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Medical school is hard enough, but Charlie Adams’s existence was on the line, so he took a day off from clinic rotations in Kansas City and drove three hours to the Missouri Capitol.

Republican legislators had proposed nine bills to restrict transgender rights. Two sought to limit the definition of sex. <a href="https://legiscan.com/MO/drafts/HB1519/2024" target=_blank>Another</a> gave doctors the right to discriminate against trans people. And four aimed to keep them out of the bathrooms that match their identities.

Adams, 27, has a full beard and a deep voice, and as he spoke recently to a committee of legislators, a patch of chest hair peeked out from his navy blue scrubs.

“Do you want to see me in the women’s restroom next time you’re at the hospital?” he asked.

Adams spoke for two minutes, thanked the legislators, then scurried out. He had eight more bills to fight.

The legislation in Missouri is part of <a href="https://www.aclu.org/legislative-attacks-on-lgbtq-rights-2024?mc_cid=692d0d1add&mc_eid=ce4f843251" target=_blank>a record number</a> of proposals that could significantly reshape the way transgender people live their lives. Republican-dominated legislatures have already enacted more than 100 laws to limit LGBTQ+ rights over the past few years, but most affected adolescents and schools. Now, policymakers are increasingly turning their focus to adults.

Christopher Smith

Lawmakers in<a href="https://www.legis.iowa.gov/legislation/BillBook?ga=90&ba=HSB649&" target=_blank> Iowa</a>, West Virginia and other states have introduced bans on transgender people using bathrooms that align with their gender identity. Officials elsewhere are attempting to narrowly define sex in a way that will leave trans people misgendered on official documents. The head of Florida’s Department of Motor Vehicles announced in late January that the agency will no longer allow trans adults to change the gender markers on their licenses and threatened criminal charges for those who don’t comply.

So far, no legislature has outright prohibited adults from transitioning, but last year, Florida passed the nation’s first health-care restrictions for trans adults, and some within the Republican Party believe other states will soon follow its lead. A handful of legislators have said they don’t believe in the care or hope to eradicate it completely.

The lawmakers pushing the bills universally contend there should be limits on how far society goes to embrace transgender adults. Some do not believe in the concept of having a gender identity different from one’s biological sex.

“There is no such thing as gender-affirming care,” Ohio state Sen. Kristina Roegner (R) <a href="https://www.ohiochannel.org/video/ohio-senate-1-24-2024?start=2235" target=_blank>said</a> in a January speech on the Senate floor. “You can’t affirm something that doesn’t exist.”

Adams said he is “overwhelmed, scared and angry.”

“Even if most of the proposed bills don’t pass, the constant vilifying of us is already doing damage,” Adams said. “I used to think if I could get into the rooms and organizations I’m in now, if I could only share the stories of all the amazing trans people I know, and if they got to know me as a colleague, they would understand we’re just people and our rights are worth protecting. But I’m learning lately that that may not be enough.”

State legislators largely left trans people undiscussed until 2016, when, less than a year after the Supreme Court legalized same-sex marriage nationwide, North Carolina passed the nation’s first bathroom-restrictions bill.

The legislation was hugely unpopular. The NBA pulled its All-Star Game from the state, the NCAA withdrew a number of sporting events, and several musicians, including Bruce Springsteen and Pearl Jam, canceled concerts there. All told, the legislation <a href="https://www.washingtonpost.com/news/post-nation/wp/2017/03/27/north-carolinas-bathroom-bill-cost-the-state-at-least-3-7-billion-new-analysis-finds/" target=_blank>cost the state $3.7 billion</a>, and the governor who had signed the bill lost his reelection campaign.

Still, conservative strategists believed trans bills could become a political winner. In <a href="https://www.splcenter.org/hatewatch/2017/10/23/christian-right-tips-fight-transgender-rights-separate-t-lgb" target=_blank>meetings</a> and <a href="https://www.motherjones.com/politics/2023/03/anti-trans-transgender-health-care-ban-legislation-bill-minors-children-lgbtq/" target=_blank>emails</a>, they described a game plan that started by restricting participation in sports, then ramped up to banning gender transition care for adolescents.

