1=Meagan |title=Youngkin's meeting with Va. delegation gets heated over trans policy|newspaper=The Washington Post }}{{Cite web|url=https://www.thetrevorproject.org/resources/article/facts-about-lgbtq-youth-suicide/|title=Facts About Suicide Among LGBTQ+ Young People|date=December 15, 2021 }} Senate Candidate Herschel Walker from Georgia was also reported as saying that trans children would not be able to get into heaven.{{Cite web |url=https://www.advocate.com/news/2022/9/29/gop-senate-candidate-hershel-walker-says-trans-kids-wont-go-heaven |title=GOP Senate Candidate Herschel Walker: Trans Kids Won't Go to Heaven |last1=Wiggins |first1=Christopher|date=September 29, 2022 }}

In April 2022, the left-leaning media watchdog Media Matters published a study stating that within a three week period spanning from March 17 to April 6, Fox News ran 170 segments on trans people, throughout which "the network spread dangerous lies about the trans community and repeatedly invoked the long-debunked myth that trans people pose a threat to minors and seek to groom them".{{Cite web |url=https://www.mediamatters.org/fox-news/doom-groom-fox-news-has-aired-170-segments-discussing-trans-people-past-three-weeks |title="Doom & Groom": Fox News has aired 170 segments discussing trans people in the past three weeks |last1=Paterson |first1=Alex|website=Media Matters for America |date=April 8, 2022 }}

In June 2022, the New York Times published a front page article titled "The Battle Over Gender Therapy", which reportedly "uncritically platformed gender-critical group Genspect, and the New York Times Magazine's article said the group has held 'web-based seminars that are critical of social and medical transition'", and that "Some parents, who are part of Genspect, told [the author] that they believed the 'rise in trans-identified teenagers was the result of a 'gender cult' – a mass craze'".{{Cite web |url=https://www.pinknews.co.uk/2022/06/16/new-york-times-magazine-trans-article-backlash/ |title=The New York Times faces searing backlash for publishing 'harmful' anti-trans 'propaganda': 'Do better' |last1=Baska |first1=Maggie|date=16 June 2022 |archive-url=https://web.archive.org/web/20220616214437/https://www.pinknews.co.uk/2022/06/16/new-york-times-magazine-trans-article-backlash/ |archive-date=2022-06-16 }} The Texas Observer described the article as elevating "a handful of outliers and their discredited theories about trans people to prominence they do not enjoy among the medical community" and that "the article echoes right-wing fear-mongering about whether trans kids should be allowed to transition and even suggests their existence could be dangerous to other young people", noting that "the state of Texas is using it as evidence in an ongoing attempt to investigate trans-supportive healthcare as 'child abuse'".{{Cite web |url=https://www.texasobserver.org/emily-bazelon-transgender-healthcare-debate-new-york-times/ |title=There Is No Legitimate 'Debate' Over Gender-Affirming Healthcare |last1=O'Connell |first1=Kit|date=July 22, 2022 }}

In July 2022, the New York Times published an op-ed falsely attributing the overturning of Roe v. Wade by six conservative Supreme Court justices, to the existence of trans women causing the "erasure" of "women as a biological category".{{Cite magazine |url=https://newrepublic.com/article/166991/pamela-paul-new-york-times-trans-great-replacement-theory |last1=Gira-Grant |first1=Melissa |title=Pamela Paul's Great Replacement Theory|magazine=The New Republic }} This article was widely circulated, with Representative Rashida Tlaib issuing a statement in response saying that "During escalating assaults on trans people & trans rights nationwide, the New York Times is featuring writers debating whether trans people should even exist and scapegoating this already-marginalized community."{{Cite web |url=https://www.teenvogue.com/story/nyt-transphobia-july-oped/amp |title=The New York Times, The Atlantic, More Keep Publishing Transphobia. Why? |last1=McMenamin |first1=Lexi|date=July 22, 2022 }}

Since then, the New York Times has published several more pieces arguing in favor of restricting access to gender affirming healthcare for trans people, many of which have been widely criticized as "misinformation" by medical experts.{{Cite web|url=https://www.wpath.org/media/cms/Documents/Public%20Policies/2022/USPATHWPATH%20Statement%20re%20Nov%2014%202022%20NYT%20Article%20Nov%2022%202022.pdf?_t=1669165505&fbclid=IwAR0HLA3jq1rOoJlU5YluT3qXMUTrnRl7KvM1paj7i3fGR7nZN11UgNaSprg|title=USPATH and WPATH Respond to NY Times Article "They Paused Puberty, But Is There a Cost?" published on November 14, 2022}}{{Cite web |url= https://sciencebasedmedicine.org/what-the-new-york-times-gets-wrong-about-puberty-blockers-for-transgender-youth/ |last1=Eckert |first1=AJ |title= What the New York Times gets wrong about puberty blockers for transgender youth|date=December 4, 2022 }}{{Cite web |url=https://theintercept.com/2022/12/31/trans-rights-abortion-liberals/ |last1=Lennard |first1=Natasha |title=Liberals Rose to Fight the Assault on Abortion — but Not Trans Rights|date=December 31, 2022 }}{{cite news |last1=Santoro |first1=Helen |title=The Myth That Fuels the Panic Over Surgery for Trans Teenagers |url=https://slate.com/technology/2022/10/top-surgery-teens-gender-affirming-care-hurdles.html |work=Slate |date=11 October 2022 }}

In February 2023, more than 200 NYT contributors signed an open letter expressing "serious concerns about editorial bias in the newspaper's reporting on transgender, non⁠-⁠binary, and gender nonconforming people". The letter characterized the NYT's reporting as using "an eerily familiar mix of pseudoscience and euphemistic, charged language", and raised concerns regarding the NYT's employment practices regarding trans contributors.{{Cite news |publisher=NPR |url=https://www.npr.org/2023/02/15/1157181127/nyt-letter-trans |title='New York Times' contributors slam paper's coverage of transgender people |last1=Mary |first1=Yang |date=Feb 15, 2023}}

{{Main|LGBT grooming conspiracy theory}}

Popularization of the grooming conspiracy theory in the United States has been linked to Christopher Rufo, who tweeted in August 2021 about "winning the language war," and James A. Lindsay.{{cite news |url=https://www.washingtonpost.com/outlook/2022/04/05/qanon-groomer-hawley-desantis-jackson/ |title=The QAnon catchphrases that took over the Jackson hearings |date=2022-04-07 |orig-date=2022-04-05 |first1=Donald |last1=Moynihan |newspaper=The Washington Post |place=Washington, D.C. |issn=0190-8286 |oclc=1330888409}}{{WaPoCheckDates}}{{Cite news |date= 2022-04-27 |title=How the Intellectual Dark Web Spawned 'Groomer' Panic |work=The Daily Beast |url= https://www.thedailybeast.com/how-the-intellectual-dark-web-spawned-anti-lgbtq-groomer-panic |access-date= 2022-05-16}} Following the Wi Spa controversy in July 2021, Julia Serano noted that there a rise in false accusations of grooming directed towards transgender people, saying that it appeared as if there was a movement to "lay the foundation for just smearing all trans people as child sexual predators."{{cite web | url=https://www.theguardian.com/world/2021/jul/28/anti-trans-video-los-angeles-protest-wi-spa | title='A nightmare scenario': How an anti-trans Instagram post led to violence in the streets | website=The Guardian | date=28 July 2021 }} Libs of TikTok (LoTT) also helped popularize the term 'groomer' as a pejorative for LGBT people, supporters of LGBT youth,{{cite web |last1=Stahl |first1=Jeremy |title=The Hate-Fueled and Hugely Influential World of Libs of TikTok |url=https://slate.com/news-and-politics/2022/04/chaya-raichik-libs-tiktok-groomer-tweets.html |website=Slate |access-date=27 July 2022 |language=en |date=27 April 2022}}{{cite web |last1=Persaud |first1=Chris |title=Babylon Bee CEO of Juno Beach backs Twitter firebrand who calls LGBTQ people pedophiles |url=https://www.palmbeachpost.com/story/news/local/2022/05/10/babylon-bee-ceo-juno-beach-backs-libs-tiktok-creator/7385009001/ |website=The Palm Beach Post |access-date=27 July 2022}} and those who teach about sexuality.{{cite web |title=The Twitter activist behind the far-right 'Libs of TikTok' is an Orthodox Jew. Does that matter? |url=https://www.jta.org/2022/04/19/politics/the-twitter-activist-behind-the-far-right-libs-of-tiktok-is-an-orthodox-jew-does-that-matter |publisher=Jewish Telegraphic Agency |access-date=27 July 2022 |date=19 April 2022}} In November 2021 LoTT claimed that the Trevor Project was a "grooming organization" and later in the year claimed that Chasten Buttigieg was "grooming kids."

On February 24, The Heritage Foundation, a conservative Washington, D.C.-based think tank, tweeted that the bill "protects young children from sexual grooming".{{cite news |last1=Mathis-Lilley |first1=Ben |title=How One Florida Woman With Twitter Problems Plunged Us Into a Nightmarish National Conversation About 'Grooming' |url=https://slate.com/news-and-politics/2022/04/christina-pushaw-ron-desantis-libsoftiktok-groomer.html |work=Slate |date=21 April 2022 }} On March 4, Christina Pushaw, press secretary for Florida Governor Ron DeSantis, referred to the bill as "an anti-grooming bill" and stated via twitter that anyone against it was "probably a groomer".

Since then, numerous right wing pundits began describing the behavior of parents and teachers who want to allow children to express their transgender identity as grooming, and the term "groomer" has become widely used by conservative media and politicians to imply that the LGBTQ community and their allies are pedophiles or pedophile-enablers.{{Cite web |url=https://www.vox.com/platform/amp/culture/23025505/leftist-groomers-homophobia-satanic-panic-explained |title=The right's moral panic over "grooming" invokes age-old homophobia |last1=Romano |first1=Aja|date=April 21, 2022 }}{{Cite web |url=https://www.vice.com/en/article/child-grooming-lgbtq-smear/ |title=Conservatives Are Smearing 'Don't Say Gay' Opponents as Pedophile 'Groomers' |last1=Cameron |first1=Joseph|date=April 5, 2022 }} Slate magazine later described the word "grooming" as "the buzzword of the season".

In April 2022, the left-leaning media watchdog Media Matters published a study stating that within a three week period spanning from March 17 to April 6, Fox News ran 170 segments on trans people, throughout which "the network spread dangerous lies about the trans community and repeatedly invoked the long-debunked myth that trans people pose a threat to minors and seek to groom them".

The Canadian Anti-Hate Network has stated that trans people are "slandered the same way homosexual men were slandered in the 70s, and for the same reason: to deny them safety and equal rights," adding that "the far-right and their fellow travelers in the so-called Gender Critical or Trans-Exclusionary Radical Feminist movements use the exact same tropes in a bid to deny equal rights to trans persons."{{cite web|date=7 April 2022|title=Trans People Are Being Slandered As Groomers And Pedophiles By The Far-Right|url=https://www.antihate.ca/trans_people_slandered_groomers_pedophiles_far_right|access-date=29 July 2022|work=Canadian Anti-Hate Network}} Florence Ashley of the University of Toronto has stated that the focus of the conspiracy on LGBT+ people and on trans people in particular is used to radicalize public opinion towards the far-right, comparing it to the White genocide conspiracy theory.{{cite web |url=https://www.cbc.ca/news/canada/canada-us-transgender-hate-1.6503087 |title=Transphobia is gaining ground in the U.S. Gender-diverse people in Canada worry it could happen here |first=Nick |last=Logan |publisher=CBC News |date=July 2, 2022}}

According to a joint report in August 2022 by the American Human Rights Campaign, and the British Center for Countering Digital Hate found that the 500 most influential hateful "grooming" tweets were seen 72 million times, and that "grooming" tweets from just ten influential sources were seen 48 million times. It also found that Meta, formerly known as Facebook, had accepted up to $24,987 for ads pushing the grooming conspiracy theory, which had been served to users over 2.1 million times, and that Twitter - despite saying groomer slurs were a violation of its hate speech policy - failed to act on 99% of tweets reported for such.

{{See also|Bathroom bill}}

[[File:Map of current Bathroom Legislation in the United States in regard to Gender and Gender Identity.png|thumb|200px|States and counties in the United States which have enacted legislation on restrooms, locker rooms, and other sex-segregated public accommodations, in regard to their access from those who are transgender, or have gender dysphoria as of March 2023:

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{{legend|#9ccb86|State, city, or county mandates single-user unisex restrooms in all public buildings}}

{{legend|#009392|State explicitly prohibits discrimination in restrooms on the basis of gender identity}}

{{legend|#39b185|State legislation or school guidelines currently allow students to use restrooms that correspond with gender identity}}

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{{legend|#e88471|State legislation or school guidelines currently prohibit students from using restrooms that differ from biological sex}}

{{Legend striped|#e88471|white|Currently considering state legislation or school guidelines that would prohibit students from using restrooms that differ from biological sex}}

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{{legend|#aa1f4b|State indecent exposure law may be construed to criminalize trans people from undressing in locker rooms or using restrooms that do not match their biological sex}}

{{Legend striped|#aa1f4b|white|Currently considering bills that may criminalize trans people from undressing in locker rooms or using restrooms that do not match their biological sex}}

]]

An area of legal concern for transgender people is access to restrooms which are segregated by gender. Transgender people have, in the past, been asked for legal identification while entering or using a gendered restroom.{{cite web|url=http://www.10news.com/news/team-10/team-10-transgender-man-claims-he-was-harassed-in-department-store-bathroom|title=Team 10: Transgender man claims he was harassed in department store bathroom|first=Allison|last=Ash|work=10News|date=June 27, 2015 |url-status=live|archive-url=https://web.archive.org/web/20150804133152/http://www.10news.com/news/team-10/team-10-transgender-man-claims-he-was-harassed-in-department-store-bathroom|archive-date=August 4, 2015|df=mdy-all}}{{cite web|url=http://thinkprogress.org/lgbt/2013/06/26/2216781/transgender-bathroom-study/|title=Study: Transgender People Experience Discrimination Trying To Use Bathrooms|work=ThinkProgress|url-status=live|archive-url=https://web.archive.org/web/20150908122147/http://thinkprogress.org/lgbt/2013/06/26/2216781/transgender-bathroom-study/|archive-date=September 8, 2015|df=mdy-all}}{{cite web|url=http://www.advocate.com/politics/transgender/2015/03/03/angry-activists-confront-trans-teen-charlotte-bathroom-nondiscrimina|title=Angry Activists Confront Trans Teen in Charlotte Bathroom, As Nondiscrimination Ordinance Fails|first=Mitch|last=Kellaway|work=Advocate.com|date=March 3, 2015|url-status=live|archive-url=https://web.archive.org/web/20150811082925/http://www.advocate.com/politics/transgender/2015/03/03/angry-activists-confront-trans-teen-charlotte-bathroom-nondiscrimina|archive-date=August 11, 2015|df=mdy-all}} Recent legislation has moved in contradictory directions. On one hand, non-discrimination laws have included restrooms as public accommodations, indicating a right to use gendered facilities which conform with a person's gender identity.{{cite news|url=http://keranews.org/post/texas-court-sidelines-houstons-nondiscrimination-ordinance|title=Texas Court Sidelines Houston's Nondiscrimination Ordinance|agency=Associated Press|work=keranews.org|url-status=live|archive-url=https://web.archive.org/web/20150906025146/http://keranews.org/post/texas-court-sidelines-houstons-nondiscrimination-ordinance|archive-date=September 6, 2015|df=mdy-all}} On the other, some efforts have been made to insist that individuals use restrooms that match their biological sex, regardless of an individual's gender identity or expression.{{cite magazine|url=https://time.com/3734714/transgender-bathroom-bills-lgbt-discrimination/|title=Transgender Bathroom Laws: Kentucky, Florida Bills to Restrict Access|first=Katy|last=Steinmetz|date=March 6, 2015|magazine=Time|url-status=live|archive-url=https://web.archive.org/web/20150918011656/http://time.com/3734714/transgender-bathroom-bills-lgbt-discrimination/|archive-date=September 18, 2015|df=mdy-all}}

