gender reassignment surgery oregon

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Dr. Toby Meltzer

Globally Recognized Leader In the Specialty of Gender Surgery

Dr. Toby Meltzer, MD is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early ’90s. Dr. Meltzer is widely recognized as one of the leading surgeons in the field of Gender Surgery, having completed over 4000 gender-affirming surgeries. He currently performs approximately 200 genital reconstruction surgery cases per year in Scottsdale, Arizona and Portland, Oregon.

Dr. Meltzer is board-certified in both General and Plastic Surgery. He graduated from LSU Medical School in 1983 and completed his plastic surgery residency at the University of Michigan. He served as an Assistant Professor of Plastic and Reconstructive Surgery at Oregon Health Sciences University (OHSU) from 1990 to 1996, before going into private practice. He started performing Vaginoplasty at OHSU in 1993. In 2003, Dr. Meltzer became the first surgeon in Arizona to specialize in Gender Surgery when he moved to Scottsdale to expand his practice. He operates at Scottsdale Healthcare Osborn Campus at the Greenbaum Surgery Center and also has privileges at Scottsdale Healthcare Shea Campus.

Despite the move to Scottsdale, Dr. Meltzer always maintained roots in Portland. For example, several key staff members from The Meltzer Clinic are still based in Portland. To improve accessibility for his patients in the Pacific Northwest, Dr. Meltzer partnered with Legacy Good Samaritan in 2019 to offer Gender Confirmation Surgery once again in Portland. Patients can now choose between either Scottsdale or Portland for surgery dates.

Dr. Meltzer is a member of the American Society of Plastic and Reconstructive Surgeons, as well as the World Professional Association for Transgender Health. He is a regular presenter at transgender conferences, including WPATH, First Event, Gender Spectrum, Gender Odyssey, Keystone, and Southern Comfort. He is also involved with the Human Rights Campaign (HRC), Phoenix Pride, Fenway Health Center and Harvard Medical.

Dr. Meltzer was awarded the Independent Equality Award by the HRC and was honored at the 2016 HRC Awards Gala. The following video was produced for the gala.

“Dr. Meltzer is so much more than an accomplished surgeon – he is an artist. Because of him I am now a complete, functioning attractive woman. And throughout it all, Dr. Meltzer treated me with the utmost competence, caring, dignity, respect and most of all kindness. And his wonderful staff did likewise.” — Patient who had Vaginoplasty, Facial Feminization and Breast Augmentation

Gender Reassignment Surgery in Arizona & Oregon

• Facial Feminization Surgery: Hairline Correction, Forehead Recontouring, Brow Lift, Rhinoplasty, Cheek Implants, Lip Lift, Chin Recontouring, Jaw Recontouring, Tracheal Shave
• Orchiectomy
• Vulvoplasty
• Vaginoplasty – Penile Inversion with Clitoroplasty, Labiaplasty
• Breast Augmentation
• Buttock Augmentation
• Body Feminization
• Top Surgery – Double Incision with Nipple Grafts, Peri-Areolar
• Metoidioplasty: Simple or Full
• Mons Resection
• Phalloplasty: Groin Flap, RFF, Combined Groin + RFF, with Urethroplasty, Glansplasty, Penile Implant
• Scrotoplasty and Testicular Implants
• Facial Masculinization
• Dr. Ley coordinates with a team for FTM Bottom Surgery, which includes a Urologist, and a Gynecologist, Dr. Burt Webb , for Vaginectomy and Hysterectomy.

Electrolysis Now Available at The Meltzer Clinic

The Senza Pelo MedSpa has opened a satellite treatment room at the Meltzer Clinic. Stephanie Shields will be available every Wednesday from 12pm-6pm for electrolysis. Rates are: 15 minutes for $50, 30 minutes for $65, 45 minutes for $85 and 60 minutes for $135.

For patients having Vaginoplasty, the Meltzer Clinic offers a spermatic cord anesthesia block prior to your electrolysis session. The bupivicaine injection into the spermatic cord and scrotal nerve numbs the area for 4-8 hours. This allows a longer duration of an electrolysis session with greater clearance of hair. The result is less pain plus fewer overall number of sessions, which reduces cost. If you are interested in numbing injects, you must book the first appointment of her day so the doctors can administer the necessary injection. There is no additional fee. Injections are only available with a minimum of one hour of electrolysis.

“ I couldn’t have asked for a better experience with Dr. Meltzer and his staff. While recovering from surgery in Scottsdale, I ended up having to call Dr. Meltzer in the early morning hours and he knew exactly what it was and made it a point to drop by the hotel later that day. It’s really nice to have a doctor who makes “house calls” when one is recovering from surgery. Given my experience with Dr. Meltzer and his staff, there is absolutely no way I would have ever considered going to a different surgeon. I honestly can’t say enough good things about Dr. Meltzer and his staff!” — Patient

Surgery Requirements Dr. Meltzer follows WPATH guidelines for Gender Surgery:

• You will need to provide two referrals from qualified mental health professionals for genital procedures; one referral for other procedures unless otherwise specified by insurance.
• A letter from your hormone specialist stating you have been on 12 months of continuous hormones for genital procedures, unless clinically contraindicated.
• Dr. Meltzer will operate on minors with parental consent.

Financing & Insurance Dr. Meltzer accepts cash, credit cards and medical financing. He also accepts insurance. The Meltzer Clinic contracts with Kaiser and have also worked successfully with BCBS, UHC, Aetna, Cigna and Harvard Pilgrim. Medicaid (Apple Health) and PacificSource are also accepted at the Portland location.