Though <a href="https://www.pewresearch.org/short-reads/2022/09/15/how-americans-view-policy-proposals-on-transgender-and-gender-identity-issues-and-where-such-policies-exist/" target=_blank>polls have found that Americans are split</a> on how they view gender transition care for minors, the bills have passed with increasing ease. States began trying to ban the treatments in 2020, but the bills all died without becoming law. Arkansas passed the first youth health-care ban in 2021. Alabama approved the second in 2022, and last year another 21 states followed suit. District courts have enjoined many of those, but appeals courts in Cincinnati and Atlanta have <a href="https://www.washingtonpost.com/dc-md-va/2023/11/01/transgender-care-ban-tennessee-supreme-court/" target=_blank>allowed them to take effect</a>.

As state after state prohibited gender transition care for young people, conservative policymakers said they were concerned that adolescents’ brains weren’t developed enough to decide to take puberty blockers or cross-sex hormones. Adults, the lawmakers said, could do whatever they wanted.

Then, in April 2023, Missouri Attorney General Andrew Bailey (R) went a step further and announced new regulations that advocates said essentially banned the care in the state for everyone, even adults.

The ruling terrified Adams. He asked his pharmacist to give him as much testosterone as he legally could, but that only covered three months. Other trans people went online to find hormones illegally, and Adams researched those options, too. Going off testosterone was “not an option,” he said, and he planned to do whatever he could to stay on it.

“I’m not going back,” he said. “My life before testosterone, I was not happy. And now I finally get to live a good life. I have come so far and found so much happiness. The thought of detransitioning because of lack of access is the worst thing that could possibly happen to me.”

Bailey eventually backed off after the courts got involved. But a few weeks later, in May, Florida legislators passed their own adult restrictions.

In <a href="https://flsenate.gov/media/VideoPlayer?EventID=1_s8dpcxna-202303131530&Redirect=true" target=_blank>session</a>, the bill’s Republican sponsor described it as a measure to protect children. But seven pages into the <a href="https://www.flsenate.gov/Session/Bill/2023/254/BillText/er/PDF" target=_blank>bill</a>, he also outlined new regulations that cut thousands of trans adults off their hormones. From now on, the law stipulated, trans adults could only receive hormones from a medical doctor who sees them in person.

Because <a href="https://www.kff.org/other/issue-brief/trans-people-in-the-u-s-identities-demographics-and-wellbeing/#:~:text=About%20Four%20in%20Ten%20Trans,Share%20Among%20Non%2DTrans%20Adults&amp;text=Income.,higher%20unemployment%20(see%20below)." target="_blank">more than half of trans people</a> are low-income and nurse practitioners are cheaper than doctors, clinicians and activists <a href="https://www.losangelesblade.com/2023/05/11/trans-patients-being-dropped-as-florida-law-bans-up-to-80/" target="_blank">say</a> roughly 80 percent of trans adults in Florida were getting hormones from nurses, a standard medical practice the law banned. Others saw doctors through telehealth services.

Spike Poma, an intersex trans man from Polk County in Central Florida, had been getting testosterone from a Planned Parenthood nurse practitioner for four years, but after the bill passed, he said, the clinic canceled his prescription.

Seven months later, Poma still has not been able to access testosterone, and he is struggling with numerous health problems because of it.

“Life isn’t living,” he said. “It’s just surviving at this point.”

Nearly every red state passed a sports or health-care ban for minors last year, and now lawmakers are using similar language to reach into other avenues of life.

Last year, four predominantly Republican state legislatures — Kansas, Montana, North Dakota and Tennessee — <a href="https://www.lgbtmap.org/img/maps/citations-defining-sex.pdf" target="_blank">passed laws</a> narrowly defining sex in a way that not only makes it harder for trans adults to update their legal documents but also erodes their protections against discrimination in housing and governmental programs. The GOP governors of Nebraska and Oklahoma made similar changes by issuing executive orders, and <a href="https://www.aclu.org/legislative-attacks-on-lgbtq-rights-2024?impact=75152" target="_blank">13</a> others are considering comparable bills.