Numerous jurisdictions and states have passed or considered so-called "bathroom bills" which restrict the use of bathrooms by transgender people, forcing them to choose facilities in accordance with their biological sex.{{cite news|url=https://www.huffingtonpost.com/2013/06/06/arizona-transgender-bathroom-bill-_n_3394164.html|title=Arizona Transgender Bathroom Bill Won't Move|date=June 6, 2013|work=HuffPost|url-status=live|archive-url=https://web.archive.org/web/20150924183715/http://www.huffingtonpost.com/2013/06/06/arizona-transgender-bathroom-bill-_n_3394164.html|archive-date=September 24, 2015|df=mdy-all}}{{cite web|url=http://www.texasobserver.org/transgender-children-bathroom-bills/|title=Parents Fight Bathroom Bills for Transgender Children|work=The Texas Observer|date=April 28, 2015|url-status=live|archive-url=https://web.archive.org/web/20150906104746/https://www.texasobserver.org/transgender-children-bathroom-bills/|archive-date=September 6, 2015|df=mdy-all}}{{cite web|url=http://mic.com/articles/114066/statistics-show-exactly-how-many-times-trans-people-have-attacked-you-in-bathrooms|title=Statistics Show Exactly How Many Times Trans People Have Attacked You in Bathrooms|work=Mic|date=April 2, 2015 }} {{As of|2024|May}}, Alabama, Arkansas, Florida, Idaho, Iowa, Kansas, Kentucky, Mississippi, North Dakota, Oklahoma, Tennessee and Utah have such laws.{{Cite web |last=Lavietes |first=Matt |date=2024-05-13 |title=Mississippi enacts transgender bathroom ban in public schools |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/mississippi-reeves-transgender-bathroom-ban-public-schools-rcna152036 |access-date=2024-05-13 |publisher=NBC News |language=en}}{{Cite web |date=2024-01-31 |title=Utah joins 10 other states in regulating bathroom access for transgender people |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/utah-joins-10-states-regulating-bathroom-access-transgender-people-rcna136521 |access-date=2024-02-01 |publisher=NBC News |language=en}}

On March 23, 2016, North Carolina passed a comprehensive bathroom restriction bill (the Public Facilities Privacy & Security Act, also known as "HB2"), overriding a prior municipal Charlotte non-discrimination ordinance on the same subject.Dave Phillips, {{cite web |url=https://www.nytimes.com/2016/03/24/us/north-carolina-to-limit-bathroom-use-by-birth-gender.html |title=North Carolina Bans Local Anti-Discrimination Policies |last=Philipps |first=Dave |date=March 23, 2016 |website=The New York Times |archive-url=https://web.archive.org/web/20160505161215/http://www.nytimes.com/2016/03/24/us/north-carolina-to-limit-bathroom-use-by-birth-gender.html |archive-date=May 5, 2016}} It was quickly signed into law by Gov. Pat McCrory, but on March 30, 2017, following national controversy, the part of the law related to bathrooms was repealed.{{cite web |url=http://www.charlotteobserver.com/news/local/article141647789.html |title=Understanding the HB2 Repeal Law - What it Does and Doesn't Mean |last1=Henderson |first1=Bruce |last2=Funk |first2=Tim |date=March 30, 2017 |website=Charlotte Observer |access-date=July 9, 2021}} According to the ACLU, the partial repeal still allowed discrimination against transgender persons.{{cite web|title=ACLU Opposes HB2 Proposal that Would Continue Discrimination|url=https://www.aclu.org/news/aclu-opposes-hb-2-proposal-would-continue-discrimination|website=American Civil Liberties Union|publisher=American Civil Liberties Union of North Carolina|access-date=March 31, 2017}}

In April 2016, objecting to the "bathroom predator myth", a coalition of over 200 U.S. organizations for sexual assault and domestic violence survivors noted that, while "over 200 municipalities and 18 states" had legal protections for transgender people, none of these places had tied an increase in sexual violence to these nondiscrimination laws.{{Cite web|url=https://abcnews.go.com/US/sexual-assault-domestic-violence-organizations-debunk-bathroom-predator/story?id=38604019|title=Sexual Assault and Domestic Violence Groups Debunk 'Bathroom Predator Myth'|last=Borrello|first=Stevie|date=22 April 2016|website=ABC News|language=en|access-date=2019-11-20}}

In September 2016, California governor Jerry Brown signed a bill requiring all single-occupancy bathrooms to be gender-neutral, effective since March 1, 2017.{{cite web|last1=Howe|first1=Jason|title=Governor Signs California "All-Gender" Restroom Bill|url=http://www.eqca.org/gov-1732/|website=Equality California|access-date=October 5, 2016|date=September 29, 2016|url-status=live|archive-url=https://web.archive.org/web/20161221023943/http://www.eqca.org/gov-1732/|archive-date=December 21, 2016|df=mdy-all}} California is the first U.S. state to adopt such legislation.{{cite web|last1=Megarry|first1=Daniel|title=California becomes first US state to introduce gender-neutral bathroom law|url=http://www.gaytimes.co.uk/news/49984/california-becomes-first-us-state-introduce-gender-neutral-bathroom-law/|website=Gay Times|access-date=October 5, 2016|date=October 4, 2016|url-status=live|archive-url=https://web.archive.org/web/20161012001744/http://www.gaytimes.co.uk/news/49984/california-becomes-first-us-state-introduce-gender-neutral-bathroom-law/|archive-date=October 12, 2016|df=mdy-all}} Vermont, New Mexico and Illinois have since followed suit in 2019.{{Cite web|url=https://thehill.com/homenews/state-watch/455029-illinois-officially-passes-bill-requiring-all-single-bathrooms-be|title = Illinois officially passes bill requiring all single bathrooms be designated gender neutral| work=The Hill |date = July 27, 2019 | last1=Folley | first1=Aris }}

On May 2, 2019, Tennessee governor Bill Lee signed into law legislation defining a trans person using the bathroom corresponding with their gender identity as "indecent exposure." The Tennessee Equality Project had complained about the bill's original language, and although that language was altered before it became law, the organization still believed the bill was harmful to trans people.{{Cite web|url=https://www.metroweekly.com/2019/05/tennessee-senate-approves-pair-anti-transgender-bathroom-bills/|title=Tennessee governor signs 'indecent exposure' bill, sparking fear about anti-trans harassment|date=May 8, 2019|website=Metro Weekly}}

On April 8, 2022, Alabama Governor Ivey signed a bathroom bill applying to public schools.{{Cite web |last=Alfonseca |first=Kiara |date=April 8, 2022 |title=Alabama governor signs 'Don't Say Gay,' trans care and bathroom ban bills |url=https://abcnews.go.com/US/alabama-legislature-passes-dont-gay-trans-care-bathroom/story?id=83940764 |access-date=2024-03-20 |website=ABC News |language=en}} {{As of|2024|March}}, she is likely to sign a similar bill applying to universities.{{Cite web |last=Griesbach |first=Rebecca |date=2024-03-19 |title=Alabama passes wide-ranging bill banning college DEI programs, training |url=https://www.al.com/educationlab/2024/03/alabama-sends-bill-banning-college-dei-programs-training-to-governors-desk.html |access-date=2024-03-20 |website=al |language=en}}

On May 3, 2023, the Florida legislature passed the "Safety in Private Spaces Act", which the governor was expected to sign, making it a second-degree misdemeanor to use a bathroom other than that which is designated for people of one's sex assigned at birth.{{Cite web |last=Shapero |first=Julia |date=2023-05-04 |title=Florida passes transgender bathroom bill |url=https://thehill.com/homenews/state-watch/3987176-florida-passes-transgender-bathroom-bill/ |access-date=2023-05-04 |website=The Hill |language=en-US}} An earlier attempt in 2015 had failed.{{cite web |first=Dawn |last=Ennis |date=April 28, 2015 |title=Florida's Trans Bathroom Bill Dies |url=http://www.advocate.com/politics/2015/04/28/breaking-floridas-trans-bathroom-bill-dies |url-status=live |archive-url=https://web.archive.org/web/20160510070225/http://www.advocate.com/politics/2015/04/28/breaking-floridas-trans-bathroom-bill-dies |archive-date=May 10, 2016 |work=Advocate.com |df=mdy-all}}

In September 2021, following extensive right wing protests, a Los Angeles trans woman was charged by the LAPD with felony indecent exposure after she was recorded using the women's changing room at a local nude spa. The trans woman had two previous convictions for indecent exposure and a conviction for failing to register as a sex offender.{{Cite web |url=https://www.pinknews.co.uk/2021/09/03/wi-spa-los-angeles-darren-agee-merager/|title=Trans woman charged with indecent exposure at spa says she's victim of harassment |last1=Kelleher |first1=Patrick|date=September 3, 2021 }}{{Cite web|url=https://www.latimes.com/california/story/2021-09-02/indecent-exposure-charges-filed-trans-woman-spa |title=Indecent exposure charges filed against trans woman over L.A. spa incident |last1=Queally |first1=James |last2=Chabria |first2=Anita|website=Los Angeles Times |date=September 2, 2021 }} The nude spa in question had an explicitly trans-inclusive policy, and mandated nudity in gender segregated areas.{{Cite web|date=July 19, 2021|title=About Wi Spa|url=https://wispausa.com/about-wi-spa/|url-status=live|access-date=November 27, 2021|website=Wi Spa USA|language=en-US|archive-date=July 19, 2021|archive-url=https://web.archive.org/web/20210719112659/https://www.wispausa.com/about/about-wi-spa/}}

In February 2023, another trans woman was charged with indecent exposure for using the changing room at the YWCA in Xenia, Ohio, despite the facility's policy also being one of support.{{Cite news |url=https://www.independent.co.uk/news/world/americas/transgender-woman-indecent-exposure-ymca-b2274736.html |title=Transgender woman charged with indecent exposure for undressing in female YMCA locker room |last1=Asher |first1=Abe}}

In Doe v. Regional School Unit, the Maine Supreme Court held that a transgender girl had a right to use the women's bathroom at school because her psychological well-being and educational success depended on her transition. The school, in denying her access, had "treated [her] differently from other students solely because of her status as a transgender girl." The court determined that this was a form of discrimination.{{cite web|url=http://www.lambdalegal.org/know-your-rights/transgender/restroom-faq|title=FAQ: Answers to Some Common Questions about Equal Access to Public Restrooms|work=Lambda Legal|url-status=live|archive-url=https://web.archive.org/web/20150905212105/http://www.lambdalegal.org/know-your-rights/transgender/restroom-faq|archive-date=September 5, 2015|df=mdy-all}}

In Mathis v. Fountain-Fort Carson School District 8 (2013), Colorado's Division of Civil Rights found that denying a transgender girl access to the women's restroom at school was discrimination. They reasoned, "By not permitting the [student] to use the restroom with which she identifies, as non-transgender students are permitted to do, the [school] treated the [student] less favorably than other students seeking the same service." Furthermore, the court rejected the school's defense—that the discriminatory policy was implemented to protect the transgender student from harassment—and observed that transgender students are in fact safest when a school does not single them out as different. Based on this finding, it is no longer acceptable to institute different kinds of bathroom rules for transgender and cisgender people.

In May 2016, guidance was issued by the United States Department of Justice and the United States Department of Education stating that schools which receive federal money must treat a student's gender identity as their sex (for example, in regard to bathrooms). However, this policy was revoked in 2017.

{{main|G.G. v. Gloucester County School Board}}

In October 2016, the Court agreed to take on the case of whether a transgender boy, Gavin Grimm, could use the boys' bathroom in his Virginia high school. Grimm was assigned female at birth but is a transgender male. For a while, he was permitted access to the boys' bathroom but was later denied access after a new policy was adopted by the local school board. The ACLU took on the case, stating that girls objected when he tried to use the girls' bathroom in accordance with the new policy and that he was humiliated when the school directed him to use a private bathroom, unlike other boys. After challenging the policy, he won his case in the Court of Appeals in 2015 in a tie vote.{{cite news |last=Liptak |first=Adam |date=October 28, 2016 |title=Supreme Court to Rule in Transgender Access Case |url=https://www.nytimes.com/2016/10/29/us/politics/supreme-court-to-rule-in-transgender-access-case.html |url-status=live |newspaper=The New York Times |archive-url=https://web.archive.org/web/20161030055217/http://www.nytimes.com/2016/10/29/us/politics/supreme-court-to-rule-in-transgender-access-case.html |archive-date=October 30, 2016 |access-date=2016-10-29 |df=mdy-all }}{{cite news|first1=Robert|last1=Barnes|first2=Moriah|last2=Balingit|title=Supreme Court takes up school bathroom rules for transgender students|url=https://www.washingtonpost.com/politics/courts_law/supreme-court-takes-up-school-bathroom-rules-for-transgender-students/2016/10/28/0eece4ea-917f-11e6-a6a3-d50061aa9fae_story.html|newspaper=The Washington Post|access-date=October 29, 2016|date=October 28, 2016|url-status=live|archive-url=https://web.archive.org/web/20161029160838/https://www.washingtonpost.com/politics/courts_law/supreme-court-takes-up-school-bathroom-rules-for-transgender-students/2016/10/28/0eece4ea-917f-11e6-a6a3-d50061aa9fae_story.html|archive-date=October 29, 2016|df=mdy-all}} This marked the first ruling by an appeals court to find that transgender students are protected under federal laws that ban sex-based discrimination.{{cite news|url=https://www.reuters.com/article/us-usa-court-transgender-idUSKCN0ZT1XD|title=Transgender bathroom legal fight reaches Supreme Court|date=July 13, 2016|newspaper=Reuters|last1=Hurley|first1=Lawrence}} However, later in 2016 the U.S. Supreme Court agreed to put that ruling on hold.{{cite web|last=Williams |first=Pete |url=https://www.nbcnews.com/news/us-news/supreme-court-blocks-transgender-bathroom-ruling-n622476 |title=Supreme Court Blocks Transgender Bathroom Ruling |date=August 4, 2016 |publisher=NBC News |access-date=2016-08-08}} Then in 2017 the U.S. Supreme Court vacated the decision of the 4th U.S. Circuit Court of Appeals and refused to hear the case.{{cite web|last=Grindley |first=Lucas |url=http://www.advocate.com/transgender/2017/3/06/grimm-case-vacated-sessions-sets-back-trans-rights-supreme-court |title=Grimm Case Vacated, Sessions Sets Back Trans Rights at Supreme Court |date=March 6, 2017 |publisher=Advocate.com |access-date=2017-03-07}} Later in 2017, it was announced that the 4th Circuit would send the case back to the district court for the judge to determine whether the case was moot because Grimm graduated.{{cite web|url=http://wavy.com/2017/08/02/judges-send-gavin-grimm-case-back-to-lower-court/|title=Judges send Gavin Grimm case back to lower court|publisher=WAVY-TV |agency=Associated Press|date=August 2, 2017|access-date=January 20, 2018|archive-date=August 4, 2017|archive-url=https://web.archive.org/web/20170804214351/http://wavy.com/2017/08/02/judges-send-gavin-grimm-case-back-to-lower-court/}} The District Court found the case was not moot, and ruled in favor of Grimm, which was later upheld by the Fourth Circuit on appeal in August 2020, using the Supreme Court's recent decision in Bostock v. Clayton County as a basis for their decision.{{Cite news | url = https://www.washingtonpost.com/local/legal-issues/court-rules-in-favor-of-transgender-student-barred-from-using-boys-bathroom/2020/08/26/57a8c2d2-e7af-11ea-970a-64c73a1c2392_story.html | title = Court rules in favor of transgender student barred from using boys' bathroom | first = Emily | last = Davies | date = August 26, 2020 | access-date = August 27, 2020 | newspaper = The Washington Post }}

A similar case had occurred in the public schools of Dallas, Oregon, which had allowed transgender students to use the restrooms and locker rooms of the school based on their gender identity on the basis of the 2016 federal policy. Parents of other students had sued to have the policy overturned, but the policy was upheld at both the United States District Court for the District of Oregon and the United States Court of Appeals for the Ninth Circuit. The Supreme Court denied to hear the challenge to the Ninth Circuit in November 2020, leaving that decision in place.{{cite web | url = https://thehill.com/regulation/court-battles/529023-supreme-court-denies-review-of-school-transgender-bathroom-policy | title = Supreme Court denies review of school transgender bathroom policy | first1 = John | last1 = Kruzel | first2= Justine | last2= Coleman | date = December 7, 2020 | access-date = December 7, 2020 | work = The Hill }}

Rights to restrooms that match one's gender identity have also been recognized in the workplace and are actively being asserted in public accommodations. In Iowa, for example, discrimination in public accommodations on the basis of sexual orientation and gender identity has been prohibited by law since 2007 through the Iowa Civil Rights Act.

In Cruzan v. Special School District #1, decided in 2002, a Minnesota federal appeals court ruled that it is not the job of the transgender person to accommodate the concerns of cisgender people who express discomfort with sharing a facility with a transgender person. Employers need to offer an alternative to the complaining employee in these situations, such as an individual restroom.