Booking a Consultation Dr. Meltzer is available for in-person consultations in either Scottsdale or Portland for a fee of $100. Contact Dr. Meltzer’s office to book your consultation and you’ll hear back with more details.

Current wait list for a surgery date: 12 months.

What is gender-affirming care?

Most broadly stated, gender-affirming care is care that respects and validates a transgender, non-binary, or intersex person’s experience. In terms of accessing transition-related treatment, gender-affirming care refers to interventions that support people in their gender transition. 

Click on a link below to view our gender-affirming care handout:

• Traditional Chinese
• Simplified Chinese

What type of gender-affirming care does CareOregon cover?

CareOregon’s coverage includes medically-necessary transition-related healthcare as established by the Oregon Health Plan and House Bill 2002 . These services include coverage for puberty suppression, primary care and specialist doctor visits, mental health care visits, hormone therapy, electrolysis, top surgery, bottom surgery, body contouring, facial gender confirmation surgery, lab work, and more. 

Click on the arrows below for dropdown lists of covered medical and surgical services. If you have questions or don't see your desired care listed, please call Customer Service at 503-416-4100 , toll-free 800-224-4840 (TTY 711 ) for additional information. Please note: s ome services may require prior approval. 

Medical care

• Hormone therapy
• Puberty blockers
• Hormone blockers
• Mental health therapy, including letters of support
• Electrolysis
• Surgical site hair removal
• Pre-and post-surgical pelvic physical therapy
• Speech therapy
• Medical tattooing

Surgical care

• Mastectomy & chest reconstruction/reduction
• Breast augmentation & mastopexy
• Urethroplasty
• Orchiectomy
• Phalloplasty
• Metoidioplasty
• Scrotoplasty
• Penile & testicular implants
• Scrotectomy
• Nullification surgery
• Clitoroplasty
• Vaginectomy
• Vaginoplasty
• Vulvoplasty
• Hysterectomy
• Salpingo-oophorectomy
• Facial gender confirmation/facial feminization surgery
• Tracheal shave
• Body contouring
• Surgical revisions

Where can I find gender-affirming care?

CareOregon contracts with many licensed behavioral health professionals, primary care doctors, specialists (such as endocrinologists), and surgeons who can provide gender-affirming care.

Gender-affirming care providers, those with experience and training in working with people who are a wide variety of genders, can be found in the lists below.

Please note:

• These lists are updated quarterly and are current as of October 2023.
• For security, some providers go by first name only.
• Many behavioral health providers offer services statewide.