In late January, Republican Iowa Gov. Kim Reynolds introduced a bill that would prohibit trans people from updating their driver’s license unless they have surgery. (Last year, a Post-KFF poll <a href="https://www.washingtonpost.com/dc-md-va/2023/03/23/transgender-adults-transitioning-poll/" target="_blank">found</a> that only 1 in 6 trans adults has had gender-affirming surgery.) Those who do would have to list both their sex assigned at birth and their gender identity.

“Just like we did with girls’ sports, this bill protects women’s spaces and rights afforded to us by Iowa law and the constitution,” Reynolds said in a statement.

Chuck Liddy

Jon Cherry

Other states are considering proposals to create what trans people describe as “registries.” <a href="https://myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=80354&" target=_blank>In Florida</a>, every resident would have to sign an affidavit certifying that the sex listed on their driver’s license is the sex they were assigned at birth. And in Ohio, the governor issued <a href="https://odh.ohio.gov/about-us/offices-bureaus-and-departments/ogc/draft-rules/draft-rule-3701-3-17,%203701-59-07,%203701-83-61" target=_blank>a draft order</a> this month that would require health-care professionals to report every time they diagnose someone as trans, prescribe cross-sex hormones or perform a gender reassignment surgery. According to the governor’s rules, those reports will be sent to the General Assembly.

Cam Ogden, a trans woman who co-runs the advocacy group Trans Allies of Ohio, said she worries the data will be used in bad faith. Republicans have a supermajority in the Ohio House and Senate, and they have proposed six bills to limit trans rights this session.

“The General Assembly hasn’t exactly been passing legislation to protect trans people the last few years,” Ogden said. “If the data is intended to help the legislature, the only way it can is to help them attack us further.”

Logan Casey, a trans Missourian who works as the senior researcher at the independent think tank Movement Advancement Project, said the number and diversity of bills can be mind-boggling to track.

“We’re under attack across virtually every aspect of our lives, and each new day is bringing with it some new escalation,” Casey said.

Indeed, as major corporations have backed away from boycotts, Republicans are returning to bathroom bills similar to the one North Carolina abandoned in 2016. Utah <a href="https://www.sltrib.com/news/politics/2024/01/30/utah-transgender-bathroom-ban-goes/" target=_blank>passed</a> one in late January, and Missouri legislators are still looking for a way to pass one of theirs.

Missouri state Rep. Mark Matthiesen, a Republican who sponsored one of four bathroom bills, said he decided to act after a group of women in conservative St. Charles County told him they don’t feel safe sharing the locker room at a local pool with trans women.

As more trans people <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808707" target=_blank>undergo medical interventions</a>, Matthiesen said, and as workplaces have offered them greater protections, “conservatives are finally standing up and saying, no, we can’t be part of this. Enough is enough. This has gotten out of hand, and we’ve got to stop promoting it.”

Matthiesen said he has received hate mail from “liberal women all over St. Louis,” but he doesn’t fear the kind of boycotts North Carolina faced six years ago. In fact, he said, conservatives are more likely to boycott a company such as Bud Light if they “virtue-signal too far,” as they did last year, he said, when the beer company partnered with a trans woman in a social media promotion.

Still, Matthiesen said his bill is unlikely to pass in its current form. <a href="https://reports.hrc.org/2023-state-equality-index" target=_blank>According to the LGBTQ+ advocacy group Human Rights Campaign</a>, nearly 90 percent of proposed anti-LGBTQ+ bills died last year without becoming law.

“Even the conservatives want to give the liberals their ability to run their own lives,” Matthiesen said. “One of the main oppositions to my bill has to do with private property rights. I’m trying to regulate what a private business can do and allow.”

Matthiesen said he is studying Utah’s bill to craft a new version that limits the regulation to government buildings and other public spaces.

Adams said he is unsure what he’ll do if the law goes through. He suspects he could keep using the men’s room without drawing suspicion.

“But I’ll be breaking the law if I do that,” he said. “If I do go into the women’s restroom, I’m going to freak people out. But I’ll be following the law. Then there’s a good chance I could get beaten up. They may think I’m a man trying to sneak in the women’s restroom. But how do I prove to them that I’m a trans man? I’m not going to drop my pants or have my birth certificate with me there.”