Equal Employment Opportunity Commission (EEOC) chair Charlotte A. Burrows issued guidelines in 2021 stating that "employers may not deny an employee equal access to a bathroom, locker room, or shower that corresponds to the employee's gender identity."{{Cite web|title=Protections Against Employment Discrimination Based on Sexual Orientation or Gender Identity {{!}} U.S. Equal Employment Opportunity Commission|url=https://www.eeoc.gov/laws/guidance/protections-against-employment-discrimination-based-sexual-orientation-or-gender|access-date=2021-10-24|website=www.eeoc.gov|date=June 15, 2021 }}

[[File:Map_of_Transgender-related_hate_crime_law_in_the_United_States.svg|250px|thumb|right|US state hate crime laws as they pertain to gender identity as of June 2020

{{legend|#800080|Gender identity recognized in state hate crimes law}} {{legend|#cccccc|No enumerated protection}}Anti-Defamation League, June 2006. Retrieved May 4, 2007]]

{{further|Hate crime laws in the United States}}

Federal hate crimes legislation include limited protections for gender identity. The Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act of 2009 criminalized "willfully causing bodily injury (or attempting to do so with fire, firearm, or other dangerous weapon)" on the basis of an "actual or perceived" identity. However, protections for hate crimes motivated on the basis of a victim's gender identity or sexual orientation is limited to "crime affect[ing] interstate or foreign commerce or occur[ring] within federal special maritime and territorial jurisdiction." This limitation only applies to gender identity and sexual orientation, and not to race, color, religion or national origin.{{cite web|url=https://www.justice.gov/crt/matthew-shepard-and-james-byrd-jr-hate-crimes-prevention-act-2009-0|title=The Matthew Shepard and James Byrd, Jr., Hate Crimes Prevention Act of 2009|work=justice.gov|date=August 6, 2015|url-status=live|archive-url=https://web.archive.org/web/20150828003803/http://www.justice.gov/crt/matthew-shepard-and-james-byrd-jr-hate-crimes-prevention-act-2009-0|archive-date=August 28, 2015|df=mdy-all}} Therefore, hate crimes which occur outside these jurisdictions are not protected by federal law.

22 states plus Washington D.C. have hate crimes legislation which includes gender identity or expression as a protected group. They are Vermont, Massachusetts, Connecticut, New Jersey, Delaware, Illinois, Maryland, Missouri, Minnesota, Colorado, New Mexico, Nevada, Rhode Island, Washington, Oregon, California, Hawaii, Maine, Tennessee, Puerto Rico, Utah, Virginia{{Cite web|url=https://www.lgbtmap.org/equality-maps/hate_crime_laws|title = Movement Advancement Project | Hate Crime Laws}} and New York. Twenty-seven states have hate-crimes legislation which exclude transgender people. Six states have no hate-crimes legislation at all.{{cite web|url=http://transgenderlawcenter.org/equalitymap|title=National Equality Map – Transgender Law Center|work=transgenderlawcenter.org|url-status=live|archive-url=https://web.archive.org/web/20150905125541/http://transgenderlawcenter.org/equalitymap|archive-date=September 5, 2015|df=mdy-all}}

Numerous municipalities have passed hate-crime legislation, some of which include transgender people. However Arkansas, North Carolina and Tennessee recently passed laws which ban municipalities from enacting such protections for sexual orientation, gender identity or expression.{{Cite web|url=https://www.lgbtmap.org/equality-maps/non_discrimination_ordinances|title=Movement Advancement Project | Local Nondiscrimination Ordinances|website=lgbtmap.org}}{{cite news|url=https://www.huffingtonpost.com/2015/02/13/arkansas-lgbt-discrimination_n_6680802.html|title=Arkansas House Votes In Favor Of LGBT Discrimination|date=February 13, 2015|work=HuffPost|url-status=live|archive-url=https://web.archive.org/web/20150924212436/http://www.huffingtonpost.com/2015/02/13/arkansas-lgbt-discrimination_n_6680802.html|archive-date=September 24, 2015|df=mdy-all}}

{{see also|Transgender health care|Transgender#Healthcare}}

Transgender people confront two major legal issues within the healthcare system: access to health care for gender transitioning and discrimination by health care workers.

Many Republican legislators across the country are increasingly proposing legislation to restrict gender-affirming care for adults or make such care harder to access. However, no states have outright banned gender-affirming care for adults. Efforts to restrict adults' access to healthcare relies heavily on claims from self-described "gender-critical" organizations such as Genspect that young people should not be recognized as adults until they turn 25.{{cite web|last=Migdon|first=Brooke|url=https://thehill.com/homenews/state-watch/3810926-transgender-youth-health-care-bans-have-a-new-target-adults/|title=Transgender youth health care bans have a new target: adults|website=The Hill|date=January 13, 2023|access-date=2024-02-05}}{{cite web|last=Goldman|first=Maya|url=https://www.axios.com/2024/01/10/trans-care-adults-red-states|title=States are limiting gender-affirming care for adults, too|website=Axios|date=January 10, 2024|access-date=2024-02-05}}{{cite web|last=Lang|first=Nico|url=https://www.them.us/story/trans-adults-next-target-gop-war-on-gender-affirming-health-care|title=Trans Adults Are the Next Target in the GOP's War on Gender-Affirming Health Care|website=them.us|date=February 16, 2024|access-date=2024-03-10}}

As of January 2024, seven states limit access to gender-affirming care for adults without banning it, such as allowing private health plans, Medicaid, and correctional facilities to exclude all coverage for gender-affirming care, prohibiting the use of federal funds for gender-affirming care or requiring special informed consent practices.{{Cite web |last1=Dawson |first1=Lindsey |last2=Kates |first2=Jennifer |date=January 31, 2024 |title=The Proliferation of State Actions Limiting Youth Access to Gender Affirming Care |url=https://www.kff.org/policy-watch/the-proliferation-of-state-actions-limiting-youth-access-to-gender-affirming-care/ |access-date=February 5, 2024 |website=KFF |language=en-US}}

In January 2024, in a conversation about trans healthcare with several Republican legislators, Michigan State Rep. Josh Schriver asked, "If we are going to stop this for anyone under 18, why not apply it for anyone over 18? It’s harmful across the board and that’s something we need to take into consideration in terms of the endgame." Michigan State Rep. Brad Paquette and Ohio State Rep. Gary Click expressed agreement with that sentiment.{{cite web|last=Reed|first=Erin|url=https://www.advocate.com/politics/ohio-republicans-ban-trans-care|title=Ohio, Michigan Republicans in released audio: 'Endgame' is to ban trans care 'for everyone'|website=The Advocate|date=29 January 2024|access-date=2024-01-31}}{{cite web|last=Heywood|first=Todd|url=https://www.yahoo.com/news/depth-michigan-lawmakers-discuss-gender-045725600.html|title=In-depth: Michigan lawmakers discuss gender-affirming care ban|publisher=Yahoo!|date=30 January 2024|access-date=2024-01-31}}

In December 2024, Tennessee Senator, Bo Watson said that, although banning gender-affirming care for adults may not currently be of interest to the Tennessee legislature, he would not rule out a ban in the future.{{Cite web |title=Would Tennessee ban gender-affirming care for trans adults? Lawmaker has doubts, but doesn't rule it out |url=https://www.timesfreepress.com/news/2024/dec/25/would-tennessee-ban-gender-affiming-care-for/#/questions/ |access-date=31 December 2024 |website=Chattanooga Times Free Press|date=December 25, 2024 }}

In 2025, Texas Representative, Brent Money introduced a bill in the Texas House of Representatives that would ban gender affirming care for transgender individuals of all ages.{{Cite web |title=89(R) HB 3399 - Introduced version - Bill Text |url=https://capitol.texas.gov/tlodocs/89R/billtext/html/HB03399I.htm |access-date=2025-02-28 |website=capitol.texas.gov}}{{Cite web |title=TX HB3399 {{!}} Anti-trans legislation |url=https://translegislation.com/bills/2025/TX/HB3399 |access-date=2025-02-28 |website=translegislation.com}}

These states make it easy for trans adults to sue their doctors:

• Utah: In January 2023, Utah stripped liability protections from any doctor who treats a trans person under the age of 25, and allowed any trans person under 25 to retroactively "disaffirm" consent and sue the doctor for providing care they previously consented to.
• South Dakota: In February 2023, South Dakota passed a law stating that any civil action to recover damages for injury suffered as a result of gender-affirming care performed on a minor must be commenced before the date on which the person reaches age 25.{{Cite web |publisher=South Dakota Legislature |year=2023 |title=House Bill 1080 |url=https://mylrc.sdlegislature.gov/api/Documents/249156.pdf |access-date=14 February 2023}}
• Arkansas: On March 13, 2023, Governor Sarah Huckabee Sanders signed a bill giving adults 15 years to file malpractice lawsuits for gender-affirming care they received as minors, whereas for other types of care (under preexisting law) a malpractice lawsuit must generally be filed within two years.{{Cite web |date=2023-03-14 |title=Sarah Huckabee Sanders Signs Arkansas Trans Care Malpractice Bill Into Law |url=https://www.huffpost.com/entry/sarah-huckabee-sanders-arkansas-transgender-health-bill_n_6410f966e4b0cfde25c1c240 |access-date=2023-03-15 |website=HuffPost |language=en}}

These states restrict treatment for trans adults (as well as younger people):

• Florida: In August 2022, the state of Florida voted to require any trans adult seeking gender affirming healthcare to receive approval from the Florida Board of Medicine at least 24 hours in advance.{{Cite web |last1=Woodward |first1=Alex |date=August 5, 2022 |title=Florida begins rule-changing process to ban gender-affirming care for trans youth |url=https://www.independent.co.uk/news/world/americas/us-politics/florida-transgender-health-ban-desantis-b2139308.html |website=The Independent}} On May 17, 2023, DeSantis signed a law{{Cite web |last=Yurcaba |first=Jo |date=2023-05-17 |title=DeSantis signs 'Don't Say Gay' expansion, gender-affirming care ban |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/desantis-signs-dont-say-gay-expansion-gender-affirming-care-ban-rcna84698 |access-date=2023-05-17 |publisher=NBC News |language=en}} banning insurance providers from covering gender-affirming care for adults, as well as banning nurse practitioners and physicians' assistants (estimated to make up 80% of gender affirming care providers) from administering it, and banning it from being offered via telehealth. The Florida state legislature had passed the bill the previous month.{{cite web | url=https://www.tallahassee.com/story/news/politics/2023/04/19/in-one-day-three-bills-targeting-transgender-life-pass-florida-house/70130655007/ | title=In one day, three bills targeting transgender Floridians pass House }}{{Cite news |url=https://www.losangelesblade.com/2023/05/11/trans-patients-being-dropped-as-florida-law-bans-up-to-80/ |title=Trans patients being dropped as Florida law bans "Up To 80%" |work=Los Angeles Blade |date=May 11, 2023}} In June 2024, a judge permanently blocked the law from taking effect. In August 2024, the 11th Circuit Court of Appeals stayed the permanent injunction while the matter is appealed.
• Missouri: In April 2023, the state attorney general issued an emergency order instituting a three-year waiting period of continuous documented dysphoria before qualifying for gender-affirming care, disqualifying people if they have untreated depression or anxiety, mandating screening for autism, and mandating periodic screenings for "social contagion".{{cite web | url=https://www.businessinsider.com/missouri-attorney-general-regulations-gender-affirming-care-transgender-depression-2023-4 | title=Missouri's attorney general opened a new front in the GOP's attacks on transgender people: Banning treatment for any adult with depression | website=Business Insider }}{{cite web | url=https://autisticadvocacy.org/2023/03/asan-condemns-restrictions-on-gender-affirming-care/ | title=ASAN Condemns Restrictions on Gender-Affirming Care | date=March 22, 2023 }}{{cite web | url=https://thehill.com/homenews/state-watch/3949521-missouri-ag-issues-emergency-order-restricting-gender-affirming-health-care/ | title=Missouri AG issues emergency order restricting gender-affirming health care | work=The Hill | date=April 13, 2023 | last1=Migdon | first1=Brooke }}{{Cite web | url=https://ago.mo.gov/docs/default-source/press-releases/2023-04-13---emergency-reg.pdf?sfvrsn=7f78d4fc_2 | title=Gender Transition Interventions - EMERGENCY RULE | website=ago.mo.gov | date=2023-04-13}} This has been characterized by many as a de facto ban on trans healthcare for adults, since depression and anxiety are common symptoms of gender dysphoria.{{Cite news |title=Gender-Affirming Care for Adults Is Now Basically Banned in Missouri |work=Vice |url=https://www.vice.com/en/article/missouri-gender-affirming-care-ban/}}{{Cite news |title=Transgender adults brace for treatment cutoffs in Missouri |work=The Seattle Times |url=https://www.seattletimes.com/seattle-news/health/transgender-adults-brace-for-treatment-cutoffs-in-missouri/}}{{Cite news |title=Missouri AG Directly Cites the New York Times' Anti-Trans Coverage To Justify Horrific New Ban |work=The Mary Sue |url=https://www.themarysue.com/missouri-ag-directly-cites-the-new-york-times-anti-trans-coverage-to-justify-horrific-new-ban/}} A judge temporarily blocked enforcement of the order and scheduled a hearing for May 11.{{Cite web |last=Ballentine |first=Summer |date=2023-05-02 |title=Judge Blocks Missouri Rule That Would Limit Transgender Care |url=https://www.huffpost.com/entry/transgender-health-missouri_n_6450cfaae4b04997b579a580 |access-date=2023-05-02 |website=HuffPost |language=en}} The attorney general withdrew this order on May 16 after the state legislature passed two bills restricting gender-affirming care for trans youth.{{Cite news |title=Missouri attorney general drops controversial emergency rule that would have banned gender-affirming care for children and many adults |publisher=CNN |url=https://www.cnn.com/2023/05/17/us/missouri-gender-affirming-care-minors-ban/index.html#:~:text=Bailey's%20rule%20sought%20to%20make,intense%20pattern%20of%20gender%20dysphoria.%E2%80%9D}}{{Cite news |title=AG Bailey ends emergency rules restricting transgender healthcare |publisher=KMOV |url=https://www.kmov.com/2023/05/16/ag-bailey-ends-emergency-rules-restricting-transgender-healthcare/}} On June 7, 2023, Governor Mike Parson signed a bill that contained a provision banning gender-affirming care for prisoners, which took effect on August 28.

{{see also|Transgender youth|Detransition#Forced detransition}}

File:Transhealthcarebans.svg

Donald Trump signed an executive order in 2025 in an effort to federally prevent gender-affirming care for all people under 19 years old.{{cite web |url=https://www.whitehouse.gov/presidential-actions/2025/01/protecting-children-from-chemical-and-surgical-mutilation/ |title=Executive Order: Protecting Children for Chemical and Surgical Mutilation |publisher=US White House |date=January 28, 2025 |access-date=January 29, 2025 |archive-date=January 29, 2025 |archive-url=https://web.archive.org/web/20250129224724/https://www.whitehouse.gov/presidential-actions/2025/01/protecting-children-from-chemical-and-surgical-mutilation/ |url-status=live}}{{source-attribution}} The order revokes federal funding for any institutions providing such care and directs federal agencies to take further steps.{{cite news |url=https://www.nytimes.com/2025/01/28/us/politics/trump-trans-gender-affirming-care.html |title=Trump Signs Order Restricting Gender-Affirming Treatments for Minors |first=Zach |last=Montague |newspaper=The New York Times |date=January 28, 2025 |access-date=January 29, 2025 |archive-date=January 29, 2025 |archive-url=https://web.archive.org/web/20250129151708/https://www.nytimes.com/2025/01/28/us/politics/trump-trans-gender-affirming-care.html |url-status=live}} Multiple states sued,{{cite news |last=Christensen |first=Jen |date=February 4, 2025 |title=Social justice groups sue to block Trump executive order restricting care for transgender children |url=https://www.cnn.com/2025/02/04/health/trump-executive-order-transgender-children/index.html |access-date=February 13, 2025 |publisher=CNN}} and a federal judge, Brendan A. Hurson, blocked the order from taking effect while the PFLAG v. Trump lawsuit is ongoing.{{cite news |last1=Portnoy |first1=Jenna |last2=Rizzo |first2=Salvador |title=Judge blocks Trump order on transgender youth health care |url=https://www.washingtonpost.com/nation/2025/02/13/trump-transgender-health-care-youth-lawsuit/ |access-date=14 February 2025 |newspaper=The Washington Post |date=February 13, 2025}}{{Cite web |last=Hurson |first=Brendan |date=March 4, 2025 |title=Memorandum opinion |url=https://assets.aclu.org/live/uploads/2025/03/093114694750.pdf |access-date=March 5, 2025 |website=assets.aclu.org}}