County codes: Clackamas = CL; Multnomah = MU; Washington = WA

Multnomah county

Provider Name

Owl's Nest North Therapy Joint

Credentials

503-281-1166

André Pruitt

503-860-1213

Rustic Sage, LLC

Madeline Harmon

503-444-8214

Madeline Harmon | Sankofa Counseling

LaTrece Gaither

LaTrece Gaither | Sankofa Counseling

Vanessa Washington

Vanessa Washington | Sankofa Counseling

503-662-2808

Nature Abundance

Madilyn Long

971-264-0944

Madilyn Long, MSW, LCSW | Seasons Mental Health and Wellness

Elisia Lopez-Mendiola

971-910-8918

Elisia Lopez-Mendiola | Healing Tides Counseling

Nohemi Robles Hernandez

she/her/ella

Nohemi Robles Hernandez | Healing Tides Counseling

Leah Gregory

Leah Gregory | Healing Tides Counseling

Kian Kolahi

Kian Kolahi | Healing Tides Counseling

Maddison VanderHoff

Maddison VanderHoff | Healing Tides Counseling

Talle Selhorst

Talle Selhorst | Healing Tides Counseling

S. Devoll | Healing Tides Counseling

Matthew Lucas

503-567-9317

Matthew Lucas, MSW, CSWA | Pulse Wellness

Ian Schroeder

LPC, CADC III

503-445-7699

Ian Schroeder | Prism Health

Katya Ludwig

971-319-4827

Katya Ludwig | Sprout Therapy PDX

Noa Grayevsky

503-765-5733

Noa Grayevsky, MA, QMHP | Full Spectrum Therapy

Aleks Taylor

LPC Associate

Aleks Taylor | Full Spectrum Therapy

Quinn Connick

Quinn Connick | Full Spectrum Therapy

Chloe Jacobson

Chloe Jacobson | Full Spectrum Therapy

Julie Cloutier

Julie Cloutier | Full Spectrum Therapy

Dave Eccles

Dave Eccles | Full Spectrum Therapy

Oriol Zemko

FNP-BC, MSN

Oriol Zemko | Full Spectrum Therapy

Gabby Hancher

Counseling Practicum Student

Gabby Hancher | Full Spectrum Therapy

Eli Cuda | Full Spectrum Therapy

Gracen Tichelaar

Gracen Tichelaar | Full Spectrum Therapy

Del Likins | Full Spectrum Therapy

Jenny Lee | Full Spectrum Therapy

Kayla Daniels

LCSW, CADC I

Kayla Daniels | Prism Health

Mattie Boucher

Mattie Boucher | Prism Health

Andrew Decker

Andrew Decker | Prism Health

Chance Hessel

Chance Hessel | Prism Health

Rain Estrada

503-476-1068

Deirdre Rundle

503-300-1941

Lodestar Mental Health Services, LLC

Vivi Nguyen

503-486-8936

Vivi Nguyen | Brave Space

LCSW, CADC II

Tara Rose Therapy

Quinn Rivenburgh

MAAT, ATR-BC, LAT, LPC

Quinn Rivenburgh | Portland Therapy Center

Elise Himes

971-270-0167

Elise Himes | Health Allies Counseling

Alyssa Nagel

Alyssa Nagel | Health Allies Counseling

Jack Marvin

503-974-6885

Jack Marvin | Portland Therapy Center

Sasha Strong

MA, PhD, LPC

971-279-7261

Sasha Strong, MA, PhD, LPC | Portland Therapy Center

Sid Napier, MS | Full Spectrum Therapy

ATR, LAT, LPC

Sam Skye | Portland Therapy Center

Kaspar Woods

Kaspar Woods | Brave Space

Anna Cullop

503-568-1499

Anna Cullop, LPC | Cocoon Counseling Services

Colette Gordon

503-780-4169

Colette Gordon | Do It Together Counseling

971-200-5254

Kat Canada, LCSW | Portland Therapy Center

River Fagan

503-917-4768

Dragonwise Counseling and Consulting

Casey Granbois

503-622-8964

Casey Granbois, MSN, PMHNP | Portland Mental Health and Wellness

Jake Balinky

Jake Balinky | Portland Mental Health and Wellness

Trevor Rachko

503-460-0405

Trevor Rachko | Bridge City Family Medical Clinic

Eva Cicilian

Eva Cicilian | Bridge City Family Medical Clinic

Kyle Anderson

Kyle Anderson, PMHNP | Bridge City Family Medical Clinic

Nate Bagley

503-954-2188

Nate Bagley, MA, LPC | Bridge City Family Medical Clinic

971-301-4229

Chris Doud, CSWA | Spectrum Counseling

Rebekah Lubeck

503-260-8612

Rebekah Lubeck, MSW, LCSW | Pulse Wellness Cooperative

Rosanne Marmor

503-936-1924

Rosanne Marmor, MSW, LCSW | Pulse Wellness Cooperative

971-266-4291

Lola Ryan, MSW, LCSW | Pulse Wellness Cooperative

Online contact form

David | Sakura Counseling

Katie | Sakura Counseling

Taryn | Sakura Counseling

Summer | Sakura Counseling

Nancy | Sakura Counseling

Grace | Sakura Counseling

Kelsey | Sakura Counseling

Myra | Sakura Counseling

Clark Hazel

Clark Hazel, LCSW

Jennie FreimoEller

971-361-8303

Stephanie Tolentino

LMFT Associate

Riley Kastenhuber

LMFT Intern

Paris Courtney

Maia Bellavia

Jamie Brkowitz

Elizabeth Knutsen

Melisa De Seguirant

Danielle Walker

Keely Helmick

Cal Reynolds

503-545-6798

Link Therapy

Lacy Cooper

Myra Bazell

503-281-0308

Hands On Medicine

Diana Frates

Claire Tam | Full Spectrum Therapy

Caitlin O'Dell

503-954-2188x19

Caitlin O'Dell M.ED., LMFT | Bridge City Counseling

April Nunez

April Nunez, LMFT | Health Allies Counseling

Brilliancy Counseling

Kaylynne Gray

Kaylynne Gray | Full Spectrum Therapy

Kristen Cole

Kristen Cole | Full Spectrum Therapy

Full Spectrum Therapy

Cole Prophet

Cole Prophet | Full Spectrum Therapy

Vivi Langdon

Vivi Langdon | Full Spectrum Therapy

Sam C. Skye | Full Spectrum Therapy

Sarah Abramovitz

ATR-BC, LCAT, LPC

Sarah Abramovitz | Full Spectrum Therapy

Kaspar Woods | Full Spectrum Therapy

RYT, QMHP-R

Katie Wood | Full Spectrum Therapy

Bridge City Counseling

Monica Melgar-Sharman

Washington county

503-444-8230

Amy Beene, LPC | NW Counseling Associates, LLC

Clackamas and Washington counties

Regina Vander

503-303-0304

Regina Vander, LCSW | A Healing Intention

Jenna Urban

Jenna Urban | A Healing Intention

Sara Amundson

Sara Amundson | A Healing Intention

Destiny Bankhead

Destiny Bankhead | A Healing Intention

Elizabeth La Torella

Elizabeth La Torella | A Healing Intention

Jessica Farrell

Jessica Farrell | A Healing Intention

Jean Phare | A Healing Intention

Cherity Whiteaker

Cherity Whiteaker | A Healing Intention

Andy Vogler

Andy Vogler | A Healing Intention

Clackamas, Multnomah and Washington counties

Dmitri Dosamantes

503-545-2572

Dmitri Dosamantes | Portland Therapy Center

Megan Lester

503-517-8663

Catholic Community Services

Davonna Wilson

ARNP, PMHNP

971-352-6971

Davonna Wilson, PMHNP | Mindful Therapy Group

Clackamas county

LPC, CADC II

503-722-6588

Behavioral Health Division | Clackamas County

Nadine Luensman

360-980-8562

Portland Therapy Center

Arielle Ross

[email protected]

