Several US state ballot measures are deciding real legal rights for trans people, and the results are binding law. Missouri is asking voters to put a gender-affirming care ban into its state constitution. Arizona, Colorado, and Washington are targeting trans students in sport. Vermont and Virginia are moving toward stronger protections for gender identity and equality.

Something that often gets lost when journalists cover ballot measures: these are not opinion polls. They are not conversations. They are not indicators of the national mood. When they pass, they become law, and law has consequences for specific human beings who wake up the next morning in a different legal reality from the one they went to sleep in.

There are 145 statewide ballot measures across the US on this November ballot, according to Ballotpedia. Many of them are about taxes and voting procedures, which matter enormously. But several of them are about whether trans people, and in particular trans young people, will have access to healthcare, to school sport, to the basic protections of an equal society. Those are the ones I want to talk about.

Missouri: bundling a care ban with an abortion question

Just two years ago, Missouri voters rejected one of the strictest abortion bans in the country. That was a remarkable moment of democratic pushback. Now the Republican-led legislature has put abortion back on the ballot, and this time they have bundled it with a constitutional ban on gender-affirming medical care for minors.

The advertising for the measure, according to NPR's reporting, focuses almost entirely on the gender-affirming care side. That is a deliberate choice. It tells you that the people behind this measure believe that banning care for trans young people is more popular with their target voters than banning abortion. Whether or not that calculation is correct, the result, if the measure passes, is that a ban on gender-affirming care for minors moves from state statute into the Missouri state constitution. That makes it far harder to challenge, far harder to reverse, and far more durable than a law passed in a single legislative session.

The children this affects are not abstract. They are teenagers who are already navigating the particular difficulty of being trans in a state that has not been kind to them. Their access to medical care, to puberty blockers, to hormones that could spare them years of distress, is being put to a popular vote. I find that genuinely difficult to absorb. We do not generally ask voters whether diabetic children should access insulin, or whether anxious teenagers should access antidepressants. The singling-out of gender-affirming care for this kind of democratic referendum is not a neutral act.

Sport bans: Arizona, Colorado, and Washington

Arizona and Colorado both have proposals to ban transgender students from girls' school and college sports. Arizona goes further, extending restrictions into locker rooms and other spaces. Washington state's proposal would require that any student wanting to play girls' sport have their biological sex confirmed by a healthcare provider, specifically through reproductive anatomy, genetic makeup, or endogenously produced testosterone levels.

Read that Washington proposal again slowly. A teenager who wants to play sport with her friends must have a healthcare provider attest to her anatomy, her chromosomes, or her hormone levels. This is not a safeguarding measure; it is a mechanism for institutional humiliation, presented in clinical language. It also sets an impossible and internally inconsistent standard: testosterone levels fluctuate, genetic makeup is rarely tested in ordinary healthcare, and the combination of criteria is designed to create barriers, not to answer a genuine question about athletic fairness.

Trans girls are girls. They have always played sport, often without anyone knowing or caring about their medical history. The sudden political urgency around this issue is not coming from coaches or athletes reporting a problem. It is coming from legislators who have decided that trans young people are a useful wedge issue. The price of that political calculation is paid by real teenagers who just want to run, swim, kick a ball, and belong to a team.

Vermont and Virginia: moving toward protection

Not every ballot measure this cycle is heading in the same direction, and that matters.

In Vermont, voters are considering a constitutional amendment that would include an equal protection clause guaranteeing rights for gender identity and gender expression. That is not a symbolic gesture. Constitutional protections are durable in a way that statutes are not, and for trans people in states where legislatures have shown hostility, a constitutional floor is genuinely meaningful.

In Virginia, voters are being asked to replace old constitutional language banning same-sex marriage with an amendment defining marriage as between any two adults regardless of race, sex, or gender. The old ban is not currently in force, following the 2015 Supreme Court decision, but language matters and constitutional language in particular carries weight. Replacing it with something genuinely inclusive is the right thing to do.

These proposals will not make headlines the way the bans do. Good news rarely does. But they represent something real: the recognition, in law, that trans people and LGBTQ+ people belong fully in the communities they have always been part of.

What the ballot is actually asking

When I look at this landscape as a whole, what strikes me is the asymmetry of what is being risked on each side. In states proposing restrictions, the risk for trans people is access to healthcare, inclusion in sport, and recognition in law. In states proposing protections, the risk for those who oppose them is, at most, that trans people will be treated equally.

The ballot is not an abstract exercise in democratic theory. It will produce laws that affect whether a fifteen-year-old in Missouri can access the healthcare she needs, or whether a twelve-year-old in Arizona can play football with her classmates without her right to be there being questioned by the state. Those are the stakes, and they deserve to be named plainly.

I hope people in these states are voting, and I hope they are thinking about the specific human beings whose lives will be changed by the result.

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

Dr Helen Webberley is a Gender Specialist, Medical Educator, and advocate for trans rights and gender diversity.