Gender-affirming care for minors has a long history in the United States and is supported by major medical associations.{{Cite web |title=North Dakota governor signs law criminalizing trans health care for minors |url=https://www.pbs.org/newshour/politics/north-dakota-governor-signs-law-criminalizing-trans-health-care-for-minors | date=April 20, 2023 |access-date=January 3, 2024 |publisher=PBS |language=en-US}}{{Cite book |last=Gill-Peterson |first=Jules |title=Histories of the Transgender Child |publisher=University of Minnesota Press |year=2018 |isbn=9781517904661}} Efforts to prohibit gender-affirming care for minors began in the 2010s, but did not immediately receive much attention from state legislatures.{{cite web |date=6 April 2021 |title=Arkansas Lawmakers Override Veto, Enact Transgender Youth Treatment Ban |url=https://www.ualrpublicradio.org/post/arkansas-lawmakers-override-veto-enact-transgender-youth-treatment-ban |agency=Associated Press}} The conservative organization Do No Harm was influential in developing model legislation that appeared starting in 2022 in Arkansas, Florida, Iowa, Mississippi, Montana, New Hampshire, and West Virginia legislatures.{{Cite web |last1=McMillan |first1=Jeff |last2=Kruesi |first2=Kimberlee |date=2023-05-20 |title=Meet the influential new player on transgender health bills |url=https://apnews.com/article/transgender-bills-lobbying-do-no-harm-94f56059d24608d724eb78fefecf4e09 |url-status=live |archive-url=https://web.archive.org/web/20230704191142/https://apnews.com/article/transgender-bills-lobbying-do-no-harm-94f56059d24608d724eb78fefecf4e09 |archive-date=2023-07-04 |access-date=2023-09-06 |website=AP News |language=en}}{{Cite web |last=Balevic |first=Katie |title=Do No Harm, a group of 'medical professionals' fighting 'woke healthcare,' is behind many anti-trans laws |url=https://www.businessinsider.com/do-no-harm-behind-anti-trans-laws-fighting-woke-healthcare-2023-5 |url-status=live |archive-url=https://web.archive.org/web/20230606063139/https://www.businessinsider.com/do-no-harm-behind-anti-trans-laws-fighting-woke-healthcare-2023-5 |archive-date=2023-06-06 |access-date=2023-09-06 |website=Business Insider |language=en-US}} In 2023, 19 bans were enacted,{{Cite web |orig-date=October 19, 2023 |title=Nearly 100,000 transgender youth live in states that banned access to health care, sports, or school bathrooms in 2023 |url=https://williamsinstitute.law.ucla.edu/press/trans-leg-summary-press-release/ |access-date=December 29, 2023 |website=Williams Institute |language=en-US}}{{Cite web |date=2024-01-11 |title=Efforts to restrict transgender health care endure in 2024, with more adults targeted |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/efforts-restrict-transgender-health-care-endure-2024-adults-targeted-rcna133432 |access-date=2024-02-05 |publisher=NBC News |language=en}} 16 of which were being challenged in court {{As of|2024|January|alt=as of January 2024}}.

In February 2024, the American Psychological Association approved a policy statement supporting unobstructed access to health care and evidence-based clinical care for transgender, gender-diverse, and nonbinary children, adolescents, and adults, as well as opposing state bans and policies intended to limit access to such care.{{Cite web |date=February 2024 |title=APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science |url=https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care |access-date=2024-02-29 |website=American Psychological Association}}{{cite news |last1=Reed |first1=Erin |title=World's largest psych association supports trans youth care |url=https://www.advocate.com/news/apa-gender-affirming-care |access-date=29 February 2024 |work=advocate.com |language=en}}

As of February 2025, 27 states had enacted some form of ban on gender-affirming care for minors. Of those, 19 have complete bans in effect, six have partial bans, and two passed bans that are currently blocked from taking effect. While some states have banned all forms of medical transition, others such as Arizona, Nebraska, New Hampshire and Georgia have banned only specific types such as hormone therapy or surgery. Six states have exceptions which allow minors who were already receiving gender-affirming care prior to the ban to continue their treatments. Currently, all 27 states make exceptions for puberty blockers, hormones and surgery for cisgender and intersex children. Only one state, West Virginia, makes exceptions in cases of "severe dysphoria". There is also currently only one state, Missouri, that has a ban which is set to expire after a certain period of time. Nearly all states with restrictions include specific provisions with penalties for providers and 4 states include provisions directed at parents or guardians. An additional 4 states include laws/policies that impact school officials such as teachers and counselors, among others.

At the same time, many Democrat-controlled states have gone in the opposite direction and enacted laws protecting access to gender affirming care for minors and adults. These laws, often called "shield" laws, often explicitly combine protections for gender-affirming care and abortion and cover a variety of protections including protecting both providers and patients from being punished, mandating insurance providers to cover the procedures and acting as "sanctuary states" that protect patients traveling to the state from other states that have banned such treatments among other things.{{Cite web |last=Panetta |first=Grace |title=Lawmakers in blue states are linking protections for abortion and gender-affirming care |url=https://19thnews.org/2023/06/abortion-trans-health-care-shield-laws/ |access-date=2024-01-01 |website=The 19th | date=June 9, 2023|language=en-US}} As of June 2024, 16 states and the District of Columbia have enacted "shield" laws.

Of the approximately 1.6 million Americans who are transgender, about 300,000 are under the age of 18.{{cite news |last1=Hassan |first1=Adeel |date=June 27, 2023 |title=States Passed a Record Number of Transgender Laws. Here's What They Say. |work=The New York Times |url=https://www.nytimes.com/2023/06/27/us/transgender-laws-states.html}} As of October 2023, approximately 105,200 transgender youth aged 13 to 17 lived in states where gender affirming care is banned for minors. However, around 26,000 of those youth are currently still able to access care in their state due to court orders that prohibit enforcement of the laws. Conversely, around 146,700 transgender youth live in states that have passed gender-affirming care "shield" laws that support access to care by protecting doctors and parents who prescribe or seek access to medical care for youth. An analysis from KFF in late January 2024 estimated that 38% of trans youth between the ages of 13-17 in the United States lived in states with laws limiting youth access to gender-affirming care.

Bans on gender-affirming care have been criticized as governments interfering with the patient-doctor relationship and taking away healthcare decisions from parents and families for their children.{{cite web|title=Parents raise concerns as Florida bans gender-affirming care for trans kids|vauthors=Block M|publisher=NPR|url=https://www.npr.org/2023/02/20/1157493433/florida-bans-gender-affirming-care-trans-kids|access-date=11 June 2023|archive-date=11 June 2023|archive-url=https://web.archive.org/web/20230611072637/https://www.npr.org/2023/02/20/1157493433/florida-bans-gender-affirming-care-trans-kids|url-status=live}}{{cite web |title=Why GOP lawmakers want to stop doctors from prescribing gender-affirming care for Utah's youth |vauthors=Schott B |url=https://www.sltrib.com/news/politics/2023/01/18/why-gop-lawmakers-want-stop/ |access-date=2023-08-14 |website=The Salt Lake Tribune |language=en-US |archive-date=11 June 2023 |archive-url=https://web.archive.org/web/20230611072640/https://www.sltrib.com/news/politics/2023/01/18/why-gop-lawmakers-want-stop/ |url-status=live }} State level bans on gender-affirming care in the United States have led some families with transgender children to move out of their states.{{cite web |date=27 November 2022 |title=Conservative states are blocking trans medical care. Families are fleeing |vauthors=Connell-Bryan A, Kenen J, Holzman J |url=https://www.politico.com/news/2022/11/27/trans-medical-care-red-states-families-00064394 |website=Politico |access-date=30 November 2022 |archive-date=30 November 2022 |archive-url=https://web.archive.org/web/20221130110753/https://www.politico.com/news/2022/11/27/trans-medical-care-red-states-families-00064394 |url-status=live }}{{cite web|title=As state laws target transgender children, families flee and become 'political refugees'|vauthors=Ramirez M|url=https://www.usatoday.com/story/news/nation/2022/10/29/transgender-children-families-flee-states-restricting-rights/10547110002/|website=USA Today|access-date=30 November 2022|archive-date=30 November 2022|archive-url=https://web.archive.org/web/20221130110753/https://www.usatoday.com/story/news/nation/2022/10/29/transgender-children-families-flee-states-restricting-rights/10547110002/|url-status=live}}{{cite web |date=19 April 2021 |title='It's not safe': Parents of trans kids plan to flee their states as GOP bills loom |vauthors=Yurcaba J |url=https://www.nbcnews.com/feature/nbc-out/it-s-not-safe-parents-transgender-kids-plan-flee-their-n1264506 |publisher=NBC News |access-date=30 November 2022 |archive-date=30 November 2022 |archive-url=https://web.archive.org/web/20221130110753/https://www.nbcnews.com/feature/nbc-out/it-s-not-safe-parents-transgender-kids-plan-flee-their-n1264506 |url-status=live }}

In May 2024, the Department of Justice indicted a Texas doctor, Eithan Haim, for alleged HIPAA violations involving Texas Children's Hospital which he claimed was secretly providing gender-affirming care to minors. In January 2025, the Trump administration dropped the charges and the case was dismissed with prejudice.{{Cite web |date=2025-01-26 |title=DOJ drops case against Texas doctor accused of leaking data on minors' transgender care after ban - CBS Texas |url=https://www.cbsnews.com/texas/news/justice-department-drops-case-texas-doctor-leaked-transgender-care-data/ |access-date=2025-01-26 |publisher=CBS News |language=en-US}}{{Cite web |last=Tietz |first=Kendall |date=2025-01-24 |title=Trump DOJ drops case against Texas doctor who blew whistle on transgender medicine for minors |url=https://www.foxnews.com/media/trump-doj-drops-case-against-texas-doctor-who-blew-whistle-transgender-medicine-minors |access-date=2025-01-26 |publisher=Fox News |language=en-US}}

In October 2024, Texas attorney general Ken Paxton filed suit against a doctor who allegedly provided gender-affirming care to 21 minors after it had been banned for minors in the state, the first time that such a suit has been brought in the U.S.{{Cite web |last1=Lavietes |first1=Matt |last2=Yurcaba |first2=Jo |date=2024-10-17 |title=Texas AG sues doctor who allegedly provided transgender care to 21 minors |url=https://www.nbcnewyork.com/news/national-international/texas-ag-sues-doctor-allegedly-provided-transgender-care-minors/5898617/ |access-date=2024-10-17 |publisher=NBC News |language=en-US}}

{{Legend|#FFE3E3|Laws which are currently unenforceable due to a court injunction}}

{{Legend|#FFD|Laws which only partially ban gender affirming care for minors}}

In one 2016 study, the effect of puberty blockers was shown to be fully reversible.{{cite report |url=https://assets2.hrc.org/files/documents/SupportingCaringforTransChildren.pdf |title=Supporting and Caring for Transgender Children |date=September 2016 |publisher=American Academy of Pediatrics |page=11 |quote="To prevent the consequences of going through a puberty that doesn't match a transgender child's identity, healthcare providers may use fully reversible medications that put puberty on hold." |vauthors=Murchison G, Adkins D, Conard LA, Elliott T, Hawkins LA, Newby H, Ng H, Vetters R, Wolf-Gould C |display-authors=6}} Earlier studies (e.g., these in 2012 and 2015) indicated ongoing long-term research into potential effects on the brain.{{cite journal |last1=Wang |first1=Yingying |last2=Adamson |first2=Chris |last3=Yuan |first3=Weihong |last4=Altaye |first4=Mekibib |last5=Rajagopal |first5=Akila |last6=Byars |first6=Anna W. |last7=Holland |first7=Scott K. |title=Sex differences in white matter development during adolescence: A DTI study |journal=Brain Research |date=October 2012 |volume=1478 |pages=1–15 |doi=10.1016/j.brainres.2012.08.038 |pmid=22954903 |pmc=3592389 }}{{cite journal |last1=de Vries |first1=Annelou L.C. |last2=Steensma |first2=Thomas D. |last3=Doreleijers |first3=Theo A.H. |last4=Cohen-Kettenis |first4=Peggy T. |title=Puberty Suppression in Adolescents With Gender Identity Disorder: A Prospective Follow-Up Study |journal=The Journal of Sexual Medicine |date=August 2011 |volume=8 |issue=8 |pages=2276–2283 |doi=10.1111/j.1743-6109.2010.01943.x |pmid=20646177 }}

The lack of knowledge and education related to transgender health is an obstacle transgender people face.{{cite journal |last1=Schroth |first1=Peter W. |last2=Erickson-Schroth |first2=Laura |last3=Foster |first3=Linda L. |last4=Burgess |first4=Alexis |last5=Erickson |first5=Nancy S. |title=Perspectives on Law and Medicine Relating to Transgender People in the United States |journal=The American Journal of Comparative Law |year=2018 |volume=66 |pages=91–126 |jstor=26497456 }} A 2011 study published in JAMA reported that medical students cover up to "only five hours" of LGBT related content.{{cite journal |last1=Obedin-Maliver |first1=Juno |last2=Goldsmith |first2=Elizabeth S. |last3=Stewart |first3=Leslie |last4=White |first4=William |last5=Tran |first5=Eric |last6=Brenman |first6=Stephanie |last7=Wells |first7=Maggie |last8=Fetterman |first8=David M. |last9=Garcia |first9=Gabriel |last10=Lunn |first10=Mitchell R. |title=Lesbian, Gay, Bisexual, and Transgender–Related Content in Undergraduate Medical Education |journal=JAMA |date=7 September 2011 |volume=306 |issue=9 |pages=971–977 |doi=10.1001/jama.2011.1255 |pmid=21900137 }} A different study done by Lambda Legal in 2010 stated that 89.4% of transgender people felt that there are not enough medical providers that are "adequately trained" for their needs.{{Cite journal|year=2010|title=When Healthcare Isn't Caring|url=https://www.lambdalegal.org/sites/default/files/publications/downloads/whcic-report_when-health-care-isnt-caring.pdf|journal=Lambda Legal|pages=1–28}} This lack of medical training makes it harder for transgender people to find suitable and proper healthcare. A 2014 report by the Department of Justice found that 50% of trans people had actually had to teach their medical providers about trans healthcare.

A 2014 report by the Department of Justice found that 28% of trans people reported being harassed in medical settings, 19% reported being refused care, 2% reported being physically attacked in a doctor's office, 10% reported being sexually assaulted in one, 9% had been involuntarily committed, and 3% subjected to unwanted medical procedures. The report further found that it was not uncommon for trans people to be forced by psychiatric professionals to provide sexual favors in exchange for being allowed continued access to gender affirming medical care.

Transgender people also sometimes experience discrimination by healthcare professionals, who have refused to treat them for conditions both related and unrelated to their gender identity.{{cite news|url=https://www.huffingtonpost.com/2015/06/15/transgender-health-care_n_7587506.html|title=This Trans Man's Breast Cancer Nightmare Exemplifies The Problem With Transgender Health Care|date=June 15, 2015|work=HuffPost|url-status=live|archive-url=https://web.archive.org/web/20150826093209/http://www.huffingtonpost.com/2015/06/15/transgender-health-care_n_7587506.html|archive-date=August 26, 2015|df=mdy-all}}{{cite news|url=https://www.huffingtonpost.com/beck-bailey/off-to-the-er-will-i-be-treated-with-dignity_b_6754924.html|title=Off to the ER: Will I Be Treated With Dignity?|date=February 26, 2015|work=HuffPost|url-status=live|archive-url=https://web.archive.org/web/20150924215859/http://www.huffingtonpost.com/beck-bailey/off-to-the-er-will-i-be-treated-with-dignity_b_6754924.html|archive-date=September 24, 2015|df=mdy-all}}{{cite news|url=https://www.huffingtonpost.com/leslie-lagerstrom/parts-unknown_b_3948526.html|title=Parts Unknown|date=September 20, 2013|work=HuffPost|url-status=live|archive-url=https://web.archive.org/web/20150924235026/http://www.huffingtonpost.com/leslie-lagerstrom/parts-unknown_b_3948526.html|archive-date=September 24, 2015|df=mdy-all}} A 2017 report by the Center for American Progress found 29 percent of transgender people reporting they were denied care by a medical provider in the preceding year due to their gender identity or sexual orientation. The same study found that 21 percent of trans people reported medical providers used abusive or harsh language when they sought care.{{cite news|url=https://www.nbcnews.com/feature/nbc-out/religious-freedom-rule-could-cause-significant-damage-lgbtq-health-care-n1001996|title='Religious freedom' rule could cause 'significant damage' to LGBTQ health care, advocates say|last1=Moreau|first1=Julie|date=May 4, 2019|publisher=NBC News|df=mdy-all}}

The Affordable Care Act (ACA) of 2010, specifically Section 1557, prohibits sex discrimination in federally funded health care facilities, and in 2012 the federal Department of Health and Human Services (HHS) clarified that this includes discrimination based on transgender status. The government's final rule in 2016 determined that the ACA forbid discrimination based on gender identity.{{cite news|last1=Grinberg|first1=Emanuella|last2=Kantor|first2=Alice|last3=Walker|first3=Christina|date=31 May 2018|title=To be herself, she needs to change her body. But first, comes the battle with insurers|publisher=CNN|url=https://edition.cnn.com/2018/05/31/health/transgender-surgery-insurance/index.html|access-date=31 May 2018}} The ACA also forbids insurance providers from refusing to cover a person based on a pre-existing condition, including being transgender. However, a federal judge in Texas in 2016 issued a nationwide injunction stopping the ACA's transgender antidiscrimination protections from taking effect, and in 2019 that same court issued a final ruling that was binding on HHS.{{cite web|author=Sherman, Carter|date=April 25, 2019|title=Trump plans to take health care protections away from trans patients|url=https://www.vice.com/en/article/trump-administration-reportedly-plans-to-roll-back-protections-for-trans-patients/|work=Vice News}} On June 12, 2020, the Trump administration issued a new rule stating that sexual orientation and gender identity were not covered under the anti-discrimination protections of the Affordable Care Act.{{cite news|title=Transgender Health Protections Reversed By Trump Administration|url=https://www.npr.org/sections/health-shots/2020/06/12/868073068/transgender-health-protections-reversed-by-trump-administration|access-date=June 28, 2020|publisher=NPR|date=June 12, 2020|language=en|last1=Simmons-Duffin|first1=Selena}} This rule was in effect for nearly a year until it was reversed by the Biden administration, restoring the Obama-era policy.{{Cite web|last=Alonso-Zaldivar|first=Ricardo|date=2021-05-10|title=Reversing Trump, U.S. Restores Transgender Health Protections|url=https://www.huffpost.com/entry/us-restores-transgender-health-protections_n_6099311de4b012351603d287|access-date=2021-05-10|website=HuffPost|language=en}}

Complaints sent to HHS during the Trump administration indicated that medical providers were still frequently denying care to transgender people on the basis of their gender identity.