Wandering & Belonging Therapy

Margot Presley

971-361-7700

Pat Buckley

503-228-4533

Richard Bruno

MD, MPH, FAAFP, FACPM, AAHIVS

Wendy Vannoy

971-380-0121

Dr. Wendy Vannoy

Sean Peter Horan

503-236-4580

A Balanced Life Health Care

Suzanne Scopes

503-230-0812

Dr. Scopes Natural Healthcare

Angela Carter

503-459-2584

Dr. Angela Carter, ND

Connie Silverman

Connie Silverman, DNP, FNP-C | Prism Health

Ben Sokoloff

Ben Sokoloff, DO, AAHIVS | Prism Health

Rian Johnson

Rian Johnson, MN, FNP-C | Prism Health

Amy Wiser, MD, FAAFP | Prism Health

Maeve McGarry

Maeve McGarry, DNP, FNP | Prism Health

Elizabeth Yiu

Elizabeth Yiu, MSN, FNP-C | Prism Health

Rachel Jackson

503-535-3800

Rachel Jackson, MD | Outside In

PNP, MSN, MS, RN

Diana Hall, PNP, MSN, MS, RN | Outside In

Emmy Wohlgemuth

Emmy Wohlgemuth, FNP-C, CNM | Outside In

Isabelle Trepiccione

Isabelle Trepiccione, MD | Outside In

Karletia Lewis

503-287-4932

Karletia Lewis, FNP | North by Northeast

Karlyn Nieland

Karlyn Nieland, ANP | Outside In

Mandi Ruscher

MSN, FNP-C, CPEN

Mandi Ruscher, MSN, FNP-C, CPEN | Outside In

Meghan Brinson

Meghan Brinson, ND | Outside In

Miguel Mitchell

Miguel Mitchell, ND | Outside In

Shelda R. Holmes

Shelda R. Holmes, FNP | Hands On Medicine

Kim Kelsey, FNP | Hands On Medicine

Melanie Anthony

Melanie Anthony, FNP | Hands On Medicine

Teri Bunker

Teri Bunker | Bridge City Family Medical Clinic

Gwyneth Jones

Gwyneth Jones | Bridge City Family Medical Clinic

Brittany Kolluru

Brittany Kolluru | Bridge City Family Medical Clinic

Amber Oyama

Amber Oyama | Bridge City Family Medical Clinic

Healthy Living Community

971-438-6112

Ruth Christiansen

503-494-9992

Ruth Christiansen PA-C | OHSU

Dr. Jackson

ND, LMT, CPT

503-882-0752

Dr. Jackson | Sirona Integrated Health

Michelle Williams

Michelle Williams | Sirona Integrated Health

Emily Rose Jacobson

503-418-3900

Emily Rose Jacobsen PA-C | OHSU

Megan Brusca

503-249-1900

Megan Brusca, MD | Broadway Medical Clinic

Darcie Clark

Hands on Medicine

Zannah Martell

Stephen Levy

ND, LAC, LMT

503-831-8116

Soaring Health & Wellness

Planned Parenthood NE Portland Health Center

888-875-7820

Planned Parenthood

Planned Parenthood Hillman East Portland Center

Tove Silver

503-848-5861

Tove Silver | Neighborhood Health Center

Megan Manley

503-352-6000

Virginia Garcia Beaverton Wellness Center

Lisa Kipersztok

Ericka Horner

503-359-4773

Mountain View Medical Center

Planned Parenthood Beaverton Health Center

Telehealth only

Oshin Worthington

503-610-3828

Oshin Medicine

PPSO Telehealth Services

541-344-9411

Planned Parenthood Milwaukie-Oak Grove Health Center

Multnomah and Clark counties

Dr. V Madrigal

MU & Clark (Washington)

503-850-8216

Dr. Venessa Madrigal | Teyolia Natural Medicine

Kaiser Permanente Gender Pathways Clinic

503-249-6748

Northwest Gender Pathways Clinic

503-400-6622

Dr. Tina Jenq, MD | Oregon Cosmetic and Reconstructive Clinic

Tuan A. Nguyen

MD, FACS, DDS

503-635-1955

Lake Oswego Plastic Surgery

503-239-6800

Oscar Polo, MD, FACOG | The Oregon Clinic

503-494-6687

Jens U. Berli, MD | OHSU

Daniel Dugi

503-346-1500

Daniel D. Dugi, III, MD, FACS | OHSU

503-612-5260

Megan Bird, MD | Legacy

Hema Thakar

503-413-4992

Hema Thakar, MD, FACS | Legacy

Jyoti Chouhan

Jyoti Chouhan, DO, PharmD, FACS | OHSU

Toby Meltzer

480-657-7006

Toby Meltzer, MD | Legacy

Richard McNally

503-488-2345

Richard S. McNally, MD | Providence

Juliana E. Hansen

Juliana E. Hansen, MD, FACS | OHSU

Nick Esmonde

Nick Esmonde MD | The Meltzer Clinic

Geolani W. Dy, M.D., F.A.C.S. | OHSU

Jennifer Franz

Jennifer Franz, MD, FACOG | The Oregon Clinic

Lishiana Shaffer

503-418-4500

Lishiana Shaffer MD | OHSU

Krista Jensen

503-413-7353

Krista Jensen, DO

Scott Hoffman

Scott Hoffmann, MD

Sean McNally

Sean McNally, MD, PhD | The Oregon Clinic

Michael Schmitt

Michael Schmitt, MD | The Oregon Clinic

Hetal Fichadia

503-488-2344

Hetal Fichadia, MD, FACS

Please note: These surgeons are only available to Health Share/Kaiser members.

