Divisions have deepened despite, as Reuters recently reported, a lack of “strong evidence of the efficacy” of the treatments at issue and despite their possible long-term consequences. Here is a timeline of major developments this year: 

February 2022

• Attorney General Ken Paxton of Texas issued an opinion concluding that “performing certain ‘sex-change’ procedures on children, and prescribing puberty-blockers to them, is ‘child abuse’ under Texas law.”  

March

• Florida Governor Ron DeSantis signed a bill into law that forbids instruction on sexual orientation and gender identity in kindergarten through third grade, a measure that opponents dubbed the "Don't Say Gay" bill.
  

• The Justice Department’s Civil Rights Division issued a letter to all state attorneys general emphasizing its position that restrictions on transgender medical treatment could violate federal constitutional protections. 

• After Idaho's House passed a bill prohibiting gender reassignment surgeries, puberty blockers, and hormone therapy in connection with transitioning, the Senate killed the bill claiming it undermined parental rights. 
• Republican Governor Doug Ducey of Arizona signed into law a bill prohibiting sex reassignment surgery for those under 18 years old. 

• Republicans in the Senate and House introduced companion pieces of legislation that would “allow individuals who suffered from an irreversible and potentially sterilizing gender-transition procedure as a minor to seek justice in court.” 

August  

• A leaked State Department memo reveals the administration could classify countries permitting conversion therapy as human rights abusers, City Journal reported. 
• The Department of Justice issued a sweeping subpoena to Eagle Forum of Alabama, a nonprofit advocate for Alabama’s contested VCAP law – a move seen by some as chilling since the subpoena required the organization to produce extensive information regarding its promotion of the legislation. Eagle Forum took the Justice Department to court to quash the subpoena, and the Justice Department backed down, dramatically scaling its subpoena to “1%” of its original demands, in the words of the judge presiding over the case.  
• Georgia Republican Rep. Marjorie Taylor Greene introduced legislation that would make providing transgender medical treatment to minors a felony punishable by up to 25 years in prison. 

September

• Democratic Governor Gavin Newsom of California signed into law a bill making the Golden State the nation’s first “sanctuary state” for children seeking transgender treatment without the knowledge or consent of their parents. The governor also signed into law a bill co-sponsored by Planned Parenthood that, according to the California Family Council, “prohibits insurance companies from revealing to the policyholder  the ‘sensitive services’ of anyone on their policy, including minor children ... ” – such services including transgender treatment. 

October

• New York State state Senator Sen. Brad Holyman, a Democrat, introduced a bill that would similarly make New York a sanctuary state for transgender children. 

• Virginia state delegate Elizabeth Guzman, a Democrat, announced she would introduce legislation under which parents could be criminally prosecuted for child abuse should they refuse to affirm their kids’ transgenderism. Amid national blowback over the bill, Guzman quickly recanted. 

• Republican Governor Gov. Kevin Stitt of Oklahoma signed legislation conditioning $108.5 million in federal stimulus funds for the University of Oklahoma’s Children’s Hospital on its ceasing “gender reassignment medical treatment” for minors. The governor also called on Oklahoma to bar “irreversible gender transition surgeries and hormone therapies on minors” during the 2023 legislative session. Gov. Stitt finds himself in an unusually close race with Joy Hofmeister – the state superintendent of education – who switched parties from Republican to Democrat in 2021 to challenge him. 

• Michigan Republican state Rep. Ryan Berman introduced a bill under which doctors, as well as parents or guardians, could face child abuse charges if they “knowingly or intentionally consent to, obtain, or assist with a gender transition procedure for a child” – with a maximum penalty of life in prison. 
• The American Medical Association, American Academy of Pediatrics, and Children’s Hospital Association called on the Department of Justice to police purported social-media threats to doctors and medical facilities by opponents of transgender treatment. 
• 13 state attorneys general, led by Republican Tennessee Attorney General Jonathan Skrmetti, responded to the AMA’s letter to the Justice Department with a letter of their own to Attorney General Merrick Garland, calling for the department to “stand down and allow the national conversation to continue,” citing medical data calling into question the efficacy of transgender treatment.  

Context 

• 46 states and Washington D.C. permit "gender-affirming care" for minors.  

• Four states -- Alabama, Arkansas, Alaska, and Tennessee -- restrict such care for minors. 

• 24 states and Washington D.C. prohibit transgender exclusions from health insurance coverage, whether involving a minor or an adult.

• 26 states and Washington D.C. have Medicaid policies covering such transgender treatment, while 15 states have no explicit policy regarding such coverage and care—but do not prohibit it.   

• Nine states have Medicaid policies explicitly excluding transgender treatment.