Colorado and Missouri Vote on Medical Treatments for Transgender Minors
October 7, 2026 by
On November 3, voters in two states will decide whether to restrict medical treatments related to gender transition for people under 18. The two measures ask a similar question but answer it in different places. Colorado’s Proposition 135 would prohibit surgery. Missouri’s Amendment 3 would prohibit surgery and puberty-blocking drugs and cross-sex hormones. Nearly everyone in this debate agrees that some decisions should wait until adulthood. The disagreement is over which ones, who gets to decide, and what the evidence shows.
What Is Being Proposed?
Colorado’s Proposition 135, titled “Prohibit Surgery on Minors in Response to Perception of Sex or Gender,” would change state statute rather than the state constitution.1 The measure would prohibit a health care professional from knowingly performing surgery on a minor for the purpose of altering the minor’s biological sex characteristics, and it would bar state or federal funds and insurance coverage from paying for such surgery.2 It does not address puberty blockers or hormones. It is sponsored by Protect Kids Colorado, a coalition led by parent activist Erin Lee, which also sponsored Proposition 134 on transgender youth in school sports.3
Missouri’s Amendment 3 is a constitutional amendment referred to the ballot by the legislature. Most of its text concerns abortion: It would repeal the reproductive-rights amendment voters approved in 2024 and replace it with a ban that includes limited exceptions. One provision, however, would also “prohibit gender transition procedures for minors.”4 Missouri already does this by statute. Senate Bill 49, in effect since August 2023, bars health care providers from performing gender transition surgeries on minors or prescribing cross-sex hormones or puberty-blocking drugs to them, and a provider who does so can lose a license.5 The statute’s minors provision is scheduled to expire in August 2027; Amendment 3 would write the ban into the constitution, where a future legislature could not remove it without another statewide vote.6
Two facts shape how each measure is understood. In Colorado, the measure would not change current practice: The state’s nonpartisan Legislative Council Staff reports that the three large pediatric surgical providers—Children’s Hospital Colorado, Rocky Mountain Children’s, and Denver Health—do not perform these surgeries on transgender patients under 18, and it projects the measure’s fiscal impact as minimal.7 Children’s Hospital has said it never has. Protect Kids Colorado’s own materials say the surgery ban is one step in “a multi-pronged plan to outlaw puberty blockers and cross-sex hormones for minors as well.”8 In Missouri, polling suggests the minors provision is the amendment’s strongest selling point. A February SLU/YouGov survey found 67% of Missourians opposed gender transition medications for minors and 73% opposed surgeries.9 The campaign has followed the numbers: Yard signs for the amendment emphasize the ban on gender-affirming surgery, and one television ad does not use the word “abortion” at all.10 An August SLU/YouGov poll found 43% of likely voters supporting the amendment.11
A Dispute Over What the Words Cover
Much of the Colorado argument is about the measure’s text rather than its purpose. The prohibited act is surgery, but the definition of “health care professional” reaches across the healing arts, including podiatrists, dentists, chiropractors, pharmacists, and mental health therapists—none of whom perform surgery—and the language includes terms such as prescriptions that are not obviously about surgery.12 Opponents read this as a sign the measure will not stay contained; they also argue that a phrase like “any surgery to alter biological sex characteristics” could be read to cover procedures on non-transgender children for medical or cosmetic reasons.13 Supporters answer that the measure does exactly what its title says. As Protect Kids Colorado Board Director Lori Gimelshteyn put it, the group’s aim is to protect children 17 and under from irreversible sex-change surgery so that they can “develop the skills necessary in order to make an informed decision.”14 The nonpartisan Blue Book analysis lands between them. It notes the measure “may also limit other surgeries for minors, including non-transgender minors,” if a treatment is interpreted as responding to a minor’s perception of sex or gender, but it also states that the measure allows circumcision and treatment of medically verifiable disorders of sex development, and that counseling and social transition are not restricted.15 Both campaign readings have some footing: the act banned is narrow, the class of people bound is wide, and the hardest questions concern surgeries at the edges of the definition rather than mental health care.