Rahul Kasukurthi

503-652-2880

Rahul Kasukurthi, MD | Kaiser Permanente

Alexander J. Gougoutas

Alexander Gougoutas, MD | Kaiser Permanente

Hao-Jun J. Chong

Hao-Jun Chong, MD | Kaiser Permanente

Patricia H. Sandholm

Patricia Sandholm, MD | Kaiser Permanente

Jennifer A. Murphy

Jennifer Murphy, MD | Kaiser Permanente

Sara Spettel

503-297-1078

Sara Spettel, MD | Northwest Urology

Christopher Razavi

Christopher R. Razavi, MD | OHSU

Sasha Druskin

503-223-6223

Sasha Druskin, MD | Northwest Urology

Marcie Drury Brown

Type of care

Pediatric Endocrinologist

503-216-6050

Marcie Drury Brown, MD | Providence

Karmen Steffan

Voice therapy

971-346-0355

Breatheworks

Hair removal

619-922-9933

Auntie Claire's Permanent Hair Removal

Michelle Cappadona

Michelle Cappadona | OHSU

Jaimee T Bloom

503-224-3300

Portland Electrolysis & Skin Care

Kathryn Trosen

503-410-1751

Heather Onoday

Dermatology

RN, FNP, MN

503-418-3376

Heather Onoday, RN, MN, FNP | OHSU

Radhika Purushothaman

503-413-1600

Radhika Purushothaman, MD | Legacy Health

David Snyder

David Snyder, MD | Legacy Health

Sevket Yigit

Sevket Yigit, MD | Legacy Health

Kara Connelly

503-346-0640

Kara J. Connelly, MD | OHSU

Hayley Baines

Hayley Baines, MD | OHSU

Stephanie Tarlow

P.A.-C, C.D.C.E.S.

Stephanie Tarlow, P.A.-C, C.D.C.E.S. | OHSU

Rowan Everard

Acupuncture

630-297-3705

Inner Sanctuary Wellness

Gender Communication Lab

503-725-3070

Joshua Shindler

503-494-5947

Joshua S. Schindler MD | OHSU

The Wellness Group - Voice, Speech and Swallowing LLC

503-946-6907

The Wellness Group

Jackie Cano

Jackie E Cano MA | OHSU

Alice Berry

503-701-4900

Transformations Electrolysis LLC

Maya Hunter

Maya Hunter, MD | Legacy Health

Karin Selva

Karin Selva, MD | Legacy Health

Monte Nido - West Linn

Eating disorder residential treatment

888-228-1253

The Living Room 

Community center & peer support

503-825-2535

The Living Room

Prism Health

primary care, hormone therapy and mental health care clinic

Transgender Health Program - OHSU

Education, case management, community support

503-494-7970

The Equi Institute (previously Sacred Vessel)

Case management, community support, and peer support

The Equi Institute

Northwest Gender Pathways Clinic - Kaiser

Advocacy, community supprt

Contact form

Portland Two Spirit Society

Community support

Facebook page

Portland Two Spirit Society - Facebook page

TransActive Gender Center

503-768-6024

Lewis & Clark Graduate School TransActive Gender Project

Sexual & Gender Minority Youth Resource Center (SMYRC) - New Avenues for Youth

503-872-9664

The Q Center

503-234-7837

Me Cuido, Te Cuido Trainings - Familias en Accion

503-201-9865

Black and Beyond the Binary Collective

Education, community support, mutual aid

971-258-1713

The Queer Resource Center - Portland State University

Community center

503-725-3000

primary care and hormone therapy clinic

503-535-3860

Quest Center for Integrative Health

503-238-5203

gender-affirming voice and communication techniques

Website Intake form

True Colors Recovery

Community center & peer support, substance use recovery

online contact form

Mental Health & Addiction Association of Oregon

Peer support

503-922-2377

PDX Trans Housing Coalition

PDX Trans Housing Coalition - Facebook page

STRIDE (LifeWorks NW)

Peer support & case management

503-619-9007

LifeWorks NW Prevention Services

Doernbecher Gender Clinic (Pediatric) - OHSU

primary care, hormone therapy and mental health for gender diverse youth and families

Doernbecher Gender Services

Legacy's T-Clinic (Pediatric)

Randall Children's Gender Care Center

Rahab's Sisters

community gatherings, mental health support, street outreach

971-208-3176

Clackamas, Multnomah, Washington and Clark counties

Northwest Gender Alliance

CL, MU, WA, Clark Co

Community support & peer support

AFFIRM Groups

mental health support for youth

AFFIRM - Options Counseling and Family Services

Planned Parenthood Southwestern Oregon

Basic Rights Oregon

Advocacy organization

503-222-6151

Out Dance Project - Boom and Bust

Statewide and Clark county

Planned Parenthood Columbia Willamette

Statewide & Clark Co

888-576-7526

Beyond These Walls

Project HEAL

Eating disorder support

FEDUP Collective

The FEDUP Collective

Dem Bois Inc.

financial assistance to person(s) of color for gender affirming surgeries

Website intake form

Dem Bois website

What are the steps to accessing services?

1. start with your primary care and mental health providers.

They can help you with most everything from your initial gender dysphoria diagnosis to accessing hormone treatment and/or surgeries. In some cases, it is necessary to have a referral from a primary care provider and a mental health provider in order to schedule a consult for surgery. You can search for providers from the lists above or by calling Customer Service.

