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First · United States

United States

State-by-state hub · federal record

2025–2026

United States

MedicalMixed

Many states have banned or limited sex-rejecting procedures — puberty blockers, hormones of the opposite sex, and surgeries meant to make a child look like the opposite sex. In June 2025 United States v. Skrmetti said those state bans may stand. A federal Medicaid and children’s-insurance (CHIP) rule (CMS-2451-F) stops taxpayer funding for those procedures on minors.

Open the U.S. hub and state grid
Medical status map

click a state for more details.

  • BanStatute in force.
  • RestrictionNarrower than a total ban.
  • Litigation-setbackBan or limit was enacted, then a court blocked it. The statute is on the books; it is not enforced.
  • Proposed billA bill has been introduced. It is not law yet.
  • No banNo statewide medical ban. Shield laws, if any, are in the state summary.
United States map colored by pediatric medical-transition statusEach state uses the same Ban, Restriction, Litigation-setback, Proposed bill, and No ban colors as the alphabetical cards. No ban is solid light gray. Proposed bill is that gray with white stripes. Some No ban states also have a shield law — that detail is on the state card, not a second map color. Litigation-setback states are paper with blue diagonal stripes: a ban or limit was enacted, then a court blocked it. District of Columbia is labeled in an inset. Click a state to jump to its note.Alabama — BanAlaska — No banArizona — RestrictionArkansas — BanCalifornia — No banColorado — No banConnecticut — No banDelaware — No banDistrict of Columbia — No banFlorida — BanGeorgia — RestrictionHawaii — No banIdaho — BanIllinois — No banIndiana — BanIowa — BanKentucky — BanLouisiana — BanMaine — No banMaryland — No banMassachusetts — No banMinnesota — No banMississippi — BanMissouri — BanNebraska — RestrictionNevada — No banNew Hampshire — BanNew Mexico — No banNew York — No banNorth Carolina — BanNorth Dakota — BanOhio — BanOklahoma — BanOregon — No banRhode Island — No banSouth Carolina — BanSouth Dakota — BanTennessee — BanTexas — BanUtah — BanVermont — No banVirginia — No banWashington — No banWest Virginia — BanWisconsin — No banWyoming — BanKansas — Litigation-setbackMichigan — Proposed billMontana — Litigation-setbackNew Jersey — Proposed billPennsylvania — Proposed billDistrict of Columbia — No banDC

Jump to a state

  • Ban · 22
  • Restriction · 3
  • Litigation-setback · 2
  • Proposed bill · 3
  • No ban · 21

Jump to a state

One A–Z grid: all 50 states and D.C. Color is medical status. Full sourced cards are on the hub.

The world

Official medical and school policies — country by country. Click a country for sources.

World medical status map

click a country for more details.