Some jurisdictions have their own laws prohibiting discrimination on the basis of sex, gender identity or gender expression in public accommodations, as well as under medical malpractice and misconduct law.{{cite web|title=FAQ About Health Provider Discrimination|url=http://www.lambdalegal.org/know-your-rights/transgender/health-provider-discrimination-faq|url-status=live|archive-url=https://web.archive.org/web/20150905212100/http://www.lambdalegal.org/know-your-rights/transgender/health-provider-discrimination-faq|archive-date=September 5, 2015|work=Lambda Legal|df=mdy-all}}

In 2020, the Supreme Court ruled in Bostock v. Clayton County that discrimination on the basis of sexual orientation or gender identity is necessarily also discrimination "because of sex" as prohibited by Title VII of the Civil Rights Act of 1964, and thus that Title VII protects employees against such discrimination.

A 2022 study on the allocation of ventilators during the pandemic found that respondents across the entire political spectrum were, when presented with the choice between allocating a ventillator to a cisgender man or a transgender person, on average less likely to allocate it to the trans person than to the cis man. In particular, respondents with conservative political leanings, when given a choice between allocating a ventilator to a cis man or a trans woman, were 14.3% less likely to allocate it to the trans woman, and when given a choice between allocating a ventilator to a cis man or a trans man, were 18.6% less likely to allocate it to the trans man.{{Cite journal |journal=Health Affairs |date=October 2022 |last1=Ne'eman |first1=Ari |last2=Bell |first2=Elizabeth |last3=Schneider |first3=Monica |last4=Strolovitch |first4=Dara |title=Identifying And Exploring Bias In Public Opinion On Scarce Resource Allocation During The COVID-19 Pandemic|volume=41 |issue=10 |pages=1513–1522 |doi=10.1377/hlthaff.2022.00504 |pmid=36190885 |s2cid=252682023 |doi-access=free }}

Republican amendments to funding bills could defund trans healthcare, affecting hundreds of thousands of trans adults and children by restricting access to essential medical treatments like hormone therapy and surgeries.{{cite news|title=Republicans are quietly pushing to defund transgender healthcare - and not just for minors|date=23 July 2024|url=https://www.independent.co.uk/news/world/americas/us-politics/transgender-healthcare-funding-republicans-b2583938.html|website=Independent|archive-url=https://web.archive.org/web/20240723205458/https://www.independent.co.uk/news/world/americas/us-politics/transgender-healthcare-funding-republicans-b2583938.html|archive-date=July 23, 2024|access-date=24 July 2024|url-status=live}}

1 in 6 patients in the United States are treated in a Catholic facility.{{Cite news |url=https://www.nytimes.com/2018/08/10/health/catholic-hospitals-procedures.html |title=As Catholic Hospitals Expand, So Do Limits on Some Procedures |work=NYT|date=August 10, 2018 |last1=Hafner |first1=Katie }} In March 2023, the United States Catholic Bishops issued guidelines for Catholic hospitals, entitled "Moral Limits to the Technological Manipulation of the Human Body", which banned the provision of gender affirming healthcare by such hospitals entirely.{{Cite news |url=https://apnews.com/article/catholic-bishops-lgbtq-transgender-health-care-d840600deab56a681e02d16463322892 |agency=Associated Press |title=U.S. bishops' new guidelines aim to limit trans health care}}

A form of discrimination in healthcare settings is known as "trans broken arm syndrome", in which a doctor mistakenly assumes that a trans person's medical ailments stem from their trans status or gender-affirming care and consequently treats their problem incorrectly or denies them care entirely. Trans patients often hide their trans status when visiting a doctor if their problem, such as a broken arm, isn't related to their trans status.{{Cite web |last1=Payton |first1=Naith |date=9 July 2015 |title=Feature: The dangers of trans broken arm syndrome |url=https://www.thepinknews.com/2015/07/09/feature-the-dangers-of-trans-broken-arm-syndrome/ |access-date=25 April 2023 |website=Pink News}} This is especially common in rural or more conservative areas.{{Cite web |last1=Oliver |first1=David |date=27 July 2021 |title='Being transgender is not a medical condition': The meaning of trans broken arm syndrome |url=https://www.usatoday.com/story/life/health-wellness/2021/07/27/trans-broken-arm-syndrome-what-it-how-combat-discrimination-health-care/8042475002/ |access-date=25 April 2023 |website=USA Today}}

A 2022 survey from the Center for American Progress revealed that 19 percent of trans individuals had experienced this form of discrimination in the past year.{{Cite web |url=https://www.americanprogress.org/article/discrimination-and-barriers-to-well-being-the-state-of-the-lgbtqi-community-in-2022/ |title=Discrimination and Barriers to Well-Being: The State of the LGBTQI+ Community in 2022 |last1=Medina |first2=Lindsay |last2=Mahowald |first1=Caroline|date=January 12, 2023 }}

Transgender people have the right to medical privacy. According to the Health Insurance Portability and Accountability Act (HIPAA), medical providers and insurance companies are prohibited from disclosing any personal medical information including a person's transgender status.{{Cite web|url=https://transequality.org/know-your-rights/health-care|title=Health Care|website=National Center for Transgender Equality|language=en|access-date=2019-10-07|archive-date=March 4, 2023|archive-url=https://web.archive.org/web/20230304015209/https://transequality.org/know-your-rights/health-care|url-status=dead}} HIPAA also allows transgender people to access and receive a copy of their medical records from health care facilities.

[[File:Transgender Medicaid Coverage.svg|250px|thumb|right|US Medicaid coverage of health care related to gender transition for transgender people by state as of August 2023

{{legend|#cccccc|State with no explicit policy on Medicaid coverage of health care related to gender transition for transgender people}}

{{legend|#0000ff|State Medicaid policy explicitly includes health care coverage related to gender transition for transgender people}}

{{legend|#ff0000|State Medicaid policy explicitly excludes coverage of health care related to gender transition for transgender people}}]]

[[File:Transgender Insurance Coverage USA.svg|250px|thumb|right|Map of states by laws protecting transgender rights in private insurance as of July 2020{{Update inline|date=October 2024|reason=Not updated in 4 years}}

{{legend|#cccccc|State with no protections for transgender people in insurance coverage}}

{{legend|#0000ff|State prohibits discrimination against transgender people in health insurance coverage and prohibits transgender exclusions}}

{{legend|#800080|State prohibits transgender exclusions in health insurance}}]]

It can be difficult for transgender people to find insurance coverage for their medical needs.{{Cite journal|last1=Gonzales|first1=Gilbert|last2=Henning-Smith|first2=Carrie|year=2017|title=Barriers to Care Among Transgender and Gender Nonconforming Adults|journal=The Milbank Quarterly|volume=95|issue=4|pages=726–748|doi=10.1111/1468-0009.12297|pmid=29226450|pmc=5723709}}

Even though there is medical consensus that hormone therapy and gender-affirming surgery (GAS) are medically necessary for many transgender people, the kinds of health care associated with gender transition are sometimes misunderstood as cosmetic, experimental or simply unnecessary. This has led to public and private insurance companies denying coverage for such treatment.{{cite web|url=http://www.socialworktoday.com/news/dn_031414.shtml|title=Transgender Patients Discriminated Against for Health Care Services|work=socialworktoday.com|publisher=Great Valley Publishing Company|url-status=live|archive-url=https://web.archive.org/web/20150924103246/http://www.socialworktoday.com/news/dn_031414.shtml|archive-date=September 24, 2015|df=mdy-all}} Courts have repeatedly ruled that these treatments may be medically necessary and have recognized gender dysphoria as a legitimate medical condition constituting a "serious medical need".{{cite web|url=http://www.lambdalegal.org/know-your-rights/transgender/transition-related-care-faq|title=FAQ on Access to Transition-Related Care|work=Lambda Legal|url-status=live|archive-url=https://web.archive.org/web/20150830090422/http://www.lambdalegal.org/know-your-rights/transgender/transition-related-care-faq|archive-date=August 30, 2015|df=mdy-all}}

The ban on Medicare coverage for gender reassignment surgery was repealed by the US Department of Health and Human Services in 2014. Insurance companies, however, still hold the authority to decide whether the procedures are a medical necessity. Thus, insurance companies can decide whether they will provide Medicare coverage for the surgeries.

Under federal tax laws, the Internal Revenue Code, section 213, defines the purpose of "medical care" as "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body."{{Cite journal|last1=Youngman|first1=Julie|last2=Hauck|first2=Courtney|date=July 1, 2019|title=Medical Necessity: A Higher Hurdle for Marginalized Taxpayers?|url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=135983978&site=ehost-live|journal=Loyola of Los Angeles Law Review|volume=51|pages=1–59|via=EBSCOHost}} Only cosmetic surgeries promoting the physical or mental health of an individual can qualify for medical deductions. Transgender people have used the diagnosis of gender dysphoria to qualify for deductible health care.

The idea that transition-related care is cosmetic or experimental has been ruled as discriminatory and out of touch with current medical thinking. The AMA and WPATH have specifically rejected these arguments, and courts have affirmed their conclusion.{{cite web|url=http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1352&pk_association_webpage=3947|title=WPATH|work=wpath.org|archive-url=https://web.archive.org/web/20150814225232/http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1352&pk_association_webpage=3947|archive-date=August 14, 2015|df=mdy-all}}{{cite web|title=Removing Barriers to Care for Transgender Patients: AMA Resolution Supporting Health Insurance Coverage for Treatment of GID|url=https://www.glad.org/uploads/docs/publications/ama-resolution-fact-sheet.pdf|website=GLADanwers.org|publisher=Gay & Lesbian Advocates & Defenders|access-date=August 28, 2015|archive-url=https://web.archive.org/web/20150303032822/http://www.glad.org/uploads/docs/publications/ama-resolution-fact-sheet.pdf|archive-date=March 3, 2015|df=mdy-all}} In a case brought by Gay and Lesbian Advocates and Defenders (GLAD), O'Donnabhain v. Commissioner, for instance, the Internal Revenue Service lost its claim that such treatments were cosmetic and experimental when a transgender woman deducted her GAS procedures as a medical expense. Courts have also found that psychotherapy alone is insufficient treatment for gender dysphoria, and that for some people, GAS may be the only effective treatment.

In April 2024, The Biden administration announced expansive new protections for gay and transgender medical patients, prohibiting federally funded health providers and insurers from discriminating on the basis of sexual orientation and gender identity. The new rules overturn Trump-era restrictions, but preserve religious exemptions.{{cite web|url=https://www.nytimes.com/2024/04/26/us/politics/biden-gay-transgender-health-care.html|title=Biden Administration Restores Health Protections for Gay and Transgender People|website=The New York Times|date=April 26, 2024|access-date=June 12, 2024}} In June 2024, the Attorneys General in fifteen Republican-led states sued the Biden administration over the new rules. On July 3, 2024 a federal judge temporarily blocked enforcement of the new rule.{{Cite web |url=https://thehill.com/homenews/lgbtq/4754761-federal-judge-blocks-rule-transgender-protections/ |title=Judge blocks Biden administration's new transgender health protections |last1=Migdon |first1=Brooke|website=The Hill |date=July 3, 2024 }}

In June 2022, the Florida Agency for Healthcare Administration, the agency which is responsible for overseeing the state's Medicaid service, released a report which stated that transgender hormone therapy is "experimental and investigational".{{Cite web |url=https://www.foxnews.com/media/florida-health-agency-transgender-treatment-youth-experimental |title=Florida Medicaid Moves Against Transgender Therapies Coverage, Calls It 'Experimental' |last1=Grossman |first1=Hannah|publisher=Fox News |date=June 2, 2022 }}{{Cite web |url=https://www.tampabay.com/news/florida-politics/2022/07/14/florida-report-on-transgender-care-flawed-politically-motivated-yale-experts-say/ |title=Florida Report on Transgender Care Flawed, Politically Motivated, Yale Experts Say |last1=O'Donnel |first1=Christopher |last2=Wilson |first2=Kirby}} The report was quickly rebuffed by the wider scientific community, with experts from Yale in July publishing an analysis in which they stated that the report ignored accepted scientific studies and consensus regarding gender dysphoria, had its writers chosen from those with ties to anti-LGBTQ groups specifically for their bias, cited sources with no scientific merit - including a student blog post and a letter to the editor, and that if the state used the same standard it used in the report to evaluate other treatments, it would no longer allow Medicaid to pay for a wide array of common medications. The Yale analysis also stated that "it seems clear that the report is not a serious scientific analysis but, rather, a document crafted to serve a political agenda" and that "medical treatment for gender dysphoria does meet generally accepted professional medical standards and is not experimental or investigational".{{Cite web |url=https://apnews.com/article/science-health-medicaid-yale-university-government-and-politics-0ab8f29c092e6a40c3fdd67b612dd180 |title=Academics Attack Florida Plan to Limit Transgender Treatment|agency=Associated Press |date=July 15, 2022 }}

On August 21, 2022, Florida issued state Medicaid regulations banning coverage of sexual reassignment surgery, hormone replacement therapy, puberty blockers and "any other transgender healthcare initiatives" for all individuals, regardless of age.{{cite news |last1=Russell |first1=John |title=Florida bans Medicaid coverage for gender-affirming healthcare |url=https://www.lgbtqnation.com/2022/08/florida-bans-medicaid-coverage-gender-affirming-healthcare/ |work=LGBTQ Nation |date=August 12, 2022}}{{cite press release |last1=Berg-Brousseau |first1=Henry |title=Human Rights Campaign Condemns DeSantis Administration Move Banning Medicaid Coverage for Gender-Affirming Health Care |url=https://www.hrc.org/press-releases/human-rights-campaign-condemns-desantis-administration-move-banning-medicaid-coverage-for-gender-affirming-health-care |work=Human Rights Campaign |date=August 12, 2022}} On June 21, 2023, the court decided in Dekker v. Weida that Medicaid must continue to cover gender-affirming healthcare.{{Cite web |date=June 21, 2023 |title=Dekker v. Weida, 4:22cv325-RH-MAF |url=https://casetext.com/case/dekker-v-weida-1 |access-date=2023-10-17 |website=Casetext}} The decision was appealed. On October 13, 2023, legal representatives from 19 states—principally Attorneys General Steve Marshall of Alabama, Tim Griffin of Arkansas, and Jonathan Skrmetti of Tennessee—submitted an amicus brief arguing that the court should reverse its decision and forbid Medicaid coverage of all gender-affirming care, including care for adults. The amicus brief cited the Dobbs decision.{{Cite web |date=October 13, 2023 |title=Brief of Alabama, Arkansas, Tennessee, and 15 Other States as Amici Curiae Supporting Appellants and Reversal |url=https://www.alabamaag.gov/wp-content/uploads/2023/10/10.13.23-Florida-11ca-Am.-Br-FILED.pdf |access-date=October 16, 2023 |website=alabamaag.gov}} On November 22, 2024, the 11th U.S. Circuit Court of Appeals heard arguments appealing the case.{{Cite web |date=November 22, 2024 |title=Court hears arguments on Florida's restrictions on trans care |url=https://www.wusf.org/courts-law/2024-11-22/court-hears-arguments-florida-restrictions-trans-care-medicaid |access-date=November 25, 2024 |publisher=NPR}}

In 1992, UC Irvine researchers published an article detailing medical experiments performed on every trans female inmate in the California state prison system, ending with all subjects being indefinitely taken off hormone therapy. When the study began, prison policy was to provide hormone therapy to all inmates who had proof of receiving hormone therapy prior to incarceration. In 1988, prison policy changed on the basis of the claim that "hormone therapy was not beneficial to the inmates' general health." The authors wrote: "withdrawal of therapy was also associated with adverse symptoms in 60 of the 86 transsexuals. Rebound androgenization, hot flashes, moodiness, and irritability or depression were the most frequent complaints."{{cite journal |last1=Valenta |first1=L. J. |last2=Elias |first2=A. N. |last3=Domurat |first3=E. S. |title=Hormone pattern in pharmacologically feminized male transsexuals in the California State prison system |journal=Journal of the National Medical Association |date=March 1992 |volume=84 |issue=3 |pages=241–250 |pmid=1578499 |pmc=2571763 }} At the time, no right to access gender appropriate care existed in California state prisons.