Late last month, Republican state legislators from Ohio and Michigan talked about the future of gender transition care in <a href="https://twitter.com/i/spaces/1eaKbgwLQNYGX?s=20" target=_blank>an audio discussion via the social media site X</a>. (Erin Reed, an independent researcher who tracks anti-LGBTQ+ legislation<a href="https://www.erininthemorning.com/p/ohio-michigan-republicans-in-released" target=_blank> first reported</a> the conversation.)

The event was billed as a discussion about minors, and the legislators invited Prisha Mosley, a woman who began taking testosterone at 17, then later detransitioned. Mosley <a href="https://www.documentcloud.org/documents/23882834-prisha-mosley-complaint" target=_blank>sued</a> her doctors in North Carolina last year and has accused them of lying and telling her testosterone would cure “her numerous, profound mental and psychological health problems,” including borderline personality disorder and trauma from sexual assault.

As the legislators talked, Michigan state Rep. Josh Schriver (R) suggested they should not stop at banning the care for young people.

“In terms of endgame, why are we allowing these practices for anyone?” Schriver said. “If we are going to stop this for anyone under 18, why not apply it for anyone over 18?”

Ohio state Rep. Gary Click (R), who led his state’s successful campaign to ban care for minors, cautioned that lawmakers might have to “take small bites” to “get any legislation across the finish line,” but told Schriver his comments were a “very smart thought.”

Click told The Washington Post he was trying to be polite, not suggesting that he intends to pass additional legislation. Though Click has criticized Planned Parenthood and other clinics that offer hormones without requiring mental health assessments, he said he believes adults should be able to do whatever they want.

Another Michigan Republican state legislator, Rep. Brad Paquette, later <a href="https://michiganadvance.com/2024/01/30/michigan-gop-lawmaker-defends-trans-health-care-discussion/" target=_blank>told</a> the nonprofit news site Michigan Advance he agreed that gender transition harms adults and had subsequently sent a letter to every hospital that treats trans patients to learn more.

Still, one prominent conservative strategist says he doesn’t expect states will pursue full health-care bans for adults anytime soon. Terry Schilling, executive director of the American Principles Project, a conservative nonprofit that raises money for anti-trans legislation, said adult bans seem so far-fetched, his group hasn’t even poll-tested them.

But, Schilling said, many state legislators came away from public hearings about minors concerned about the overall landscape of gender care. A <a href="https://www.nytimes.com/2023/05/16/us/politics/transgender-care-detransitioners.html" target=_blank>small number of detransitioners </a>traveled state to state to say they regretted taking hormones and having surgeries to reshape their bodies.

“They’re acknowledging that there was harm done to these kids, and now they’re thinking, well, the harm is actually also being done to these adults, too,” Schilling said.

Schilling said he expects “many more states” to follow Florida’s lead in passing restrictions. Ohio Gov. Mike DeWine (R) proposed a similar set of regulations in January, but he abandoned them last week. His spokesman told The Post that the governor is focused on “protecting children” and issuing rules “where there was consensus.” After reviewing nearly 4,000 public comments, the spokesman said, the governor decided to redraft his proposal.

Still, trans Ohioans say they fear lawmakers will try again. Republican legislators tried three times to pass a health-care ban for adolescents before ultimately succeeding in late December.

“This is far from the end,” Ogden, of Trans Allies of Ohio, said.

None of the nine Missouri bills have become law yet, but late last month, while Adams was working a rotation, a committee passed a measure that would allow doctors to refuse to treat trans patients. Of all the bills that target adults, Adams said that one might hurt the most.

“We take an oath,” Adams said. “I would without hesitation treat any person regardless of their beliefs, and I did when I worked in the ER. It hurts that even though all my intentions are good, even for someone who hates me, and I’d never want them denied care, they are trying to make it legal for people to deny me care.”

An earlier version of this article incorrectly stated that Prisha Mosley transitioned as an adult. According to court documents, she began taking testosterone at 17 and had surgery at 18. The article has been corrected.

Trans adults on edge as legislatures broaden focus beyond children