  • BanStatute in force.
  • RestrictionNarrower than a total ban.
  • MixedNo one nationwide medical rule.
  • Proposed billA bill has been introduced. It is not law yet.
  • No banNo medical ban.
World map colored by official pediatric medical statusCountries use Ban (dark blue), Restriction (blue), Mixed (paper with blue diagonal slashes), Proposed bill (gray with white stripes), and No ban (solid gray). The United States paints Mixed. Click a country for that write-up.Afghanistan — No banAlbania — RestrictionAlgeria — No banAngola — No banArmenia — No banAustria — No banAzerbaijan — No banBahamas — No banBangladesh — No banBelarus — RestrictionBelgium — No banBelize — No banBenin — No banBhutan — No banBolivia — No banBosnia and Herzegovina — No banBotswana — No banBrunei — No banBulgaria — No banBurkina Faso — No banBurundi — No banCambodia — No banCameroon — No banCentral African Republic — No banChad — No banChina — No banCôte d'Ivoire — No banCroatia — No banCuba — No banCyprus — No banCzechia — No banDemocratic Republic of the Congo — No banDenmark — RestrictionDjibouti — No banDominican Republic — No banEgypt — RestrictionEl Salvador — No banEquatorial Guinea — No banEritrea — No banEstonia — RestrictionEswatini — No banEthiopia — No banFiji — No banFinland — RestrictionGabon — No banGambia — No banGeorgia — BanGhana — No banGreece — No banGreenland — No banGuatemala — No banGuinea — No banGuinea-Bissau — No banGuyana — No banHaiti — No banHonduras — No banHungary — No banIceland — No banIndonesia — No banIran — No banIraq — BanIreland — No banIsrael — No banItaly — RestrictionJamaica — No banJapan — No banJordan — BanKazakhstan — RestrictionKenya — No banKosovo — No banKuwait — BanLaos — No banLatvia — No banLebanon — No banLesotho — No banLiberia — No banLibya — No banLithuania — No banLuxembourg — No banMadagascar — No banMalawi — No banMalaysia — RestrictionMali — No banMauritania — No banMexico — No banMoldova — No banMongolia — No banMontenegro — No banMorocco — No banMozambique — No banMyanmar — No banNamibia — No banNepal — No banNetherlands — No banNicaragua — No banNiger — No banNigeria — No banNorth Korea — No banNorth Macedonia — No banNorway — RestrictionOman — BanPalestine — No banPanama — No banPapua New Guinea — No banParaguay — No banPhilippines — No banPoland — No banPuerto Rico — BanQatar — No banRepublic of the Congo — No banRomania — No banRussia — BanRwanda — No banSaudi Arabia — RestrictionSenegal — No banSerbia — RestrictionSierra Leone — No banSlovakia — No banSlovenia — No banSolomon Islands — No banSomalia — No banSouth Africa — No banSouth Korea — No banSouth Sudan — No banSri Lanka — No banSudan — No banSuriname — No banSweden — RestrictionSwitzerland — No banSyria — No banTaiwan — No banTajikistan — No banTanzania — No banThailand — RestrictionTimor-Leste — No banTogo — No banTrinidad and Tobago — No banTunisia — No banTurkey — RestrictionTurkmenistan — No banUganda — No banUkraine — No banUnited Arab Emirates — BanUnited Kingdom — RestrictionUruguay — No banUzbekistan — No banVanuatu — No banVenezuela — No banVietnam — RestrictionYemen — No banZambia — No banZimbabwe — No banArgentina — MixedAustralia — MixedBrazil — MixedCanada — MixedChile — MixedColombia — Proposed billCosta Rica — Proposed billEcuador — Proposed billFrance — MixedGermany — MixedIndia — MixedKyrgyzstan — Proposed billNew Zealand — MixedPakistan — MixedPeru — Proposed billPortugal — Proposed billSpain — MixedUnited States — MixedAndorra — RestrictionAntigua and Barbuda — No banBahrain — No banBarbados — No banCabo Verde — No banComoros — No banDominica — No banFrench Guiana — No banGrenada — No banHong Kong — RestrictionKiribati — No banLiechtenstein — No banMaldives — No banMalta — No banMarshall Islands — No banMauritius — No banMicronesia — No banMonaco — No banNauru — No banPalau — No banSaint Kitts and Nevis — No banSaint Lucia — No banSaint Vincent and the Grenadines — No banSamoa — No banSan Marino — No banSão Tomé and Príncipe — No banSeychelles — No banSingapore — RestrictionTonga — No banTuvalu — No banVatican City — Restriction

Dots are listed countries too small for an outline. Scotland’s card is in the Europe list — the island shape is the United Kingdom.

Middle East

Official medical and school policies — country by country. Click for sources.

Country cards below →

Americas

Official medical and school policies — country by country. Click for sources.

United States

MedicalMixed

2025–2026

Many states banned or limited sex-rejecting procedures for minors, the Supreme Court said those state bans may stand, and a federal Medicaid rule cuts funding for those procedures on minors.

Official sources

Mixed: there is no nationwide ban; state law is a patchwork. Skrmetti lets state bans stand; CMS-2451-F is a Medicaid/CHIP funding rule.

  • Puerto Rico

    MedicalBanned

    Puerto Rico bans puberty blockers, hormones, and surgeries for gender dysphoria under 21.

