Puerto Rico has enacted legislation imposing the strictest bans on gender-affirming medical care for minors and young adults in the United States, barring sex change surgeries and hormone therapies for individuals under 21. Signed into law this week and effective October 1, the measure includes severe penalties for healthcare providers: up to 15 years in prison, fines reaching $50,000, and permanent revocation of medical licenses. It also blocks public funding for such treatments.
The law’s text argues that minors lack the “emotional, cognitive, and physical maturity” to consent to procedures with “irreversible consequences.” Advocates for the policy, including its legislative backers, frame it as a safeguard for youth. However, Puerto Rico’s LGBTQ+ Federation has denounced the measure as a dangerous escalation, warning it risks marginalizing transgender individuals and pushing them toward unregulated, high-risk alternatives. Director Justin Jesús Santiago pledged to contest the law in court, asserting it violates Puerto Rico’s constitutional guarantees of equality and privacy.
This legislation aligns with broader federal shifts under President Donald Trump, who has prioritized rolling back transgender rights since taking office. His executive orders have affirmed a binary gender definition, withdrawn federal support for youth gender-affirming care, banned transgender athletes from women’s sports, and targeted diversity initiatives. While facing court challenges, these policies have spurred over 20 states to enact age-based restrictions on medical transitions for minors—though none extend prohibitions as far as Puerto Rico’s 21-year threshold.
Critics argue the territory’s law reflects a disconnect with mainstream medical consensus. Major U.S. health organizations, including the American Medical Association and American Academy of Pediatrics, endorse age-appropriate, individualized care for transgender youth, citing evidence that such interventions reduce risks of depression and suicide. Advocates warn the ban could exacerbate mental health crises among LGBTQ+ youth, who already face elevated rates of discrimination and isolation.
As legal battles loom, the law places Puerto Rico at the center of a national debate over bodily autonomy, parental rights, and the role of government in medical decisions. Its implementation in October may set precedents for similar policies across U.S. jurisdictions, while testing constitutional protections for transgender communities.
