January 14, 2026 3:02PM # Federalism and Transgender Care for Minors By [Jeffrey Miron](https://www.cato.org/people/jeffrey-miron) --- SHARE Listen to this article Generated with [ ElevenLabs](https://elevenlabs.io/) AI technology. Loading the [Elevenlabs Text to Speech](https://elevenlabs.io/text-to-speech) AudioNative Player... ![doctor](/sites/cato.org/files/styles/pubs_2x/public/2026-01/doctor%20patient.jpg?itok=W3aKzlCt) As of late 2025, [more than two dozen US states](https://www.cnn.com/politics/state-ban-gender-affirming-care-transgender-dg) had enacted laws that partially or completely ban gender-affirming medical care for minors; roughly half of all transgender adolescents now live in states where such care is restricted or at risk of being banned. In addition, the federal government [recently](https://www.pbs.org/newshour/show/trump-administration-moves-to-restrict-gender-affirming-care-for-minors-nationwide) adopted measures that effectively ban gender‑affirming care for minors nationwide. What are the arguments for and against such policies? On the one hand, states already define and enforce an age of majority, below which minors cannot engage in certain activities even with parental consent. Examples include alcohol or drug use, driving a car, or purchasing a gun. Such restrictions aim to protect minors (and others) from parents who cannot or do not always make the best choices for their offspring. Some people believe transgender care should fall in this category. On the other hand, all states grant parents substantial discretion regarding the risks their minor children undertake. Parents can allow participation in contact sports that [sometimes](https://www.bu.edu/articles/2023/study-tackle-football-at-young-age-raises-risk-for-brain-decline-later/) result in life-altering injuries; they can impose medical care that minor children do not want; they can authorize risky medical procedures when [physicians recommend them](https://www.aan.com/globals/axon/assets/8857.PDF); and [they can withhold](https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/72) medically recommended health care in many non-emergency situations. Some people believe policy should treat transgender care similarly: legally allow it when the minor, parents, and doctors all agree. Thus, regarding state policies, reasoned arguments and precedent exist both for and against restrictions on transgender care for minors. This suggests leaving such policies to individual states: neither side will be satisfied, but there will be reduced polarization. Using federal policies to ban such care nationwide will generate polarization and bitterness. *Cross-posted from* [*Substack*](https://jeffreymiron.substack.com/)*. Jai Glazer, a student at Harvard College, co-wrote this piece.* ##### Related Tags [Regulation](https://www.cato.org/regulatory-studies), [Health Care](https://www.cato.org/health-care) [![Creative Commons License](/build/cato_2020/images/creative-commons.svg)](http://creativecommons.org/licenses/by-nc-sa/4.0/) This work is licensed under a [Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License](https://creativecommons.org/licenses/by-nc-sa/4.0/).