    Open Puerto Rico →

Open hub →

Uruguay

MedicalAffirmingSchoolsCSE in schools

2026

Uruguay’s trans law gives a statutory right to hormones and surgery, including for minors with a legal representative’s consent for irreversible genital surgery.

Official sources

Ley 19.684 gives a statutory right to hormones and surgery, including for minors with a legal representative’s consent for irreversible genital surgery.

Read full update →

Caribbean

Antigua and Barbuda

MedicalAffirming

2026

No data at this time. Please email us at Contact if you have official updates.

Read full update →

Saint Kitts and Nevis

MedicalAffirming

2026

No data at this time. Please email us at Contact if you have official updates.

Read full update →

Saint Vincent and the Grenadines

MedicalAffirming

2026

No data at this time. Please email us at Contact if you have official updates.

Read full update →

Europe

Official medical and school policies — country by country. Click for sources.

Belarus

MedicalRestricted

2010–2025

Belarus only runs official sex-change/correction for adults in state facilities.

Official sources

Restricted: MoH Resolution 163 (9 December 2010, as amended) is an adult-only state pathway — hormones and/or surgery after an interdepartmental commission. Not an all-ages prohibition like Russia 386-FZ.

Read full update →

Croatia

MedicalAffirming

2016

Croatia’s 2016 ministry guidelines allow puberty blockers from early puberty (Tanner stage 2).

Official sources

Ministry of Health expert guidelines (NN 7/2016) set the WPATH (the World Professional Association for Transgender Health)-aligned pathway, including hormones for people with gender dysphoria.

Read full update →

Denmark

MedicalRestrictedSchoolsCSE in schools

2023

Denmark is tightening clinical guidance on puberty blockers; there is no legislative ban.

Official sources

Restricted: Sundhedsstyrelsen is revising 2018 clinical guidance toward psychosocial support first — a clinical limit, not a legislative ban.

Read full update →

Estonia

MedicalRestrictedSchoolsCSE in schools

2023–2025

The Social Ministry–funded hormone guideline requires adulthood before opposite-sex hormones.

Official sources

Restricted: the Social Affairs Ministry-funded hormone guideline requires adulthood (täisealisus) before hormones for sex-rejecting procedures.

Read full update →

Georgia

MedicalBannedSchoolsSchools ban

2024

Georgia forbids surgery or other medical manipulation to assign a sex different from biological sex, for people of any age.

Official sources

Officially banned: Family Values law Article 6 forbids surgery or other medical manipulation to assign a different sex (all ages). Not the U.S. state. Art. 6 has no carve-out that leaves puberty blockers legal.

Read full update →

Greece

MedicalAffirmingSchoolsCSE in schools

2017–2021

Law 4491/2017 lets a person from age 15 change the registered sex after an interdisciplinary medical committee.

Official sources

Law 4491/2017 lets a person from 15 correct the registered sex marker after an interdisciplinary medical committee.

Read full update →

Latvia

MedicalAffirmingSchoolsCSE in schools

2013–2024

Latvia does not perform surgical sex-change on minors.

Official sources

Civil-registry sex-marker change requires a medical certificate of sex change. The national children’s hospital has documented puberty blockers for diagnosed adolescents.

Read full update →

North Macedonia

MedicalAffirmingSchoolsSchools restriction

2013–2025

The health ministry’s 2013 guideline sets an official adult-framed pathway for hormones and surgery.

Official sources

The 2013 Ministry of Health evidence-based-medicine guideline on transsexualism is official medical-pathway guidance, framed for adult sex-change treatment.

Read full update →

Spain

MedicalMixedSchoolsCSE in schools

2026

A Valencian rule on puberty blockers for minors is in court.

Official sources

Mixed: Valencia’s 2025 Ley 8/2017 amendments sit under Constitutional Court suspension.

  • Catalonia

    MedicalAffirmingSchoolsCSE in schools

    No official pediatric medical policy listed.

    Open Catalonia →

  • Spain (Valencia)

    MedicalCourt suspension

    Valencia passed regional rules on puberty blockers for minors; Spain’s Constitutional Court paused them.

    Open Spain (Valencia) →

Read full update →

Vatican City

MedicalRestrictedSchoolsSchools restriction

2024

Holy See teaching in Dignitas Infinita rejects gender theory and sex-change interventions.

