Just one day after the midterm elections in the United States, lawmakers in Tennessee filed bills to ban gender-affirming health care for children in next year’s state legislative session.

The bill would prohibit medical providers from prescribing puberty blockers, which delay puberty to allow children who are transgender or grappling with their gender to determine their gender identity. The bill would also prohibit gender-affirming hormones and surgery. While gender-affirming surgeries for children are not recommended under prevailing standards of care and are exceptionally rare, interventions to delay puberty are more common and are critically important for the mental and physical health of many transgender people. The American Medical Association and other leading professional groups have strongly opposed restrictions on gender-affirming care.

The Tennessee legislature has been particularly hostile to lesbian, gay, bisexual, and transgender (LGBT) young people. In 2021, it enacted laws requiring parental notification and opt-outs when schools use LGBT-inclusive curricula and preventing transgender children from participating in sports alongside their peers. It previously banned pre-pubertal hormonal interventions for children, puzzling critics who pointed out that this is not a standard element of gender-affirming care. The state has also failed to take positive steps to protect LGBT children, and it does not have inclusive antidiscrimination laws or antibullying laws to defend LGBT children’s rights.

Tennessee’s bill is the first anti-LGBT bill filed for state legislative sessions in 2023 following the midterm elections.

But in 2022, state lawmakers across the US filed a record number of anti-LGBT bills, particularly targeting transgender people and LGBT young people in schools. Many of these bills passed, with ten states barring transgender students from playing sports, two states barring transgender students from accessing bathrooms, and two states restricting discussions about sexual orientation or gender identity in schools.

Other states have also sought to restrict gender-affirming care. Alabama, Arkansas, and Arizona have all banned different forms of gender-affirming care, with Alabama subjecting medical providers to felony charges. Oklahoma has withheld funding to healthcare providers who offer gender-affirming care, and Texas has investigated parents who help their children obtain needed care.

Tennessee’s bill suggests that lawmakers intend to put the rights of LGBT people at risk once again in 2023. Lawmakers, including governors, should stand strong against these efforts and reject bills that interfere with children’s rights to information and health care.