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Other states have passed laws to create “sanctuaries” to shield against outside laws, or passed state level civil rights laws defining gender as a protected class for anti-discrimination laws. Several cities, including New York City and Kansas City, have declared themselves a “sanctuary city”.
Many of these “sanctuary states” have passed bans on psychotherapy for minors with gender identity disorder by state licensed mental health professionals. The bans are given the misnomer “conversion therapy” because the legislation joins gender identity disorder with sexual orientation. Historically, psychotherapy to change one’s sexual orientation is called “conversion therapy” or “sexual orientation change efforts (SOCE)” , but this practice is widely discredited as unethical, harmful, and ineffective. Gender identity disorder is different from sexual orientation, and psychotherapy is endorsed as the first line treatment by the Dutch Protocol and several progressive European countries, including England’s National Health Service.
States that have raised the age to at least 18 for gender modification interventions, strictly regulate the practice, or define it as child abuse, OR prevent restrictions on psychotherapy for gender identity disorder.
States that have partially restricted gender modification interventions for minors, have pending legislation, or ongoing investigations.
States that act as "sanctuaries", or have pending "sanctuary" laws, for gender modification interventions for minors, OR bans against psychotherapy for gender identity disorder.
No laws, regulations, or active bills restricting or creating "sanctuaries" for gender modification interventions for minors.
Last Updated: July 3rd, 2023
View Circuit Court map to see which states are affected by Circuit Court cases.
This state has no active bills restricting treatments or creating enhanced protections.
There are no active bills restricting medical treatments (hormones, surgeries) or creating enhanced protections for medical treatments. However, in 2017, Connecticut passed a law banning psychotherapy for gender identity disorder.
This state has no active restrictions or protections regarding medical treatments (hormones, surgeries) for minors. However, Delaware, in 2018, passed a law banning exploratory psychotherapy for minors with gender identity disorder.
There are no regulations restricting psychotherapy for gender distress.
This state has no active bills restricting treatments or creating enhanced protections.
Given the number of countries that have some policy or practice about youth gender transition care, this table is incomplete. We have emphasized larger developed countries where current practice is well-defined. For comparison we show recommendations of the latest version of ‘Standards of Care’ from WPATH, the World Professional Association for Transgender Health. Readers with more up-to-date information are encouraged to help us update the table.
| Finland | Sweden | Norway | United Kingdom |
Year & Authority
| July 2020 Council for Choices in Health Care | December 2022 National Board of Health and Welfare | March 2023 Norwegian Healthcare Investigative Board | Judicial review in 2020 NICE reviews of cross-sex hormones and puberty blockers, March 2021 Cass Interim Report Feb. 2022 NHS Update May 2023 NHS Update Implementing Advice from Cass Review June 9, 2023 |
General Guideline | First line treatment should be psychosocial support, gender-explorative therapy, treatment of comorbid conditions.
| Summary of National Guidelines for Children and Adolescence with Gender Dysphoria: Link
| NHS Update May 2023 and NHS Update June 2023 * Establishes regional hubs affiliated with children’s hospitals *Research oversight Board *Determining standards for data collection and longitudinal tracking *Psychotherapy first *Puberty blockers only within research settings | |
Social Transition | Not specified | Not specified | Not specified | “Not a neutral act” |
Puberty blockers | Not recommended | Risks outweigh benefits. Use only in research setting | “Experimental” | Only in clinical trial research settings if <18 yo |
Cross-Sex hormones | Only if early childhood onset and no mental health issues which could interfere with the gender dysphoria diagnosis | Risks outweigh benefits. Use only in research setting | “Experimental” | 16+ |
Mastectomy | 18+ | 18+ | “Experimental” | Not specified |
Genital surgery | 18+ | 18+ | “Experimental” | Not specified |
Notes | Blockers and hormone allowed in rare circumstances but “no decisions should be made that can permanently alter a minor’s mental and physical development.” | The NBHW states “Risks outweigh benefits at a group level”. | Non-binding report. Finland officially follows WPATH SOC 8. | Closed Tavistock late 2022, “not a safe place for children” |
| Netherlands | Spain | Australia | WPATH 8.0 |
Year & Authority
| Original home of the ‘Dutch protocol,’ but clinics are loosening eligibility criteria | Feb 2023 passed national Trans Law. | 2020. Royal Children’s Hospital, Melbourne, Standards of Care, v 1.3 Endorsed by AusPATH | 2022. Standards of Care 8.0 |
General Guideline | No official guideline. Original protocol evolving: rising case load, switch to predominance of natal girls, later referrals, less extensive psychological support | Bill broadly addresses societal aspects of LGBTQ integration, and deals with youth gender care only in a limited way Children can change legal sex from age 12 w/o medical attestation | Largely followed WPATH 7.0 | Compared to version 7, removed minimum ages for blockers, hormones, and surgery |
Social Transition | Part of protocol | Supported at any age | Endorsed at any age | No minimum age |
Puberty blockers | Part of protocol | Not specified | “reversible” No minimum age; begun at Tanner Stage 2 | No minimum age |
Cross-Sex hormones | Part of protocol | Not specified | No minimum age | No minimum age |
Mastectomy | Part of protocol | Not specified | Probably ok at 16 | No minimum age |
Genital surgery | Part of protocol | 12+ | Best deferred to adulthood | No minimum age |
Notes | ——– | Bans counseling which tries to halt or reverse transition process, even at request of patient | Australia’s most populous state, NSW, is funding expansion of medical transition services | ———- |
Canada’s policies are generally supportive of the Dutch Protocol, but each province has its own health authority and delivery system. For instance, the British Columbia Provincial Health Services Authority follows WPATH standards closely, and facilitates transition for people of all ages through “Trans Care BC.”
France does not have an official national policy. However in February 2022 the French National Academy of Medicine released an opinion noting an ‘epidemic-like phenomenon’ across the developed world,’ opining that “a great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects, and even serious complications, that some of the available therapies can cause.”
New Zealand shares many medical guidelines and specialty societies with Australia, including the Royal Australian and New Zealand College of Psychiatrists, which has tried to take a mediating position, and in 2021 affirmed (against the ‘informed-consent’ model) the need for careful psychiatric evaluation and support of gender-conflicted youth. In September 2022, the New Zealand Ministry of Health, recognizing trends in Europe, removed its support of puberty blockers as “a safe and fully reversible medicine” and simply described blockers as “a medicine that can be used to halt the progress of potentially unwanted puberty-related physical changes.”
For more detailed information on several countries, see this summary maintained by French autism advocate Magali Pignard.
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