Arizona Legislature Passes Bill Banning Gender-Affirming Care for Minors in Phoenix Session

The Arizona Legislature passed Senate Bill 1138 during its Phoenix session, banning gender-affirming care, including surgeries and hormone treatments, for minors effective March 31, 2023. Officials said the law aims to prohibit irreversible gender transition procedures for individuals under 18 and subjects healthcare providers to disciplinary action for violations.

Senate Bill 1138, known as the “Arizona’s Children Deserve Help Not Harm Act,” amends the Arizona Revised Statutes Title 32 by adding section 32-3230, effective March 31, 2023. The law prohibits physicians from providing irreversible gender reassignment surgeries, including procedures that sterilize, mastectomy, and other surgeries that remove healthy body parts, to individuals under 18 years old. It also bans the use of puberty blockers, cross-sex hormones, testosterone to females, and estrogen to males for minors, according to official legislative documents.

The bill further restricts the Arizona Health Care Cost Containment System, commonly known as Medicaid, from reimbursing gender transition procedures for those under 18.

Any healthcare provider who refers or provides gender transition procedures to minors is subject to disciplinary action by licensing boards for unprofessional conduct, records show. The effective date was delayed to allow minors currently receiving puberty blockers or cross-sex hormones to taper off these medications under physician supervision.

Before SB 1138, a 2022 law (A.R.S. § 13-3623(E)) criminalized certain sex reassignment surgeries for minors but did not explicitly ban referrals or hormone treatments. The new law closes those gaps by explicitly banning all gender-affirming care (GAC) procedures for minors and prohibiting public funds for such care regardless of age. It also makes gender transition surgeries non-tax deductible under the bill’s provisions.

The Arizona Legislature cited studies indicating that most gender-nonconforming children identify with their biological sex by adolescence or adulthood, according to legislative findings. The bill’s supporters framed the law as a measure to protect vulnerable children’s health and safety. The Center for Arizona Policy, a conservative advocacy group, endorsed the ban, citing international reversals of gender-affirming care policies and public polling that indicates a trend toward traditional heterosexual identity among young Americans.

Opponents of the bill, including Sen. Lauren Kuby, a Democrat, called the ban “cruel and dehumanizing” for minors who rely on these treatments. Michael Soto, president of Equality Arizona, said the combined effect of the U.S. Supreme Court ruling, a Trump-era executive order, and Arizona’s law leaves transgender youth with only mental health support, effectively eliminating access to medical gender-affirming care.

SB 1138 builds on prior legislative efforts, including Senate Bill 1095, which proposed cutting off hormone treatments for minors already receiving care, despite surgeries being illegal since 2022. Other related measures passed in the session restrict school bathrooms and locker rooms to birth-assigned gender and require parental approval for students’ preferred pronouns. Additionally, doctors performing gender transition procedures may face personal liability for detransition costs incurred within 25 years, according to legislative records.

The law’s enforcement has created uncertainty about referrals to out-of-state providers, as the statute does not explicitly permit such referrals. The Arizona Medical Board may interpret the law as prohibiting referrals, sources confirmed. In response, Phoenix Children’s Hospital suspended gender-affirming care indefinitely, and Planned Parenthood of Arizona followed suit two months later.

By January 2024, Arizona was among 24 states imposing penalties on practitioners providing gender-affirming care to minors, according to data compiled by advocacy organizations. More than half of U.S. states have considered or enacted similar bans, many of which are being challenged in court. Seventeen states currently face lawsuits contesting restrictions on youth gender-affirming care.

Nationally, Arkansas became the first state to pass such a ban in 2021. Since then, the number of states with laws or policies restricting gender-affirming care for minors has increased more than five-fold, with many provisions under legal challenge. The Center for Arizona Policy noted that several countries have reversed gender-affirming care policies, aligning with trends in the United States.

The Arizona law’s provisions took effect on March 31, 2023, allowing a transition period for minors already receiving puberty blockers or hormones to discontinue treatment under medical supervision. The law remains in effect indefinitely, with no sunset clause.