Official sources

Restricted: Dignitas Infinita §§55–60 rejects gender theory and sex-change interventions. Disorders of sex development (DSD) correction is named separately.

Read full update →

Oceania

Official medical and school policies — country by country. Click for sources.

Australia

MedicalMixed

2025–2028

Queensland and the Northern Territory paused new public-hospital treatment for minors.

Official sources

Mixed: the federal NHMRC is writing national under-18 gender-dysphoria guidelines. Queensland and the NT paused public-system puberty blockers and opposite-sex hormones; other states and territories still run public clinic pathways. Those cards sit on the Australia hub.

  • Australian Capital Territory

    MedicalAffirming

    The ACT’s paediatric service offers puberty blockers and hormones where it judges that appropriate.

    Open Australian Capital Territory →

  • New South Wales

    MedicalAffirmingSchoolsCSE in schools

    NSW Health’s specialist service offers puberty blockers and opposite-sex hormones to minors where it judges that clinically appropriate.

    Open New South Wales →

  • Northern Territory

    MedicalRestricted

    The Northern Territory paused public-system puberty blockers and opposite-sex hormones under 18.

    Open Northern Territory →

  • Queensland

    MedicalRestricted

    Queensland paused new public-system puberty blockers and hormones.

    Open Queensland →

  • South Australia

    MedicalAffirming

    South Australia commissioned a statewide gender-diversity model of care.

    Open South Australia →

  • Tasmania

    MedicalAffirming

    Tasmania lists a public Gender Service under child and youth health.

    Open Tasmania →

  • Victoria

    MedicalAffirmingSchoolsCSE in schools

    Victoria’s public service assesses under-16s and offers puberty blockers and opposite-sex hormones.

    Open Victoria →

  • Western Australia

    MedicalAffirming

    Western Australia’s public system still assesses teenagers for medical intervention.

    Open Western Australia →

Open hub →

Asia

Official medical and school policies — country by country. Click for sources.

Japan

MedicalAffirming

2003–2022

Japan’s psychiatry society still permits puberty blockers from Tanner 2 and, in defined cases, opposite-sex hormones before 18.

Official sources

The Japanese Society of Psychiatry and Neurology fifth-edition guideline still permits puberty blockers from Tanner 2 and, in defined cases, opposite-sex hormones before 18.

Read full update →

Kyrgyzstan

MedicalProposed billSchoolsSchools restriction

2023–2026

A Jogorku Kenesh first-reading bill (4 June 2026) would ban hormone therapy and surgery to change sex, except congenital DSD. It is not yet law.

Official sources

Proposed bill: Jogorku Kenesh first reading 4 June 2026. The bill would ban hormone therapy and surgery to change sex, except congenital DSD. It is not yet law.

Read full update →

Malaysia

MedicalRestricted

2026

Malaysia’s official public-hospital pathway is disorders of sex development (DSD) correction through a national technical committee.

Official sources

Restricted: Pekeliling Ketua Pengarah Kesihatan 1/2026 sets the official public-hospital pathway as disorders of sex development (DSD) correction through a national technical committee.

Read full update →

Singapore

MedicalRestricted

2025–2026

MOH does not recommend puberty blockers for gender dysphoria. Hormones and surgery should not be offered under 18.

Official sources

Restricted: MOH does not recommend puberty blockers for gender dysphoria. Hormones and surgery should not be offered under 18.

Read full update →

Uzbekistan

MedicalAffirming

1998

Civil-registry sex-marker change needs a health-authority conclusion.

Official sources

Civil-registry sex-marker change is allowed only on the conclusion of health authorities (Family Code Art. 229).

Read full update →

Middle East

Official medical and school policies — country by country. Click for sources.

Iran

MedicalAffirming

2013–2025

Iran allows official sex-reassignment while criminalizing homosexuality.

Official sources

State-sanctioned sex-reassignment (Khomeini-era fatwa lineage; Legal Medicine Organization and family-court process) sits beside Islamic Penal Code criminalization of same-sex acts; the UK Home Office CPIN documents conversion pressure.