According to the Vera Institute, 16% of trans adults in the US have been incarcerated, compared to 2.7% of cis adults, and trans people make up 59% of prison sexual assault victims.

In September 2011, a California state court denied the request of a California inmate, Lyralisa Stevens, for gender-affirming surgery at the state's expense.{{cite news|last=Dolan|first=Jack|title=Inmate loses bid for taxpayer-paid sex-change operation|url=https://www.latimes.com/local/la-xpm-2011-sep-22-la-me-transgender-20110922-story.html|access-date=January 18, 2014|newspaper=Los Angeles Times|date=September 22, 2011|url-status=live|archive-url=https://web.archive.org/web/20140106133202/http://articles.latimes.com/2011/sep/22/local/la-me-transgender-20110922|archive-date=January 6, 2014|df=mdy-all}}

On January 17, 2014, in Kosilek v. Spencer a three-judge panel of the First Circuit Court of Appeals ordered the Massachusetts Department of Corrections to provide Michelle Kosilek, a Massachusetts inmate, with gender-affirming surgery. It said denying the surgery violated Kosilek's Eighth Amendment rights, which included "receiving medically necessary treatment ... even if that treatment strikes some as odd or unorthodox".{{cite news|last1=Finucane|first1=Martin|last2=Ellement|first2=John R.|last3=Valencia|first3=Milton J.|title=Mass. appeals court upholds inmate's right to taxpayer-funded sex change surgery|url=https://www.boston.com/news/local/massachusetts/2014/01/17/mass-appeals-court-upholds-inmate-right-sex-change-surgery/22b7dO1vPQKnrJNjP6kLRN/story.html|access-date=January 17, 2014|newspaper=Boston Globe|date=January 17, 2014|url-status=live|archive-url=https://web.archive.org/web/20140119052651/http://www.boston.com/news/local/massachusetts/2014/01/17/mass-appeals-court-upholds-inmate-right-sex-change-surgery/22b7dO1vPQKnrJNjP6kLRN/story.html|archive-date=January 19, 2014|df=mdy-all}}

On April 3, 2015, the U.S. Department of Justice intervened in a federal lawsuit filed in Georgia to argue that denying hormone treatment for transgender inmates violates their rights. It contended that the state's policy that only allows for continuing treatments begun before incarceration was insufficient and that inmate treatment needs to be based on ongoing assessments.{{cite news|last1=Apuzzo|first1=Matt|title=Transgender Inmate's Hormone Treatment Lawsuit Gets Justice Dept. Backing|url=https://www.nytimes.com/2015/04/04/us/ashley-diamond-transgender-hormone-lawsuit.html|access-date=April 6, 2015|work=The New York Times|date=April 3, 2015|url-status=live|archive-url=https://web.archive.org/web/20150406010153/http://www.nytimes.com/2015/04/04/us/ashley-diamond-transgender-hormone-lawsuit.html|archive-date=April 6, 2015|df=mdy-all}} The case was brought by Ashley Diamond, an inmate who had used hormone treatment for seventeen years before entering the Georgia prison system.{{cite news|last1=Sontag|first1=Deborah|title=Transgender Woman Cites Attacks and Abuse in Men's Prison|url=https://www.nytimes.com/2015/04/06/us/ashley-diamond-transgender-inmate-cites-attacks-and-abuse-in-mens-prison.html|access-date=April 6, 2015|work=The New York Times|date=April 5, 2015|url-status=live|archive-url=https://web.archive.org/web/20150406183641/http://www.nytimes.com/2015/04/06/us/ashley-diamond-transgender-inmate-cites-attacks-and-abuse-in-mens-prison.html|archive-date=April 6, 2015|df=mdy-all}}

On May 11, 2018, the US Bureau of Prisons announced that prison guidelines issued by the Obama Administration in January 2017 to allow transgender prisoners to be transferred to prisons housing inmates of the gender which they identify with had been rescinded and that assigned sex at birth would once again determine where transgender prisoners are jailed.{{Cite news|url=https://www.reuters.com/article/us-usa-lgbt-prisons-idUSKCN1ID0O3|title=U.S. rolls back protections for transgender prison inmates|date=2018-05-12|work=Reuters|access-date=2019-11-22|language=en}}

In August 2022, a federal judge in Nebraska ruled against a transgender woman who had been denied gender affirming care in prison, and placed in a cell with a male sex offender that proceeded to sexually assault her. In his ruling, the judge declared there to be insufficient evidence of deliberate indifference on the prison's part to the plaintiff's gender dysphoria, and that the plaintiff hadn't sufficiently proven that she'd suffered more than minimal injuries from the sexual assault, stating that he found no support for the notion that a substantial risk of harm or deliberate indifference to it "could be plausibly inferred from a prospective cellmate's conviction of sexual offenses coupled with the alleged vulnerability of a transgender inmate transitioning to a woman in a men's prison".{{Cite web |url=https://norfolkdailynews.com/state/nebraska/transgender-inmate-loses-lawsuit-over-prisons-treatment-for-her-gender-dysphoria/article_f8ac8f64-7c14-5b4b-aa02-20c70e367505.html |last1=Pilger |first1=Lori |title=Transgender inmate loses lawsuit over prison's treatment for her gender dysphoria |access-date=August 13, 2022 |archive-date=August 13, 2022 |archive-url=https://web.archive.org/web/20220813032512/https://norfolkdailynews.com/state/nebraska/transgender-inmate-loses-lawsuit-over-prisons-treatment-for-her-gender-dysphoria/article_f8ac8f64-7c14-5b4b-aa02-20c70e367505.html |url-status=dead }}

A 2018 report from the Indiana Maurer University School of Law, along with a subsequent report in the UCLA Journal of Gender and Law,{{cite journal |last1=Oparah |first1=Julia C. |title=Feminism and the (Trans)gender Entrapment of Gender Nonconforming Prisoners |journal=UCLA Women's Law Journal |date=24 April 2013 |volume=18 |issue=2 |doi=10.5070/L3182017822 }} found that, based on accounts of former inmates, it was common for trans women placed in men's prisons to be assigned to cells with aggressive cisgender male cellmates to maintain social control and to, as one inmate described it, "keep the violence rate down". Trans women used in this manner are often raped daily. This process is known as "V-coding", and has been described as so common that it is effectively "a central part of a trans woman's sentence".{{cite journal |last1=Kulak |first1=Ash |title=Locked Away in SEG 'For Their Own Protection': How Congress Gave Federal Corrections the Discretion to House Transgender (Trans) Inmates in Gender-Inappropriate Facilities and Solitary Confinement |journal=Indiana Journal of Law and Social Equality |date=22 May 2018 |volume=6 |issue=2 |url=https://www.repository.law.indiana.edu/ijlse/vol6/iss2/6/ }}

The prisoners serving as "customers" for these women are informally referred to as "husbands". A 2021 California study found that 69% of trans women prisoners reported being made to perform sexual acts they would have rather not, 58.5% reported being violently sexually assaulted, and 88% overall reported being made to take part in a "marriage-like relationship".{{cite journal |last1=Jenness |first1=Valerie |last2=Sexton |first2=Lori |title=The centrality of relationships in context: a comparison of factors that predict the sexual and non-sexual victimization of transgender women in prisons for men |journal=Journal of Crime and Justice |date=27 May 2022 |volume=45 |issue=3 |pages=259–269 |doi=10.1080/0735648X.2021.1935298 }} Trans women who physically resist the rape are often criminally charged with assault and placed in solitary confinement, the assault charge then being used to extend the woman's prison stay and deny her parole.{{Cite book |last1=Stanley |first1=Eric |last2=Smith |first2=Nat |date=October 27, 2015 |publisher=AK Press |page=229 |isbn=9781849352345 |title=Captive Genders}}

It is common for correctional officers to publicly strip search trans women inmates, putting their bodies on display for staff members and other inmates. Trans women in this situation are sometimes made to dance, present, or masturbate at the correctional officers' discretion.{{Cite journal |last1=Kulak |first1=Ash Olli |date=May 22, 2018 |title=Locked Away in SEG 'For Their Own Protection': How Congress Gave Federal Corrections the Discretion to House Transgender (Trans) Inmates in Gender-Inappropriate Facilities and Solitary Confinement |url=https://www.repository.law.indiana.edu/cgi/viewcontent.cgi?article=1087&context=ijlse |journal=Indiana Journal of Law and Social Equality |archive-url=https://web.archive.org/web/20210427005743/https://www.repository.law.indiana.edu/cgi/viewcontent.cgi?article=1087&context=ijlse |archive-date=April 27, 2021 |access-date=November 9, 2022}} A 2017 study by the Sylvia Rivera Law Project found that 75% of trans women respondents in New York state prisons were subjected to sexual violence by a correctional officer, with 32% being victimized by two or more COs and 27% of respondents being forced to perform oral sex for a CO.{{Cite web |year=2017 |title=It's Still War in Here: A Statewide Report on the Trans, Gender Non-Conforming, Intersex (TGNCI) Experience in New York Prisons and the Fight for Trans Liberation, Self-Determination, and Freedom |url=https://srlp.org/wp-content/uploads/2025/01/Its-Still-War-In-Here-1-2.pdf |website=Sylvia Rivera Law Project}}

Nine states currently regulate pronoun use.{{cite web | url=https://www.shrm.org/topics-tools/news/inclusion-diversity/states-are-banning-preferred-pronouns-at-work-but-federal-guidelines-promote-inclusion | title=States Are Banning Preferred Pronouns at Work, but Federal Guidelines Promote Inclusion. What Should HR Do? }} In February 2025, an employee of the Texas Real Estate Board was fired after refusing to remove pronouns from his email signature. Elon Musk and Texas governor Greg Abbott announced their support for the firing on social media.{{cite web | url=https://www.theguardian.com/us-news/2025/mar/06/musk-greg-abbott-fired-worker-pronouns | title=Elon Musk and Texas governor celebrate firing of worker over pronouns in email signature | work=The Guardian | last1=Salam | first1=Erum | date=March 6, 2025 }}

In 2000, the US Ninth Circuit Court of Appeals concluded that "gay men with female sexual identities [sic] in Mexico constitute a 'particular social group{{'"}} that was persecuted and was entitled to asylum in the US (Hernandez-Montiel v. INS).{{cite court |litigants=Hernandez-Montiel v. INS |vol=225 |reporter=F.3d |opinion=1084 |court=9th Cir. |year=2000 |url=https://scholar.google.com/scholar_case?case=40589139205028766 |access-date=November 3, 2012 }}{{cite news|last=Smiley|first=Lauren|title=Border Crossers|url=http://www.sfweekly.com/2008-11-26/news/border-crossers/|access-date=November 3, 2012|newspaper=SF Weekly|date=November 26, 2008|url-status=live|archive-url=https://web.archive.org/web/20121024055657/http://www.sfweekly.com/2008-11-26/news/border-crossers/|archive-date=October 24, 2012|df=mdy-all}} Since then, several cases have reinforced and clarified the decision.{{cite web |url=http://www.immigrationequality.org/issues/law-library/trans-manual/asylum/ |title=Immigration Law and the Transgender Client: Chapter Five |website=Immigration Equality |access-date=September 17, 2021 |archive-url=https://web.archive.org/web/20120618192522/http://www.immigrationequality.org/issues/law-library/trans-manual/asylum/ |archive-date=June 18, 2012}} Morales v. Gonzales (2007) is the only published decision in asylum law that uses "male-to-female transsexual" instead of "gay man with female sexual identity". An immigration judge stated that, under Hernandez-Montiel, Morales would have been eligible for asylum (if not for her criminal conviction).{{cite court |litigants=Morales v. Gonzales |vol=478 |reporter=F.3d |opinion=972 |pinpoint=977 |court=9th Cir. |year=2007 |url=https://scholar.google.com/scholar_case?case=16574404248757912566 |access-date=November 3, 2012 }}

Critics have argued that allowing transgender people to apply for asylum "would invite a flood of people who could claim a 'well-founded fear' of persecution". Precise numbers are unknown, but Immigration Equality, a nonprofit for LGBT immigrants, estimates hundreds of cases.

The United States has no process for accepting visa requests for third gender citizens from other countries. In 2015, trans HIV activist Amruta Alpesh Soni's request for a visa was delayed because her gender is listed as "T" (for transgender) on her Indian passport. In order to receive a visa, the State Department requires the gender identification on the visa to match the gender identification on the passport.{{cite web|url=http://www.salon.com/2015/05/07/u_s_state_department_has_no_process_for_accepting_transgender_passports/|title=U.S. State Department has no process for accepting transgender passports|first=Jenny|last=Kutner|work=salon.com|date=May 8, 2015|url-status=live|archive-url=https://web.archive.org/web/20150906210119/http://www.salon.com/2015/05/07/u_s_state_department_has_no_process_for_accepting_transgender_passports/|archive-date=September 6, 2015|df=mdy-all}} On the other hand, the asylum process is expensive and transgender migrants do not have any voice in the asylum seeking process.{{Cite web |editor-first1=Eithne |editor-last1=Luibhéid |editor-first2=Karma R. |editor-last2=Chávez |title=Queer and Trans Migrations |url=https://www.press.uillinois.edu/books/?id=p085239 |access-date=2025-05-10 |website=University of Illinois Press |language=en}} For example, transgender asylum seekers must wait for their case to be processed at the U.S./Mexico Border in detention centers. Transgender asylum seekers must wait in detention where they may undergo rape, sexual assault, or harassment from authorities.{{Cite journal |last=DasGupta |first=Debanuj |date=2019-11-01 |title=The Politics of Transgender Asylum and Detention |url=https://journals.sagepub.com/doi/10.1177/194277861901200304 |journal=Human Geography |language=EN |volume=12 |issue=3 |pages=1–16 |doi=10.1177/194277861901200304 |issn=1942-7786|url-access=subscription }} ICE Detention Center agents and staff have been found to be responsible for more counts of sexual victimization against transgender migrants than detainees or inmates, specifically during strip searches in multiple studies.{{Cite journal |last1=Marquez-Velarde |first1=Guadalupe |last2=Miller |first2=Gabe H. |last3=Aldana Marquez |first3=Beatriz |last4=Shircliff |first4=Jesse E. |last5=Suárez |first5=Mario I. |date=December 2024 |title=Transgender in Detention: Victimization Experiences in Immigration Facilities |journal=Transgender Health |volume=9 |issue=6 |pages=591–600 |doi=10.1089/trgh.2022.0083 |issn=2688-4887 |pmc=11669631 |pmid=39735377|pmc-embargo-date=December 16, 2025 }} Transgender asylum seekers remain in detention oftentimes in solitary confinement which is extremely harmful for physical and mental health. ICE facilities along the U.S./Mexico Border deny transgender migrants Hormone Replacement Therapy (HRT) and fail to maintain records on access migrants have to the treatment. In addition, transgender migrants and transgender asylum seekers are sexually assaulted due to unsafe facilities which are separated through gender binaries.