2. Familiarize yourself with medical interventions and what feels best for you

There are a variety of options available when it comes to hormonal and surgical interventions. Some surgeons in our network perform different surgeries and have different techniques they use for each. We recommend contacting a surgeon’s office to review surgery types, recovery timelines, considerations and risks, along with any other questions you may have. Please note that hormonal and surgical intervention for people under 18 is limited and additional screening may be required.

3. Determine if getting a diagnosis of what has come to be called gender dysphoria is appropriate or needed to access the care you want and if so, get it in writing

Be sure your gender dysphoria evaluation is from a mental health provider qualified to diagnose gender dysphoria. Clinicians with a minimum of a Master’s degree are eligible to write letters diagnosing patients with gender dysphoria for the Oregon Health Plan. These letters must be completed by a licensed clinician or an unlicensed clinician with a licensed clinical supervisor’s signature. These letters may be referred to as “assessment letters” or “letters of support” and are necessary for accessing surgery and, in some cases, changing your gender marker on identity documentation (e.g., birth certificate, state ID, etc.). Bottom surgeries require two assessment letters.

If you need help with accessing services, or if you want to talk to someone about the services CareOregon provides, call Customer Service at 503-416-4100 , toll-free 800-224-4840 or TTY 711 .

Additional CareOregon resources

CareOregon supports transition needs outside of medical interventions. Members and their care providers can request health-related services funds (HRSF)  for items or services that aren’t covered under standard Oregon Health Plan services, but will improve a person’s health. HRS must be consistent with a member’s treatment plan, as developed by their primary care team or other treatment providers.

Some examples of items that can fall under HRSF are:

• gender affirming clothing
• prosthetics
• costs related to name changes
• gender marker changes
• identity documentation

For more information, please visit our health-related services webpage .

Outside resources

Oregon Health & Science University (OHSU) Transgender Health Program

State and nationwide resources  

Oregon Health Authority GUIDELINE NOTE 127, GENDER AFFIRMING TREATMENT

OHSU Transgender Health Program's Resources for Youth, Adults, Families, and Allies

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Northwest Gender Pathways Clinic

Gender Pathways Clinic Program and Services

The Gender Pathways Clinic at Kaiser Permanente Northwest provides culturally competent care to transgender and gender-expansive patients. Gender Pathways is a unique place for Kaiser Permanente members to receive integrated care in a comfortable, supportive setting.

Our specialist team consists of providers from internal medicine, gynecology, psychiatry, surgery, social work, nursing, and community health navigation who provide high-quality, gender-affirming:

• Hormone therapy
• Sexual and reproductive health care
• Counseling for gender-affirming medical care
• Hair removal (coverage varies depending on insurance plan)
• Pubertal suppressants
• Surgical evaluations and procedures
• Speech therapy/gender-affirming communication therapy

Our compassionate providers are leaders in their fields who have developed best practice guidelines in transgender health that are used throughout Kaiser Permanente. We look forward to partnering with you on your comprehensive health care needs.

Kaiser Permanente members, general public, and providers

The Gender Pathways Clinic is a Kaiser Permanente department, and services are available to all Kaiser Permanente members.

• If you are a new or current Kaiser Permanente member who needs a trans-competent primary care provider, please call us or contact Member Services for help.
• If you are not currently a Kaiser Permanente member and are interested in becoming one, please check out your options on kp.org .
• Patients 18 and older can self-refer to the Gender Pathways Clinic — they only need to call and set up an appointment.
• If you are a Kaiser Permanente Northwest provider, please refer transgender patients appropriate for Gender Pathways Clinic via Referral for Transgender Assessment.

Kaiser Permanente clinic resources:

Contact the Gender Pathways Clinic

Fax: 1-833-730-5020

Transgender community resources:

• Basic Rights Oregon
• OHSU Transgender Health Program
• Northwest Gender Alliance
• Transgender Law Center
• Trans Lifeline
• Parents, Families, and Friends of Lesbians and Gays
• TransActive Gender Center
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All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite 100, Portland, OR 97232. ©2023 Kaiser Foundation Health Plan of the Northwest

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Top Surgery

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Awaking to a body in which you don’t feel at home can be an unhappy situation. You should know you’re not alone. According to the Williams Institute of UCLA Law School , nearly 1.4 million people in the United States identify as transgender. That’s not a small number.

Top surgery is one of the procedures that can begin to align your external body with your true identity. Top surgery will not make you a man or a woman, you are already the person of the gender you know in your heart. Top surgery simply allows your body to match your true gender. Our Board-certified Portland plastic surgeon , Dr. Matthew Lewis, counts it as a privilege to be your partner and counselor as you embark on your journey to gender confirmation.

What is Top Surgery?

Top surgery is a procedure on the path to gender confirmation that will align your body with your internal identity. For male-to-female transgender patients, this includes sculpting the beautiful, womanly breasts that are so intertwined with femininity. For female-to-male transgender patients, this will involve removal of the breasts in order to create firm, masculine appearance to your chest.

FTM Top Surgery

Remove your natural breasts to sculpt a more masculine chest.

MTF Top Surgery

Feminize the chest with silicone or saline breast implants.

What it takes to be a candidate for Top Surgery

• At least 18 years of age
• In good overall health (physical and emotional)
• Having lived as your preferred gender for at least 1 year
• A letter of support from a doctor or therapist who knows you well
• 100% committed to the gender transition journey

Top Surgery - Frequently Asked Questions

What should i do to prepare for my top surgery.