Read full update →

Iraq

MedicalBannedSchoolsSchools restriction

2024

Federal Iraq forbids changing biological sex based on personal desire.

Official sources

Banned: Law 15/2024 Art. 2 Third forbids changing biological sex based on personal desire; disorders of sex development (DSD) surgery only after a court order and Ministry of Health instructions.

Read full update →

Kuwait

MedicalBanned

2020

Kuwait forbids operations aimed at changing sex except committee-approved correction when a baby’s sex development didn’t follow the usual path (DSD).

Official sources

Banned: Law 70/2020 Art. 19 forbids operations, surgeries, and medical interventions that would change a person’s sex; disorders of sex development (DSD) correction in ministry hospitals only.

Read full update →

Saudi Arabia

MedicalRestricted

1986–2014

Saudi Ministry of Health informed-consent guidelines list sex changes among forbidden procedures.

Official sources

Restricted: Civil Status Law executive regulation Art. 39 allows a sex-marker change only for medical reasons after a Ministry of Health committee report.

Read full update →

Turkey

MedicalRestricted

2025

Turkey’s medicines agency told doctors not to prescribe testosterone, puberty blockers, or listed oestrogens to change sex under 21.

Official sources

Restricted: TITCK/MoH under-21 bar on prescribing testosterone, puberty blockers (GnRH analogues), and ≥2 mg oestrogen for sex-change / gender-incongruence transition. Other medical indications remain. TTB confirms by suing to annul it.

Read full update →

Africa

Official medical and school policies — country by country. Click for sources.

Central African Republic

MedicalAffirming

2026

No data at this time. Please email us at Contact if you have official updates.

Read full update →

Democratic Republic of the Congo

MedicalAffirming

2026

No data at this time. Please email us at Contact if you have official updates.

Read full update →

Egypt

MedicalRestricted

2003

Egypt forbids sex-change operations except committee-approved correction for conditions where a baby’s sex development didn’t follow the usual path (DSD).

Official sources

Restricted: MoH Res. 238/2003 Art. 43 is a medical-ethics rule forbidding sex-change operations; syndicate-approved sex-correction for disorders of sex development (DSD) only. Not a parliamentary statute.

Read full update →

Equatorial Guinea

MedicalAffirming

2026

No data at this time. Please email us at Contact if you have official updates.

Read full update →

Republic of the Congo

MedicalAffirming

2026

No data at this time. Please email us at Contact if you have official updates.

Read full update →

São Tomé and Príncipe

MedicalAffirming

2026

No data at this time. Please email us at Contact if you have official updates.

Read full update →

What the labels mean

Medical

  • Ban (U.S.) / Banned (countries) — a law or rule stops doctors from giving children drugs or surgery to reject their sex
  • Restriction (U.S.) / Restricted (countries) — not a full stop. Care is limited (research only, public hospitals only, or rare exceptions)
  • Litigation-setback — a ban passed, then a court put it on hold (U.S. map: blue stripes)
  • No ban — no official ban or limit (U.S. map: light gray)
  • Affirming — no official pediatric medical policy listed. That is not evidence that children are being given drugs or surgery
  • Mixed — no one nationwide medical rule
  • Under review — officials are reviewing the evidence
  • Proposed bill — a bill has been introduced; it is not law yet. The card names the bill
  • Court suspension — a rule exists but a court paused it

Schools

  • Schools ban / Schools restriction — official school limits (not medical)
  • Schools proposed — a school bill, not a school law yet
  • Schools mixed — official school sources pull in more than one direction
  • Schools court strike — a court struck down a school law
  • CSE in schools — required or expanded comprehensive sex education (broad sex-ed lessons, often including gender ideology)

Terms

  • DSD — conditions where a baby’s sex development didn’t follow the usual path. Some laws still allow medical correction for those conditions — not a sex-change for gender identity
  • Puberty blockers — drugs that block a child’s puberty
  • Sex-rejecting procedures — puberty blockers, hormones of the opposite sex, and surgeries meant to make a child look like the opposite sex

Medical and school rules are separate.

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