Colorado's surgical ban could disrupt all healthcare for trans youth

Colorado's Proposition 135 would ban surgeries on minors that alter biological sex characteristics and strip state and Medicaid funding from those procedures. Because the language is broad and vague, providers and advocacy groups warn it could disrupt far more than the rare gender-affirming surgeries it targets, potentially preventing trans young people from accessing any surgical care at all if gender comes up in conversation with their doctor. The Colorado Medical Society opposes it on the grounds that it interferes with clinical judgement, and a Harvard study found that cisgender teenagers receive the same procedures at far higher rates than trans youth.

What Proposition 135 would actually do

The measure prohibits health care professionals from knowingly performing any surgery on a minor "for the purpose of altering biological sex characteristics." It also strips state and Medicaid funding from those procedures. The word "irreversible" did a lot of work in the earlier framing of this debate, carrying an implication that is hard to argue with on its face, because who would vote for irreversible harm to a child? That framing is doing exactly what it is designed to do: it takes a complex, carefully considered medical decision and reduces it to something that sounds reckless.

But now a new and sharper concern has emerged from people who understand how medicine actually works. The problem is not just what the measure targets. It is what the measure cannot help but catch in the process.

The language is the problem

Jax Gonzalez, political director at One Colorado and someone who is trans, put the difficulty plainly. The measure's language around a minor's "perception of sex or gender" is unclear enough that providers cannot tell what it permits. "All of us have gender and have lots of ideas about that," Gonzalez said, "and so, does that mean that if a patient brings up a conversation about their own gender, regardless of their general identity, does that mean that that provider can't treat them anymore?"

That is not a hypothetical designed to score points. It is a real clinical question with no good answer in the text of the measure. And when providers cannot answer it, they do what any reasonable person does in the face of legal uncertainty: they stop. Not just for the procedures the measure named, but for anything that feels adjacent, anything that could be misread, anything that might later become a liability.

Dr Mary Fairbanks, a retired family physician who worked with trans patients throughout her career, said the proposition does not name specific procedures but bans surgeries by approach, creating confusion about what is permitted. She worried it could disrupt the ability for young trans patients to receive any kind of surgery if discussion of their gender identity comes up in a conversation with their provider. "Any policy that interferes with the practice of medicine will cause trouble," she said. I do not think that is an overstatement.

Who the surgeries are actually happening to

Gender-affirming surgeries for minors happen very rarely, and only in cases where a young person is experiencing serious distress, after years of therapy, family involvement, and consultation with multiple clinicians. A 2024 Harvard study reviewed insurance claims data and found that no trans young person aged 12 or under received surgery as part of their gender-affirming care. For teenagers aged 15 to 17, the rate was 2.1 per 100,000 trans or gender-diverse individuals.

The same study found that 97% of breast reduction procedures performed on teenagers were for cisgender boys. The surgeries that Proposition 135 is written to ban are, by the numbers, overwhelmingly performed on cisgender young people. The measure's authors either did not know that or did not think it mattered. Either way, the people writing these laws do not appear to understand what they are banning, and that gap between intent and language is exactly where collateral damage lives.

A father who just wants to protect his daughter

Chris Cook lives in Thornton, Colorado. He has a transgender daughter. The decisions his family made about her care were made privately, carefully, and with a medical professional. He stood at the State Capitol and said what any parent would say: "I want to protect my daughter. I want to protect the decisions that she makes that we make as a family with our medical professional. The government should not get between us in these decisions at all."

That is not a political statement, it is a father talking about his child. And the thing that strikes me every time I hear a story like his is how ordinary it is. A family that sat down together, found the right doctor, asked the right questions, and made the best decision they could. That is what families are supposed to do.

The medical profession is not on board

The Colorado Medical Society's board voted to oppose Proposition 135 because it would interfere with the independent clinical decisions physicians make based on the needs of each patient. Its board president, Dr Sean Pauzauskie, was direct: "Our CMS members have diverse political views, but share one core principle, and that's that medical decisions belong in the exam room." The society made clear that its opposition is not specific to gender-affirming care; it would oppose any government interference with clinical judgement.

That matters. When more than 6,000 physicians across specialties oppose a measure on principle, not on politics, that tells you something about what the measure actually does.

Meanwhile, the two major hospitals that historically provided gender-affirming care to minors in Colorado no longer offer it. Children's Hospital Colorado never provided gender-affirming surgeries for minors; families of several trans children sued it following its cessation of other care, with a trial set for January. Denver Health stopped offering gender-affirming surgeries for youth and paused all other forms of gender-affirming care for minors following what its spokesperson described as "escalating actions" from the US Department of Health and Human Services. The federal pressure started before this ballot measure; the measure would lock it in as state law.

What is being protected, and what is being lost

The coalition behind Proposition 135 calls itself Protect Kids Colorado. The reasoning it offers is that restricting care helps "vulnerable children develop the skills necessary to make an informed decision when they're 18." I understand the surface appeal of that framing. Nobody wants a child to make a decision they will regret. But waiting until 18 is not a neutral act. Puberty continues. Every month of an unwanted one is a permanent physical change. Telling a teenager to wait while their body does something they did not choose is not protection; it is a different kind of harm, slower and quieter, but real.

Dr Fairbanks said something that has stayed with me. She described prescribing gender-affirming medications to trans women, and how many of her patients told her they felt normal for the first time in their lives. "To be able to make someone feel normal is an amazing gift, and so I'm grateful that I've been able to do that for some folks," she said.

She also said she was "baffled" by the hostility directed at trans people, in part because they represent such a small proportion of the population. "Someone who's transgender really isn't trying to impact other people. They just want to live their lives."

That is the plain truth of it. And the question Colorado voters face is whether to pass a law whose language is so imprecise that it threatens the medical care of the very children it claims to protect, along with many others who were never part of the conversation at all.

If there is a news story you would like me to cover then just let Sammy know.

Dr Helen Webberley is a Gender Expert, Medical Educator, and founder of GenderGP. She writes about gender diversity, trans healthcare, and the lives of trans people and their families.