Arguments in Favor of the Restrictions
Supporters’ central argument is about consent and permanence. Societies set age limits for voting, drinking, and signing contracts, they note, and a decision that permanently alters the body belongs on that list. Jon Caldara, president of the libertarian Independence Institute, wrote that he “struggled with how to vote” because he is “suspicious whenever government barges into a family’s decisions,” but concluded that Proposition 135 “draws its line at the permanent removal of body tissue. That distinction matters.”16 The Gazette editorial board, endorsing the measure, compared it to laws barring alcohol and vape sales to minors and requiring seatbelts: “It’s all because kids can’t protect themselves and sometimes, the adults around them don’t act responsibly to protect them, either.”17 The most prominent young voice on this side is Chloe Cole, who underwent a double mastectomy at 15 and later detransitioned. Testifying before the Senate Health, Education, Labor and Pensions Committee in June, she said, “I still very much was a child myself,” adding, “No child can consent to being sterilized.”18
Supporters also argue the evidence base for these treatments is weak. A May 2025 review by the U.S. Department of Health and Human Services concluded that existing evidence cannot support claims that puberty blockers, cross-sex hormones, and surgeries are effective at reducing gender dysphoria or improving mental health, and that some harms are likely consequences of treatment; the review recommended psychotherapy as the first approach.19 In Missouri, state officials frame the question as the legislature’s authority to protect children. After the state Supreme Court unanimously upheld SB 49 in January, Attorney General Catherine Hanaway called the ruling “a landmark victory for Missouri families” that “confirmed the legislature’s authority to safeguard the health and well-being of our state’s most vulnerable citizens.”20 State Rep. Brian Seitz, the Branson Republican who guided the amendment through the House, has argued that gender transition treatment is itself a reproductive issue because some procedures can affect a minor’s future ability to have children.21
Arguments Against the Restrictions
Opponents answer the consent question with a different decision-maker: not the child alone, but the child, the parents, and a physician together. Chris Cook of Thornton, Colorado, whose daughter is transgender, told a rally at the state Capitol, “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.”22 Nadine Bridges, co-chair of the Families Not Politics coalition and executive director of One Colorado, argued that the measures “put the government in place of families and providers and young people to make private decisions.”23
Opponents also dispute the evidence claims. The American Academy of Pediatrics responded to the HHS review within hours. “This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care,” said AAP President Susan Kressly, adding that the AAP was not consulted and that the report “prioritizes opinions over dispassionate reviews of evidence.”24 On scale, opponents point to a 2024 study in JAMA Network Open, which found no gender-affirming surgeries performed on transgender youth 12 and younger in a national insured population in 2019, and a rate of about two per 100,000 among 15- to 17-year-olds, most of them chest procedures.25
Finally, opponents argue that restrictions cause harm of their own. In Colorado, Children’s Hospital and Denver Health suspended puberty blockers and hormone therapy for minors after federal funding threats; four families sued, and in May the Colorado Supreme Court ruled the hospital had violated the state’s anti-discrimination law by ending care for transgender patients while continuing it for others.26 In Missouri, the challenge to SB 49 went through a two-week trial in 2024 that heard from parents, providers, a transgender minor, and experts on both sides before the trial court and then the state Supreme Court sided with the state.27 “Today’s decision allows the state to continue to enforce a harmful ban that singles out transgender Missourians,” said Gillian Wilcox, litigation director at the American Civil Liberties Union of Missouri.28
Broader Questions
What the two ballot measures offer is a chance to test a principle at two different points: If surgery should wait until 18, does the same reasoning reach hormones and puberty blockers, or does it stop? And whichever answer a voter gives, who should be the one to enforce it—a family, a physician, a legislature, or the voters themselves?
Discussion Questions
- What have you heard from friends, family, or people you follow online about medical treatments for transgender young people? Do those conversations focus on evidence, on values, or on who should decide?
- Colorado’s measure bans surgery only; Missouri’s also bans hormones and puberty blockers. If you believe surgery should wait until adulthood, does the same reasoning apply to the other treatments? Why or why not?
- Supporters say a minor cannot consent to a permanent change. Opponents say the decision belongs to the child, the parents, and a doctor together. Which idea of consent do you find more persuasive?
- Colorado hospitals say they do not perform these surgeries on minors, and Missouri already bans these treatments by statute. What is the purpose of a ballot measure that does not change current practice? Is that a reason to vote for it, against it, or neither?
- The HHS review and the AAP reach opposite conclusions about the same body of research. How should a voter who is not a medical expert decide whom to trust?
- If you lived in Colorado or Missouri, how would you vote on the measure on your ballot? What factors would guide your decision?
As always, we encourage you to join the discussion with your comments or questions below.
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Sources
Image Credit: Ann in the uk | Shutterstock
[1] Colorado Secretary of State, “Colorado’s 2026 General Election Ballot Certified,” news release, Sept. 4, 2026: https://www.coloradosos.gov/pubs/newsRoom/pressReleases/2026/PR20260904BallotCertification.html
[2]KDVR (Fox31 Denver), “Coalition says two propositions on November ballot would hurt people with transgender families,” Sept. 2026: https://kdvr.com/news/local/coalition-says-two-propositions-on-november-ballot-would-hurt-people-with-transgender-families/
[3] Colorado Newsline, “Two ballot initiatives gathering signatures target transgender kids in Colorado,” Jan. 8, 2026: https://coloradonewsline.com/2026/01/08/ballot-initiatives-transgender-kids-colorado/
[4] ProPublica, “Missouri’s Amendment 3 Could Repeal Voter-Approved Abortion Rights,” Aug. 21, 2026: https://www.propublica.org/article/missouri-abortion-gender-transition-minors-amendment-3
[5] KOMU, “Missouri Supreme Court upholds gender-affirming care ban,” Jan. 14, 2026: https://www.komu.com/news/state/missouri-supreme-court-upholds-ban-on-gender-affirming-care-for-minors/article_ce59440d-e0a1-44c3-b722-705bc3de0ae1.html
[6] ProPublica, “Missouri’s Amendment 3 Could Repeal Voter-Approved Abortion Rights.”
