State lawmakers across the country have introduced several anti-LGBTQ bills since November, advocacy groups say, ranging from proposals that would make it more difficult for same-sex couples to adopt to measures that could put doctors in jail for providing hormone therapy to transgender minors.

One such group, Equality Federation, said it is currently tracking about 226 bills — including more than two dozen introduced in January alone and some still active from previous legislative sessions — that have the potential to negatively affect lesbian, gay, bisexual, transgender and queer people.

“The targeting of kids is really unique this year … It’s really shocking, the depth of attack on trans youth.”

ROSE SAXE, ACLU

David Topping, the organization’s director of advocacy and civic engagement, told NBC News that since the 2015 landmark Supreme Court decision Obergefell v. Hodges, which made same-sex marriage legal across the United States, there’s been a “huge rash of anti-LGBTQ legislation.”

“It feels like every state Legislature, every year, is trying to push some kind of anti-LGBTQ agenda,” Topping said.

Jenny Pizer, law and policy director at the civil rights group Lambda Legal, said this year, while the sheer number of bills can seem eye-popping, she’s worried about more than just the quantity.

“Numbers are only one measure of how intense or threatening one legislative session might be,” Pizer said. She said she and other LGBTQ advocates are also considering other variables, such as the content of the bills, whom they target and how likely they are to succeed.

Trans rights: ‘A social and political wedge’

Pizer said that since 2016 — when more than 250 anti-LGBTQ state bills were introduced in state Legislatures across the country — the trend has been to use transgender people as “a social and political wedge.”

Freedom for All Americans, a bipartisan group focused on securing LGBTQ nondiscrimination protections nationwide, is currently tracking 44 bills it considers anti-LGBTQ that have been introduced since November. Of those bills, the organization said 42 target transgender individuals.

This year, the focus of much of this legislation has been transgender youth, particularly measures that would prohibit minors from receiving transition-related health care and those that would ban trans youth from participating on sex-segregated sports teams that align with their gender identity.

“The targeting of kids is really unique this year,” said Rose Saxe, deputy director of the American Civil Liberties Union’s LGBT and HIV Project. “It’s really shocking, the depth of attack on trans youth.”

In the current legislative session, over a dozen states have introduced bills that would impact transgender minors.

Anti-LGBTQ ‘testing grounds’

Many of the state bills involving transgender youth are strikingly similar, and both Pizer and Saxe said this is due, in part, to the influence of national conservative groups.

Pizer specifically named Project Blitz, a coalition of Christian organizations, which she said uses some conservative states as “testing grounds” to see which bills gain the most traction.

“If they have success in a very conservative environment, sometimes they get picked up elsewhere,” Pizer said.

Saxe said this “harmful” legislation is also “shopped around” by organizations including the Alliance Defending Freedom and the Heritage Foundation. She pointed to the slew of bills this session about transgender students and sports, noting this topic was a big issue that surfaced last year in the Heritage Foundation’s materialsopposing the Equality Act.

“That’s a theme they’ve been working with for a while now,” Saxe said of trans sports bills.

Requests for comment to the Congressional Prayer Caucus Foundation and the National Legal Foundation, which are both part of Project Blitz, and the Alliance Defending Freedom and the Heritage Foundation did not receive responses.

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Echoing Pizer, Saxe added “there are a handful of states that are ‘bad innovators’” for anti-LGBTQ legislation. Tennessee is among them, she said.

Last week, Tennessee became the first state this year to pass anti-LGBTQ legislation into law when its Republican governor, Bill Lee,signed a bill that permits adoption agencies that use taxpayer money to refuse to work with families that “violate the agency’s written religious or moral convictions or policies.” This means, for example, that a state-funded agency could refuse to place a child with same-sex parents.

With his signature, Lee made Tennessee the 11th state to permit state-licensed welfare agencies to refuse to place children with LGBTQ families. Similar religious refusal bills are under consideration in Kentucky and Missouri.

Tennessee is also considering HB 1572, a bill that, like others in Alabama, Georgia, Indiana, Iowa, Missouri, New Hampshire and Washington, would prohibit transgender student athletes from competing on teams consistent with their gender identity.

South Dakota is another “testing ground” state, according to Pizer. Three bills advocates have deemed anti-LGBTQ have already been introduced in the state this session, and one passed the lower chamber last week with a wide majority.

Last Wednesday, the South Dakota House passed HB 1057, a bill that would make providing certain forms of gender-affirming medical care to minors — including the prescription of puberty blockers, which a study recently linked to lower suicide risk for trans people — a Class 1 misdemeanor, which in South Dakota carries a penalty of up to one year imprisonment and up to $2,000 in fines.

“Traction is concerning because it makes it more likely other states will go down that route,” Saxe said of HB 1057’s quick success in South Dakota.

Since November, similar bills have been introduced in Florida, Colorado, Illinois, Oklahoma, South Carolina and Missouri, and a proposal introduced last year in New Hampshire is still being considered.

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Another South Dakota bill, SB 88, would “require parental notification of self-injurious behavior expressed during counseling sessions.” Pizer said this bill could compel counselors, school psychologists and social workers to “out” transgender youth to their parents.

A third bill, HB 1215, seeks to prohibit the state from “endorsing or enforcing certain policies regarding domestic relations,” including issuing marriage licenses to same-sex couples. The bill prohibits 10 other items including the passage of nondiscrimination laws on the basis of sexual orientation, the banning of conversion therapy, “drag queen story time” in public libraries and altering gender markers on birth certificates.

Pizer called HB 1215 “a random grab-bag of anti-LGBT attacks.”

“It reveals a toxic mix of unhinged, unabashed ignorance and cruelty,” she said. “Parts of the bill are obviously unconstitutional. Where the U.S. Constitution has been definitively interpreted as protecting the freedom to marry for straight, gay and bi people alike, states cannot override that fundamental federal constitutional right with a statute.”

Rep. Tony Randolph, HB 1215’s sponsor, could not be reached for comment.

Topping said that the introduction of legislation like HB 1215 is “always a huge fight for the community, but that “partners on the ground have beaten these bills every year for the past five years.”

At least three more states introduced bills this session that would impact transgender young people in other ways. Iowa, Arizona and Kentucky introduced proposals that would restrict sexual education material to exclude information on gender identity, require public school teachers to use the pronoun associated with the sex listed on a child’s birth certificate and limit bathroom access for transgender students, respectively.

Advocates’ next steps

Despite the slew of bills targeting LGBTQ rights in the current legislative session, Saxe does not predict another year like 2016, which is thought to be a record year for the introduction of anti-LGBTQ state legislation. With the change in administration, she said “opponents of LGBTQ equality” are currently “really focused on the federal regulatory gains they could get,” and are less focused on the states as they were four years ago.

Nonetheless, Saxe said, she remains worried. “Even though there is a smaller number of bills, I am more concerned than ever about our ability to stop them,” she said.

Using a mix of lobbying, organizing and public education, Saxe said she and her team are working with national and local advocacy groups across the U.S. to show “the harm of these anti-LGBTQ measures” and the “real-life implications of these bills.”

“We are trying to bring attention to these attacks on LGBTQ people, and to lift up the experiences and stories of trans, gay, lesbian and bisexual people,” she said.