{{Main|Transgender personnel in the United States military}}

Discharges for gender transitioning were once commonplace. In one case, a trans person who had had gender-reassignment surgery was discharged from the Air Force Reserve, a decision supported by the Court of Appeals.{{cite journal |last1=Green |first1=R. |title=Transsexualism and the law |journal=The Bulletin of the American Academy of Psychiatry and the Law |year=1994 |volume=22 |issue=4 |pages=511–517 |pmid=7718924 }}{{cite news |last1=Herman |first1=Robin |title='No Exceptions,' and No Renee Richards |url=https://archive.nytimes.com/www.nytimes.com/packages/html/sports/year_in_sports/08.27.html |work=The New York Times |date=27 August 1976 }}

In 2015, the Pentagon reviewed its policy regarding transgender service members and announced that its ban would be removed.{{cite magazine|url=http://time.com/3956512/transgender-military-service-ban-2/|title=Pentagon to Lift Transgender Ban in the Military|first=Eliza|last=Gray|date=July 13, 2015|magazine=Time|url-status=live|archive-url=https://web.archive.org/web/20150824140942/http://time.com/3956512/transgender-military-service-ban-2/|archive-date=August 24, 2015|df=mdy-all}} It announced on June 30, 2016, that, effective immediately, existing servicemembers who came out as transgender would no longer be discharged, denied reenlistment, involuntarily separated, or denied continuation of service simply because of their gender,{{cite news|title=TMilitary lifts transgender ban s|url=http://www.mcclatchydc.com/news/nation-world/national/article86902072.html|agency=McClatchy|date=June 30, 2016|access-date=June 30, 2016|url-status=live|archive-url=https://web.archive.org/web/20160701125548/http://www.mcclatchydc.com/news/nation-world/national/article86902072.html|archive-date=July 1, 2016|df=mdy-all}} and that, starting in July 2017, people who already identify as transgender were welcome to join the military so long as they had already adapted to their self-identified gender for at least an 18-month period.

President Donald Trump tweeted on July 26, 2017, that transgender individuals will not be allowed to "serve in any capacity in the U.S. military".{{cite news|title=Trump announces ban on transgender people in U.S. military|url=https://www.washingtonpost.com/news/post-politics/wp/2017/07/26/trump-announces-ban-on-transgender-people-in-u-s-military/|access-date=26 July 2017|newspaper=The Washington Post|url-status=live|archive-url=https://web.archive.org/web/20170726140151/https://www.washingtonpost.com/news/post-politics/wp/2017/07/26/trump-announces-ban-on-transgender-people-in-u-s-military/|archive-date=July 26, 2017|df=mdy-all}} Chairman of the Joint Chiefs of Staff General Joseph Dunford pushed back, saying that the Secretary of Defense needed time to review this order. "In the meantime," he said, "we will continue to treat all of our personnel with respect."{{cite news|title=Joint Chiefs: 'No modifications' to transgender policy from Trump tweet|url=http://www.politico.com/story/2017/07/27/trump-transgender-military-ban-no-modification-241029|access-date=27 July 2017|work=Politico|url-status=live|archive-url=https://web.archive.org/web/20170727153508/http://www.politico.com/story/2017/07/27/trump-transgender-military-ban-no-modification-241029|archive-date=July 27, 2017|df=mdy-all}} On August 1, 2017, the Palm Center released a letter signed by 56 retired generals and admirals, opposing the proposed ban on transgender military service members. The letter stated that, if implemented, the ban would "deprive the military of mission-critical talent" and would compel cisgender service members "to choose between reporting their comrades or disobeying policy".{{cite news|last1=Levin|first1=Sam|title=Top military officials call on Trump to reverse transgender ban|url=https://www.theguardian.com/us-news/2017/aug/01/donald-trump-transgender-ban-us-military|access-date=August 24, 2017|newspaper=The Guardian|date=August 1, 2017|url-status=live|archive-url=https://web.archive.org/web/20170823172825/https://www.theguardian.com/us-news/2017/aug/01/donald-trump-transgender-ban-us-military|archive-date=August 23, 2017|df=mdy-all}} To challenge Trump's intended policy, at least four lawsuits were filed (Jane Doe v. Trump, Stone v. Trump, Karnoski v. Trump, and Stockman v. Trump), as well as bipartisan Senate and House bills (S. 1820 and H.R. 4041). On August 25, 2017, Trump signed a presidential memorandum to formalize his request for an implementation plan from the Secretary of Defense and the Secretary of Homeland Security.{{cite web |url=https://trumpwhitehouse.archives.gov/the-press-office/2017/08/25/presidential-memorandum-secretary-defense-and-secretary-homeland |title=Presidential Memorandum for the Secretary of Defense and the Secretary of Homeland Security |author=Trump, Donald J. |date=25 August 2017 |access-date=26 August 2017 |via=National Archives |publisher=White House |df=mdy-all }} Several days later, Secretary of Defense Jim Mattis announced that he would set up a panel of experts to provide recommendations and that, meanwhile, currently serving transgender troops would be allowed to remain.{{cite news|last1=Siddiqui|first1=Sabrina|title=Transgender troops can stay in US military for now, James Mattis says|url=https://www.theguardian.com/us-news/2017/aug/29/transgender-troops-can-stay-now-james-mattis-trump-ban|access-date=August 29, 2017|newspaper=The Guardian|date=August 29, 2017|url-status=live|archive-url=https://web.archive.org/web/20170830032518/https://www.theguardian.com/us-news/2017/aug/29/transgender-troops-can-stay-now-james-mattis-trump-ban|archive-date=August 30, 2017|df=mdy-all}} After another memorandum in 2018, and a further memorandum in 2019, the procedures regarding serving in the armed forces were finalized.

President Joe Biden reversed the policy the first Trump Administration put in place to ban transgender people from serving in the military on January 25, 2021, only five days after he took the oath of office.{{Cite web|last=Biden|first=Joe|date=January 25, 2021|title=Executive Order on Enabling All Qualified Americans to Serve Their Country in Uniform|url=https://bidenwhitehouse.archives.gov/briefing-room/presidential-actions/2021/01/25/executive-order-on-enabling-all-qualified-americans-to-serve-their-country-in-uniform/|access-date=January 28, 2021|website=The White House}} Biden said, "It is my conviction as Commander in Chief of the Armed Forces that gender identity should not be a bar to military service. Moreover, there is substantial evidence that allowing transgender individuals to serve in the military does not have any meaningful negative impact on the Armed Forces."

Biden's executive order was implemented in a step by step process. The order Trump signed banning transgender people from the military was to be reversed, the Department of Defense was to correct the record of anyone dismissed from service due to their gender identity, and the Secretary of Defense and the Secretary of Homeland Security were to begin the process of allowing transgender service members to serve openly. On April 30, 2021, the United States Department of Defense enacted a new policy which required better medical service and assistance to transgender people serving in the United States Military.{{Cite web|url=https://www.military.com/daily-news/2021/04/30/free-be-better-soldier-transgender-service-members-cheer-reversal-of-ban.html|title = Free to be a Better Soldier: Transgender Service Members Cheer Reversal of Ban|date = April 30, 2021}}

In February 2024, the Veterans Administration issued a final ruling that it would not cover gender-affirming surgery.{{Cite web |last=US Department of Veterans Affairs, Veterans Health Administration |title=LGBTQ+ Veterans |url=https://www.patientcare.va.gov/lgbt/#:~:text=VA%20provides%20gender-affirming%20care,exception%20of%20gender-affirming%20surgery. |access-date=2024-02-23 |website=patientcare.va.gov |language=en}}{{Cite web |last=McDonough |first=Denis |date=February 22, 2024 |title=Letter to M. Dru Levasseur |url=https://ibb.co/stQPJM0 |archive-url=https://web.archive.org/web/20240224171017/https://ibb.co/stQPJM0 |url-status=usurped |archive-date=February 24, 2024 |access-date=2024-02-24 |website=ImgBB |language=en}}

The National Defense Authorization Act for Fiscal Year 2025, a bipartisan bill which Biden signed in December 2024, includes language to ban transgender healthcare financing for certain procedures for minor children of military members.{{cite news|title=Biden signs $895B Defense bill despite transgender care provision|url=https://thehill.com/homenews/administration/5048580-biden-signs-ndaa-transgender/|work=The Hill|date=24 December 2024}} The text states "medical interventions for the treatment of gender dysphoria that could result in sterilization may not be provided to a child under the age of 18."{{Cite web | url=https://docs.house.gov/billsthisweek/20241209/RCP_HR5009_xml%5B89%5D.pdf | title=Text of the house amendment to the Senate amendment to H.R. 5009 | website=docs.house.gov}}

On January 27, 2025, Trump signed an executive order called "Prioritizing Military Excellence and Readiness".{{Cite web |date=2025-01-28 |title=Prioritizing Military Excellence and Readiness |url=https://www.whitehouse.gov/presidential-actions/2025/01/prioritizing-military-excellence-and-readiness/ |access-date=2025-02-28 |website=The White House |language=en-US}} On February 7, Defense Secretary Pete Hegseth signed a memo by the same name.{{Cite web |last=Rodriguez |first=Mathew |date=2025-02-11 |title=Hegseth Orders "Pause" on Trans Enlistment and Gender-Affirming Care For Current Servicemembers |url=https://www.them.us/story/hegseth-orders-pause-enlistment-gender-affirming-care-trans-servicemembers |access-date=2025-02-28 |website=Them |language=en-US}} On February 26, Under Secretary of Defense for Personnel and Readiness, Darin S. Selnick, signed a memo with more details. The effect is to ban trans people from the military.{{Cite web |title=Exhibit 1 - 26 Feb 2025 OSD Policy – #63, Att. #1 in TALBOTT v. TRUMP (D.D.C., 1:25-cv-00240) – CourtListener.com |url=https://www.courtlistener.com/docket/69583866/63/1/talbott-v-trump/ |access-date=2025-02-28 |website=CourtListener |language=en}} In March, U.S. District Court Judge Ana C. Reyes in Talbott v. United States{{Cite news |date=2025-03-19 |title=US judge blocks Trump's ban on trans people serving in the military |url=https://www.theguardian.com/us-news/2025/mar/18/judge-blocks-trump-executive-order-trans-military-ban |access-date=2025-03-19 |work=The Guardian |language=en-GB |issn=0261-3077}}{{Cite web |last=Reyes |first=Ana |date=March 18, 2025 |title=Talbott v. United States |url=https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2025cv0240-89 |access-date=March 18, 2025 |website=ecf.dcd.uscourts.gov}} and U.S. District Court Judge Benjamin H. Settle in Shilling v. United States issued preliminary injunctions.{{Cite web |last=Settle |first=Benjamin |date=March 27, 2025 |title=Shilling v. United States. Order on Motion for Preliminary Injunction — Document #103 |url=https://www.courtlistener.com/docket/69617888/103/shilling-v-united-states-of-america/ |access-date=May 6, 2025 |website=CourtListener |language=en-us}} However, on May 6, the Supreme Court allowed the ban on trans personnel to take effect.{{Cite news |last=Liptak |first=Adam |date=2025-05-06 |title=Supreme Court Lets Trump Enforce Transgender Troop Ban as Cases Proceed |url=https://www.nytimes.com/2025/05/06/us/politics/supreme-court-transgender-troops.html?unlocked_article_code=1.FE8.RgF7.qbV3wybowmaW |access-date=2025-05-06 |work=The New York Times |language=en-US |issn=0362-4331}}

IRS Publication 502{{cite web |title=Publication 502 (2008), Medical and Dental Expenses |publisher=Internal Revenue Service |year=2009 |url=https://www.irs.gov/publications/p502/index.html |access-date=May 7, 2009 |url-status=live |archive-url=https://web.archive.org/web/20090506053947/http://www.irs.gov/publications/p502/index.html |archive-date=May 6, 2009 |df=mdy-all }} lists medical expenses that are tax-deductible to the extent they 1) exceed 7.5% of the individual's adjusted gross income, and 2) were not paid for by any insurance or other third party. For example, a person with $20,000 gross adjusted income can deduct all medical expenses after the first $1,500 spent. If that person incurred $16,000 in medical expenses during the tax year, then $14,500 is deductible. At higher incomes where the 7.5% floor becomes substantial, the deductible amount is often less than the standard deduction, in which case it is not cost-effective to claim.

IRS Publication 502 includes several deductions that may apply to gender transition treatments, including some operations.

The deduction for operations was denied to a trans woman but was restored in tax court.O'Donnabhain v. Commissioner, 134 T.C. No. 4 (February 2, 2010) The deductibility of the other items in Publication 502 was never in dispute.

{{see also|Transgender people in sports}}

[[File:Map of US laws regarding transgender athletes.svg|261px|thumb|Map of state laws which ban transgender athletes from participating in the sport of their gender identity, as of June 2023:{{Update inline|date=October 2024|reason=Many states listed are not shown on map}}

{{legend|#cc3333|Law enacted which bans trans athletes from participating in sports based on their gender identity; enforces gender classifications in sports based on registered biological sex}}

{{legend|#ef6548|Law preventing trans athletes from participating in sport in their gender identity enacted, but currently blocked from enforcement via court order{{cite web | url=https://www.aclu.org/legal-document/bpj-v-west-virginia-state-board-education-order-granting-preliminary-injunction | title=B.P.J. V. West Virginia State Board of Education - Order Granting Preliminary Injunction| work=American Civil Liberties Union}}{{Cite web|url=https://www.aclu.org/cases/hecox-v-little|title=Hecox v. Little|website=American Civil Liberties Union}}}}]]

26 U.S. States have banned transgender people from sports under their gender identity in various capacities. These states include Texas,{{cite web | url=https://www.texastribune.org/2022/01/18/texas-transgender-sports-law/ | title=Trans kids and supporters say new Texas law will keep them out of school sports | date=January 18, 2022 }} Arkansas,{{cite web | url=https://www.nbcnews.com/feature/nbc-out/arkansas-governor-signs-transgender-sports-ban-law-n1262162 | title=Arkansas governor signs transgender sports ban into law | publisher=NBC News | date=March 26, 2021 }} Florida,{{cite web | url=https://www.npr.org/2021/06/02/1002405412/on-the-first-day-of-pride-month-florida-signed-a-transgender-athlete-bill-into-l | title=On the First Day of Pride Month, Florida Signed a Transgender Athlete Bill into Law | publisher=NPR | date=June 2, 2021 }} Alabama,{{Cite web |title=Alabama Gov. Kay Ivey Signs Anti-Trans Sports Bill into Law |url=https://www.hrc.org/press-releases/alabama-gov-kay-ivey-signs-anti-trans-sports-bill-into-law |access-date=2022-06-03 |website=Human Rights Campaign|date=April 23, 2021 }} Oklahoma,{{cite web | url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/oklahoma-governor-signs-transgender-sports-ban-rcna22210 | title=Oklahoma governor signs transgender sports ban | publisher=NBC News | date=March 30, 2022 }} Kentucky,{{cite web | url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/kentucky-legislature-overrides-governors-veto-transgender-sports-ban-rcna24303 | title=Kentucky Legislature overrides governor's veto of transgender sports ban | publisher=NBC News | date=April 13, 2022 }} Mississippi,{{cite web | url=https://www.nbcnews.com/feature/nbc-out/mississippi-governor-signs-bill-banning-trans-athletes-school-sports-n1260709 | title=Mississippi governor signs bill banning trans athletes from school sports | publisher=NBC News | date=March 11, 2021 }} Tennessee,{{cite news | url=https://www.si.com/college/2022/05/06/tennessee-governor-signs-legislation-banning-collegiate-transgender-athletes | title=Tennessee Governor Signs Legislation Banning Collegiate Transgender Athletes | newspaper=Sports Illustrated | date=May 6, 2022 }} West Virginia,{{Cite web |title=West Virginia Gov. Jim Justice Signs Anti-Trans Sports Bill into Law |url=https://www.hrc.org/press-releases/west-virginia-gov-jim-justice-signs-anti-trans-sports-bill-into-law |access-date=2022-06-03 |website=Human Rights Campaign|date=April 28, 2021 }} South Carolina,{{cite web | url=https://www.npr.org/2022/05/17/1099501287/south-carolina-trans-transgender-sports-ban | title=South Carolina becomes the latest state to enact a transgender sports ban | publisher=NPR | date=May 17, 2022 }} Utah,{{cite web | url=https://www.npr.org/2022/03/25/1088908741/utah-transgender-athletes-veto-override | title=Utah bans transgender athletes in girls sports despite governor's veto | publisher=NPR | date=March 25, 2022 }} South Dakota,{{cite web | url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/south-dakota-governor-signs-2022s-first-trans-athlete-ban-law-rcna14725 | title=South Dakota governor signs 2022's first trans athlete ban into law | publisher=NBC News | date=February 4, 2022 }} Montana,{{cite web | url=https://www.theguardian.com/us-news/2021/may/07/montana-transgender-student-athletes-ban-bill | title=Montana governor signs bill banning transgender students from sports teams | website=The Guardian | date=May 8, 2021 }} Iowa,{{cite news | url=https://www.desmoinesregister.com/story/news/politics/2022/03/03/trans-transgender-girls-banned-womens-sports-kim-reynolds-lgbtq-iowa-signs-bill/9349887002/ | title=Kim Reynolds bans transgender girls from female sports, signing Republican-backed law | website=The Des Moines Register }} Arizona,{{cite news | url=https://www.si.com/college/2022/03/30/arizona-governor-signs-bill-banning-transgender-girls-sports | title=Arizona Governor Becomes Second Official to Sign Anti-Trans Sports Bill Wednesday | newspaper=Sports Illustrated | date=March 30, 2022 }} Idaho,{{cite web | url=https://www.npr.org/2021/05/03/991987280/idahos-transgender-sports-ban-faces-a-major-legal-hurdle | title=Idaho's Transgender Sports Ban Faces a Major Legal Hurdle | publisher=NPR }} Wyoming,{{cite web | url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/wyoming-bans-transgender-youth-girls-sports-teams-rcna75894 | title=Wyoming bans transgender youths from girls' sports teams | publisher=NBC News | date=March 21, 2023 }} Indiana,{{cite news | url=https://www.nytimes.com/2022/05/24/us/indiana-legislature-transgender-sports-ban.html | title=Indiana Lawmakers Override Transgender Sports Veto | newspaper=The New York Times | date=May 24, 2022 | last1=Smith | first1=Mitch }} Louisiana,{{cite web | url=https://www.huffpost.com/entry/louisiana-transgender-ban-girls-school-sports_n_62a090b2e4b0c770989a73ea | title=Louisiana Becomes Latest State to Ban Transgender Athletes in Schools | date=June 8, 2022 }} Kansas, Georgia,{{Cite web |title=Georgia High School Association Chooses to Discriminate Against Transgender Student Athletes, Issuing Ban Against Competing in High School Sports |date=May 4, 2022 |url=https://www.hrc.org/press-releases/georgia-high-school-association-chooses-to-discriminate-against-transgender-student-athletes-issuing-ban-against-competing-in-high-school-sports |access-date=2022-06-03}} North Dakota,{{cite news |title=North Dakota Bars Trans Girls and Women From Female Sports Teams |url=https://www.nytimes.com/2023/04/12/us/north-dakota-trans-women-girls-sports-ban.html |newspaper=The New York Times |date=12 April 2023 |first=David W.|last=Chen}} New Hampshire, North Carolina, Alaska and Ohio. The passage of legislation against transgender youth has seen increases in calls to Trans Lifeline, a suicide crisis hotline run by and for transgender people.{{cite web | url=https://www.pbs.org/newshour/nation/texas-is-pushing-the-most-anti-trans-bills-in-the-country-advocates-fear-deadly-consequences | title=Texas is pushing the most anti-trans bills in the country. Advocates fear deadly consequences | publisher=PBS | date=September 13, 2021 }} Some of these bans only apply to school sports and some only apply to transgender women, but not transgender men.