[7] Legislative Council Staff, Colorado General Assembly, 2026 State Ballot Information Booklet (“Blue Book”), Proposition 135 analysis and fiscal impact statement, Sept. 10, 2026: https://content.leg.colorado.gov/sites/default/files/2026-bluebook-english-accessible_1.pdf; fiscal impact statements: https://content.leg.colorado.gov/sites/default/files/2026-fiscal-impact-statements-english-accessible.pdf
[8] Colorado Newsline, “Two ballot initiatives gathering signatures target transgender kids in Colorado.”
[9] Missouri Independent, “Missouri poll finds ban on transgender care boosts support for outlawing abortion,” March 17, 2026: https://missouriindependent.com/2026/03/17/missouri-poll-finds-ban-on-transgender-care-boosts-support-for-outlawing-abortion/
[10] St. Louis Public Radio, “Missouri voters slated yet again to decide on abortion with near-total ban on the ballot,” Sept. 21, 2026: https://www.stlpr.org/show/st-louis-on-the-air/2026-09-21/missouri-voters-slated-yet-again-to-decide-on-abortion-with-near-total-ban-on-the-ballot
[11] Missouri Independent, “Anti-abortion divide could complicate Missouri Amendment 3 campaign,” Sept. 28, 2026: https://missouriindependent.com/2026/09/28/anti-abortion-divide-could-complicate-missouri-amendment-3-campaign/
[12] Colorado Newsline, “Two ballot initiatives gathering signatures target transgender kids in Colorado.”
[13] Colorado Times Recorder, “BRIEF: Advocates Rally Against Anti-Trans Ballot Measures,” Sept. 2026: https://coloradotimesrecorder.com/2026/09/brief-advocates-rally-against-anti-trans-ballot-measures/81944/
[14] KDVR (Fox31 Denver), “Coalition says two propositions on November ballot would hurt people with transgender families.”
[15] Legislative Council Staff, Colorado General Assembly, 2026 State Ballot Information Booklet (“Blue Book”), Proposition 135 analysis and fiscal impact statement.
[16] Jon Caldara, “A kid’s right to bodily integrity at heart of why I’m voting for Prop. 135,” The Gazette (Colorado Springs), Sept. 20, 2026: https://gazette.com/2026/09/20/a-kids-right-to-bodily-integrity-at-heart-of-why-im-voting-for-prop-135-jon-caldara/
[17] The Gazette editorial board, “ENDORSEMENT: Protect Colorado’s children — YES on 133, 134 & 135,” Sept. 25, 2026: https://gazette.com/2026/09/25/endorsement-protect-colorados-children-yes-on-133-134-135/
[18] The Daily Signal, “5 Things to Know About Senate Hearing on Transgender Medicine, Chloe Cole Testimony,” June 3, 2026: https://www.dailysignal.com/2026/06/03/5-things-know-about-senate-hearing-transgender-medicine-chloe-cole-testimony/
[19] U.S. Department of Health and Human Services, “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” May 1, 2025, revised Nov. 2025 (supplement): https://opa.hhs.gov/sites/default/files/2025-11/gender-dysphoria-report-supplement.pdf; summarized by KFF, “Examining HHS Report on Pediatric Gender Dysphoria and Gender Conversion Efforts,” Aug. 2025: https://www.kff.org/lgbtq/u-s-department-of-health-and-human-services-report-on-pediatric-gender-dysphoria-and-gender-conversion-efforts/
[20] KOMU, “Missouri Supreme Court upholds gender-affirming care ban.”
[21] ProPublica, “Missouri’s Amendment 3 Could Repeal Voter-Approved Abortion Rights.”
[22] KDVR (Fox31 Denver), “Coalition says two propositions on November ballot would hurt people with transgender families.”
[23] KDVR (Fox31 Denver), “Coalition says two propositions on November ballot would hurt people with transgender families.”
[24] American Academy of Pediatrics, “AAP speaks out against HHS report on gender dysphoria, infringement on physician-patient relationship,” AAP News, May 1, 2025: https://publications.aap.org/aapnews/news/32145/AAP-speaks-out-against-HHS-report-on-gender
[25] Harvard T.H. Chan School of Public Health, “Gender-affirming surgeries rarely performed on transgender youth,” July 8, 2024 (summarizing Dai et al., JAMA Network Open, June 27, 2024): https://hsph.harvard.edu/news/gender-affirming-surgeries-rarely-performed-on-transgender-youth/
[26] Colorado Newsline, “Suspended gender-affirming care brings on dire mental health concerns for trans kids in Colorado,” June 26, 2026: https://coloradonewsline.com/2026/06/26/suspended-gender-affirming-care-colorado/
[27] Lambda Legal, “Missouri Families Urge State Supreme Court to Block Ban on Transgender Health Care,” Sept. 24, 2025: https://lambdalegal.org/newsroom/en_mo_20250924_families-urge-state-supreme-court-to-block-ban-on-trans-health-care/
[28] ACLU of Missouri, “Missouri Supreme Court Refuses to Block Transgender Health Care Ban,” Jan. 14, 2026: https://www.aclu-mo.org/news/missouri-supreme-court-refuses-to-block-transgender-health-care-ban/