It is your job to make sure your body is as healthy as possible prior to any surgical procedure in order to aid the healing process and reduce downtime. Therefore, if you are a smoker it is necessary that you stop smoking at least three weeks prior to your top surgery. Smoking slows the flow of blood through your body and will impede your body’s ability to heal following surgery. You should also avoid consuming alcohol for at least two weeks prior to your procedure as it can increase your risk for bruising and bleeding.

What Kind of Anesthesia is Used in Top Surgery?

Top surgery is performed on an outpatient basis under general anesthesia in order to allow you to rest comfortably while Dr. Lewis sculpts your body.

How do I Know if Top Surgery is a Good Option for Me?

Surgery of any kind is an intensely personal decision, and you are the only one who can decide if it is right for you. Many transgender patients feel that top surgery is one of the most important procedures they have had on their road to gender confirmation. As one of the most visible parts of your body, and a symbol of both male and female sexuality, the presence of breasts or a flat, masculine chest can help you see your truest self when you look in the mirror. Dr. Lewis will happily discuss with you your goals, concerns, and dreams in seeking top surgery and help you find the best path to achieving your aesthetic goals.

Is the Recovery from Top Surgery Painful?

Since each body is different, each patient has a different experience during his or her recovery from top surgery. Most patients report mild to moderate discomfort following top surgery which can be well managed with pain medication. While pain generally doesn’t last long into the recovery period, you may find there is a bit of discomfort for a few weeks as your incisions heal, and your skin adapts to its new form.

Are you ready for a change?

Top surgery is a life-changing procedure that involves altering your physique. If you are unsure about the operation, our Board-certified Portland plastic surgeon, Dr. Matthew Lewis, is available to discuss the benefits and risks with you and help you arrive at an informed decision.

The Procedures

Female-to-male (ftm) surgery.

Perfect for large and heavy breasts, this technique involves an incision along the lower border of the breast and across the top of the breast and meeting at the corners creating an elliptical incision. Through the resulting opening, Dr. Lewis will remove breast tissue and relocate the nipple to a masculine position as a graft.

Periareolar.

If you have good skin elasticity and a minimal amount of breast tissue, this approach may be ideal. Dr. Lewis will make a semi-circular incision around the areola and remove the breast tissue through this opening.

Male-to-female (MTF) top surgery

MTF top surgery is done under general anesthesia and takes about an hour and a half. It requires a small incision along the bottom border of the chest. Through that opening, Dr. Lewis will create a pocket and place a saline or silicone breast implant. For MTF operations, Dr. Lewis typically uses silicone implants placed behind the muscle. To complete the procedure, he will carefully close the incisions to minimize scarring and wrap the area with dressings.

The Recovery

With both MTF and FTM top surgery, there is a substantial recovery period. You can expect:

• Time off from work. Plan to take approximately 7 to 9 days off from work to rest. At that point, most of our patients are able to return to sedentary jobs.
• Swelling + discomfort. Swelling, bruising, pain and discomfort are virtually guaranteed after surgery. The effects will gradually improve as you heal and Dr. Lewis will prescribe pain medication to help you manage the discomfort in the meantime.
• Rest + self-care. During the recovery period, you should rest frequently. Walk lightly around the house as soon as you’re able, but avoid heavy lifting, exercise and other strenuous activities for at least six weeks.

What are the Benefits of Top Surgery?

While the benefits of top surgery may seem evident, there are so many to consider including:

• Increased confidence
• Decreased feelings of depression
• Clothes fit better
• More proportional figure
• Your body matches your gender identity

What Should I Look for in a Surgeon when Seeking Top Surgery?

When considering your options for gender confirmation, one of the most important decisions you will make will be the selection of your plastic surgeon. Our Board-certified Portland plastic surgeon, Dr. Matthew Lewis, sees each of his patients as so much more than just a patient. It is his honor to get to know you as an individual and assist you to reveal the physical vessel which aligns with your vision for your body. Dr. Lewis is a skilled board-certified plastic surgeon with a mind inspired by science and technical skill, and an enduring compassion for and care for the patients with whom he works.

Why Should I Choose Dr. Matthew Lewis for my Top Surgery?

Choosing to begin your journey toward gender confirmation is one of the most courageous acts an individual can take. Dr. Matthew Lewis honors this journey and believes it is a privilege to assist you in finding the peace that comes from a body which matches your internal identity. As a Board-certified plastic surgeon, Dr. Lewis possesses the technical skill, experience, and artistic eye necessary to help bring your aesthetic vision to life. He will treat you with dignity, compassion, and care, advising you on the transformation that will make you feel more at home in your own body.

Schedule an appointment today >>

Top surgery is a life-changing procedure that makes many patients feel much more comfortable in their own bodies. Contact our Portland office today to schedule an appointment and begin planning for your transformation.

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A portland plastic surgeon.

407 NW 17TH AVE, STE 2 Portland, OR 97209

Matthew Lewis, MD

Discover your true beauty. At the office of Dr. Matthew Lewis, we take everything into consideration, including your comfort, discretion, and of course your outcome. Please call us to schedule an appointment.

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Gender Affirmation

Pearl Women’s Center – Your Partner in Gender Affirmation Surgery

Discover Exceptional Gender Affirmation Surgery at Pearl Women’s Center in Portland, Oregon

Are you ready to embrace your true self through gender affirmation surgery? Look no further than Pearl Women’s Center—a trusted destination for top-notch care and personalized experiences catered specifically to transgender and gender fluid patients.