In Oklahoma, all students who wish to play sports must submit a notarized affidavit of biological sex assigned at birth, under penalty of perjury.{{Cite web |url= https://kfor.com/news/local/parents-of-student-athletes-required-to-sign-gender-form-by-state-law/ |title= Parents of student athletes required to sign gender form by state law |last1=Goins |first1=Adria|work= KFOR.com Oklahoma City |date= July 28, 2022 }}

In August 2022, USA Cycling, citing new regulations on trans athletes, retroactively stripped trans woman Leia Genis of her silver medal earned at the Track National Championships that had taken place in 2022.{{Cite web |title=USA Cycling accused of "transphobia" after individual pursuit medallist stripped of national championships medal |url=https://road.cc/content/news/usa-cycling-accused-transphobia-294905 |last1=Alexander |first1=Dan |date=August 2, 2022 }}

Transgender rights organizations have argued that these discriminatory laws are not about protecting women's sports, but rather are attempts to "undermine the existence of transgender people."{{cite web | url=https://sports.yahoo.com/conservatives-want-ban-transgender-athletes-090041811.html | title=Conservatives want to ban transgender athletes from girls sports. Their evidence is shaky | date=November 15, 2021 }} Transgender advocates have commented that hormone replacement therapy and testosterone suppression reduces muscle mass and physical strength in transgender women, reducing the possibility of a competitive advantage.{{cite news | url=https://www.nytimes.com/2022/01/24/sports/lia-thomas-transgender-swimmer.html | title=As Lia Thomas Swims, Debate About Transgender Athletes Swirls | newspaper=The New York Times | date=January 24, 2022 | last1=Witz | first1=Billy }} Transgender inclusion in sports is supported by the Women's Sports Foundation, the Women's National Basketball Players Association (WNBPA), the National Women's Law Center, and Athlete Ally, as well as United States Women's National Soccer Team Captain Megan Rapinoe, tennis legend Billie Jean King, WNBA Minnesota Lynx coach Cheryl Reeve, and WNBA star Candace Parker.{{cite web | url=https://www.lambdalegal.org/in-court/legal-docs/20211014_amicus-soule-v-ciac-0 | title=Soule v. CIAC - Athletes in Women's Sports Amicus Brief }}{{cite web | url=https://www.athleteally.org/bjk-rapinoe-clarendon-turner-ct-amicus-brief/ | title=Billie Jean King, Megan Rapinoe, Layshia Clarendon, and Brianna Turner Join More Than 150 Athletes and WNBPA in Supporting Trans Youth Participation in Sports | date=October 14, 2021 }}{{Cite web |title=Georgia High School Association Chooses to Discriminate Against Transgender Student Athletes, Issuing Ban Against Competing in High School Sports |url=https://www.hrc.org/press-releases/georgia-high-school-association-chooses-to-discriminate-against-transgender-student-athletes-issuing-ban-against-competing-in-high-school-sports |access-date=2022-06-03 |website=Human Rights Campaign|date=May 4, 2022 }}{{cite web | url=https://www.athleteally.org/amicus-trans-athletes/ | title=Billie Jean King, Megan Rapinoe, and Candace Parker Join Nearly 200 Athletes Supporting Trans Youth Participation in Sports | date=December 21, 2020 }}

The US Department of Education has said transgender students are protected under Title IX.{{cite web | url=https://www.huffpost.com/entry/trans-students-title-ix-biden_n_60cac64ee4b0587266d83004 | title=Trans Students Protected Under Title IX, Biden Administration Says | date=June 17, 2021 }}

In November 2022, the 9th Circuit Court of Appeals ruled that the Miss United States of America pageant was allowed to categorically bar trans women from the competition, stating that the pageant's purpose was to celebrate "the ideal vision of American womanhood", and that allowing trans women to compete would make the pageant unable to do this. (This is a different pageant from Miss USA, which does admit trans women.){{Cite web |url=https://www.advocate.com/law/2022/11/03/miss-usa-can-reject-trans-contestants-appeals-court-rules |title=Miss USA Can Reject Trans Contestants, Appeals Court Rules |last1=Wiggins |first1=Christopher|date=November 3, 2022 }}{{Cite web |url=https://www.npr.org/2022/11/03/1134014004/pageant-can-exclude-trans-women-court-ruling |title=U.S. court says a pageant can exclude transgender women in its competitions |last1=Diaz |first1=Jaclyn|publisher=NPR |date=November 3, 2022 }}

In early 2023, the Florida High School Athletics Association recommended that all female athletes be mandated to supply up to date information on their menstrual cycles to a database accessible by their school's administrators. This was speculated by many to be a method of both enforcing abortion restrictions, and detecting any female athletes who might be trans women in violation of the state's ban.{{Cite news |url=https://newrepublic.com/post/170192/florida-panel-student-athletes-give-schools-menstrual-history |title=Florida Panel Recommends Forcing Student Athletes to Give Schools Their Menstrual History |last=Otten |first=Tori}}

In early 2023, a federal bill that would ban transgender women from competing in women's sports nationwide was introduced as HR 734, "Protecting Women and Girls in Sports Act." The bill passed the house in April 2023 with all republicans voting for it and all democrats voting against it. The senate is not expected to take up the bill and President Biden vowed to veto it if it reached his desk.{{Cite web |url=https://www.advocate.com/politics/transgender-sports-ban-house |title=The U.S. House Passes Anti-Transgender Sports Bill |date=April 20, 2023 |last=Cooper |first=Alex}}{{Cite web |url=https://legiscan.com/US/bill/HB734/2023 |title= US Congress House Bill 734 |website=Legiscan}}

In April 2023, the Biden administration proposed a Title IX rule change which would declare blanket "one size fits all" bans on trans athletes from teams consistent with their genders a violation of Title IX, but would authorize such bans if done for a number of reasons, including "fairness in competition". According to the proposal, this would most likely mean that bans that apply to elementary school students would be forbidden, but bans on high school and college students would be authorized under Title IX.{{Cite news |url=https://www.washingtonpost.com/education/2023/04/06/trans-athletes-school-sports-title-ix/ |work=WaPo |title=Biden administration says schools may bar trans athletes from competitive teams |date=April 6, 2023}}{{Cite news |url=https://www.nytimes.com/2023/04/06/us/transgender-athletes-title-ix-biden-adminstration.html |work=NYT |title=School Sports Cannot 'Categorically' Ban Transgender Athletes, Under Biden Proposal |date=April 6, 2023}}

After two delays, the final changes to Title IX were published in April 2024. The new changes cemented protections for LGBT students under federal law and reversed a number of Trump-era policies that dictated how schools should respond to cases of alleged sexual misconduct in K-12 schools and college campuses. They also effectively broadened the scope of Title IX by extending the law's reach to prohibit discrimination and harassment based on sexual orientation and gender identity, and widen the range of sexual harassment complaints that schools will be responsible for investigating. However, it did not explicitly say schools are forbidden from banning transgender women from competing in women's sports.{{Cite news |url=https://www.nytimes.com/2024/04/19/us/politics/biden-title-ix-rules.html |work=NYT |title=Biden Administration Releases Revised Title IX Rules |date=April 19, 2024}}{{Cite news |url=https://www.foxnews.com/politics/biden-dismantles-trump-era-title-ix-rules-sidesteps-issue-trans-athletes-girls-sports |publisher=Fox News |title=Biden dismantles Trump-era Title IX rules, sidesteps issue of trans athletes in girls' sports |date=April 19, 2024}} In response to these new changes, over 20 republican-led states sued the Biden Administration and refused to follow the new rules.{{Cite news |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/20-gop-led-states-sue-biden-administration-title-ix-rules-lgbtq-studen-rcna151247 |publisher=NBC News |title=Over 20 GOP-led states sue Biden administration over Title IX rules for LGBTQ students |date=May 8, 2024}} In June 2024, a judge temporarily blocked President Biden's proposed changes to the interpretation of Title IX in Texas.{{Cite news |url=https://thehill.com/regulation/court-battles/4716699-federal-judge-blocks-joe-biden-title-ix-transgender-protections/ |work=The Hill |title=Federal judge blocks Biden's Title IX transgender protections |date=June 11, 2024}} A few days later, a judge issued an injunction temporary blocking the rules in Idaho, Louisiana, Mississippi and Montana.{{Cite news |url=https://www.nbcnews.com/politics/politics-news/judge-blocks-bidens-title-ix-rule-four-states-lgbtq-protections-rcna157133 |publisher=NBC News |title=Judge blocks Biden's Title IX rule in four states, dealing a blow to protections for LGBTQ+ students |date=June 13, 2024}}{{Cite news |url=https://www.wbrz.com/news/federal-judge-sides-with-louisiana-attorney-general-against-joe-biden-s-new-title-ix-rules/ |publisher=WBRZ-TV |title=Federal judge sides with Louisiana Attorney General against Joe Biden's new Title IX rules |date=June 13, 2024}} The week after that, a judge temporarily blocked the law in Tennessee, Kentucky, Ohio, Indiana, Virginia and West Virginia.{{Cite news |url=https://www.highereddive.com/news/title-ix-rule-blocked-in-six-states-injunction/719282/ |work= Higher Ed Dive |title=Title IX rule blocked in 6 more states |date=June 18, 2024}} On July 2, 2024, a federal judge temporarily blocked the law in Kansas, Alaska, Utah and Wyoming.{{Cite news |url=https://www.washingtontimes.com/news/2024/jul/2/joe-biden-extends-losing-streak-third-judge-blocks/ |work=The Washington Times |title=Biden extends losing streak as third judge blocks rule adding 'gender identity' to Title IX |date=July 2, 2024}} This ruling also blocks the rule from taking effect in schools in Stillwater, Oklahoma, the home of a middle school student who joined the lawsuit, as well as any schools attended by members of the Young America's Foundation and the children of members of Moms for Liberty — two national conservative groups that signed onto the lawsuit.{{Cite news |url=https://www.edweek.org/policy-politics/bidens-title-ix-rule-is-now-blocked-in-14-states/2024/07 |work=Education Week |title=Biden's Title IX Rule Is Now Blocked in 14 States |date=July 3, 2024 |last1=Stanford |first1=Libby }} On July 17, 2024, the Fifth and Sixth Circuits upheld two of the blocks.{{Cite web |url=https://news.bloomberglaw.com/litigation/biden-trans-rights-rule-is-likely-unlawful-sixth-circuit-says |work=Bloomberg Law |title=Block on Biden Trans Rights Rule Upheld by Two Appeals Courts |date=July 17, 2024}} On July 26, 2024, a federal court temporarily blocked the rule from taking effect in Iowa, Arkansas, Missouri, Nebraska, North Dakota and South Dakota.{{Cite web |url=https://www.aol.com/federal-court-blocks-title-ix-104323887.html |work=AOL |title=Federal court blocks new Title IX gender identity protections in Iowa, 5 other states |date=July 26, 2024}} On August 1, 2024, the rule went into effect in all the states that had blocked them.{{Cite web |url=https://apnews.com/article/transgender-rights-title-ix-schools-2093e480783d207ee4ce9ffa7c74e932 |work=AP News |title=Federal protections of transgender students are in effect where courts haven't blocked them |date=August 1, 2024}}

On August 16, 2024, the Supreme Court, in a 5-4 ruling, denied an emergency request from the Biden Administration to reinstate the law while further legal battles play out in the lower court. The ruling did not address the merits of the lawsuits or whether the new rules were constitutional.{{Cite web |url=https://www.nytimes.com/2024/08/16/us/politics/supreme-court-transgender-discrimination-schools.html |first1=Abbie |last1=VanSickle |first2=Michael D. |last2=Shear |work=The New York Times |title=Supreme Court, for Now, Blocks Expanded Protections for Transgender Students in Some States |access-date=August 17, 2024 |date=August 16, 2024}}{{Cite web |url=https://www.bbc.com/news/articles/ckg21x1j54mo |first=Max |last=Matza |publisher=BBC |title=US Supreme Court declines to lift block on expanded trans student protections |access-date=August 17, 2024 |date=August 16, 2024}}{{Cite web |url=https://thehill.com/regulation/court-battles/4832117-supreme-court-denies-title-ix-doj-request/ |first=Zach |last=Schonfeld |work=The Hill |title=Supreme Court refuses DOJ request to partially reinstate new Title IX rule |access-date=August 17, 2024 |date=August 16, 2024}}

On January 9, 2025, U.S. District court judge Danny C. Reeves struck down the Biden administration's expanded protections nationwide in response to the lawsuit filed by the states of Tennessee, Kentucky, Indiana, Ohio, Virginia, and West Virginia.{{cite news |title=Biden's Title IX expansion protecting LGBTQ+ students struck down |url=https://www.theguardian.com/world/2025/jan/09/bidens-title-ix-struck-down |access-date=January 9, 2025 |work=The Guardian |agency=Associated Press |date=January 9, 2024}}{{cite news |title=Judge Rejects Biden's Title IX Rules, Scrapping Protections for Trans Students |url=https://www.nytimes.com/2025/01/09/us/politics/biden-title-ix-ruling.html |access-date=January 11, 2025 |work=The New York Times |date=January 9, 2025}}

In 2025, President Donald Trump signed Executive Order 14201, titled "Keeping Men Out of Women's Sports". The executive order threatens to ban federal funding from any educational institution that allows transgender girls or women to play on girls' teams, claiming a violation of Title IX.{{Cite news |last=Yilek |first=Caitlin |date=February 5, 2025 |title=Trump signs executive order that will ban transgender athletes from women's sports |url=https://www.cbsnews.com/news/trump-executive-order-banning-transgender-athletes-womens-sports/ |publisher=CBS News|access-date=February 6, 2025 }}> The executive order threatens to revoke federal funding from any elementary, secondary, and post-secondary institution that allows transgender girls to play on girls' teams, claiming they are in violation of Title IX. The order is exclusive to transgender women and does not bar transgender male athletes from playing on male sports teams.{{Cite web |last=Yurcaba |first=Jo |date=February 11, 2025 |title=Education Dept. urges NCAA to reverse transgender athletes' records, titles and awards |url=https://www.nbcnews.com/nbc-out/out-politics-and-policy/education-ncaa-transgender-athletes-records-reversal-rcna191742 |access-date=February 13, 2025|publisher=NBC News |archive-date=February 11, 2025|archive-url=https://web.archive.org/web/20250211223339/https://www.nbcnews.com/nbc-out/out-politics-and-policy/education-ncaa-transgender-athletes-records-reversal-rcna191742 |url-status=live }}

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