Uncover the Path to Transition with Laparoscopic Hysterectomy:

• We understand the unique journey you’re on. Our dedicated team of compassionate professionals is here to support you every step of the way, ensuring an exceptional patient experience. From hormonal management with BioTe pellets, to surgical intervention, we are here to support you.
• We are also proud to be in network with most major insurance companies, providing you with accessible and affordable care. Say goodbye to worries about financial barriers—our team will navigate the insurance process, allowing you to focus on your health and well being.
• Our team comprises experienced professionals who are well-versed in transgender healthcare. We understand the specific needs and concerns of our trans patients, creating a safe and inclusive environment where you can be your authentic self.
• Our renowned surgeons specialize in laparoscopic hysterectomy, a minimally invasive technique that offers reduced scarring, shorter recovery times, and outstanding surgical outcomes. Rest assured, you’re in the hands of skilled professionals who prioritize your well-being.
• As an added advantage, we have Dr. Matt Lewis of Lewis Plastic Surgery, a renowned plastic surgeon, on our team. Dr. Lewis brings his expertise in top surgery and lipo sculpting, further enhancing our comprehensive range of gender affirmation procedures.

Experience the freedom of quick access to care without compromising on quality.

Discover why we’re the trusted choice for gender affirmation surgery in Portland. Your journey to self-empowerment starts here—let us guide you to a brighter, authentic future.

Ready to take the next step? Don’t wait months on waiting lists. At Pearl Women’s Center, we have short waiting times for appointments and surgery. Call Pearl Women’s Center today at 503-803-7971 to schedule your consultation.

Visit Dr. Matt Lewis’s website at

https://www.matthewlewisplasticsurgery.com/top-surgery  to learn more about his exceptional skills in top surgery and lipo sculpting. Together with Pearl Women’s Center, we’ll help you achieve your desired transformation.

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7025 N. Scottsdale Road #302 Scottsdale, AZ 85253 Office : 480-657-7006 Fax : 480-657-7020

Toby R Meltzer MD

Toby R Meltzer MD performs approximately 200 Gender Confirmation Surgery (GCS) cases per year. He performs both MtF and FtM genital reconstruction surgeries. Dr. Meltzer works with a team for FtM GCS which includes both a Urologist and an OB/Gyn. In addition, Dr. Meltzer performs Facial Feminization Surgery (FFS) to feminize the face and body as well as standard cosmetic procedures.

Toby R Meltzer MD graduated from LSU Medical School in 1983 and is board certified in both General and Plastic Surgery. An active member of the American Society of Plastic and Reconstructive Surgeons, he started practicing at Oregon Health Sciences University in 1990 and began private practice in 1996 in Portland, Oregon.

In 2003 he moved to Scottsdale, Arizona to expand his practice with privileges at Scottsdale Healthcare Osborn Campus at the Greenbaum Surgery Center and Scottsdale Healthcare Shea Campus.

In 2019 the Meltzer Clinic expanded and we also began offering our services at Legacy Good Samaritan Medical Center in Portland, Oregon.

UNDERGRADUATE

Louisiana State University Baton Rouge, Louisiana B.S. Biochemistry, 1979

Outstanding Student of the College of Chemistry and Physics, 1978, 1979

Phi Kappa Phi Honor Society

Phi Lambda Upsilon Honorary Chemistry and Chemical Engineering Society

Dean’s Committee of Academic Appeals

Louisiana State University School of Medicine New Orleans, Louisiana M.D., 1983

Honors: Alpha Omega Alpha (AOA)

General Surgery – Charity Hospital of Louisiana Louisiana State University Department of Surgery New Orleans, Louisiana 1983-1984

General Surgery – Charity Hospital of Louisiana Louisiana State University Department of Surgery New Orleans, Louisiana 1984-1988

Plastic and Reconstructive Surgery University of Michigan Ann Arbor, Michigan 1988-1990

Burn Surgery – Detroit Receiving Hospital Department of Plastic Surgery Wayne State University Detroit, Michigan 1986-1987

HONORS Best Fifth Year Resident Senior Teaching Resident

POSTGRADUATE EXPERIENCE

Assistant clinical professor.

Division of Plastic and Reconstructive Surgery Oregon Health Sciences University Portland, Oregon 1996 – Present

Assistant Professor of Plastic and Reconstructive Surgery Oregon Health Sciences University

Oregon Health Sciences University Portland, Oregon 1990-1996

Chief, Division of Plastic and Reconstructive Surgery

Veterans Administration Medical Center Portland, Oregon 1990-1995

Arizona (Active)

California (Active)

Oregon (Active)

Michigan (Inactive)

Louisiana (Inactive)

STAFF PRIVILEGES

HonorHealth Osborn Campus Scottsdale, Arizona

HonorHealth Shea Campus Scottsdale, Arizona

Kaiser Permanente Medical Group San Francisco, California

Legacy Health Good Samaritan Portland, Oregon

SOCIETY MEMBERSHIPS

Oregon Medical Association

American Society of Plastic and Reconstructive Surgeons

James D. Rives Surgical Society

Oregon Society of Plastic Surgeons 1994-96  Secretary, Treasurer

1996-98  President

BOARD STATUS

Board Certification in General Surgery 5/3/89

Board Certification in Plastic and Reconstructive Surgery, 11/6/92

PUBLICATIONS IN PEER - REVIEWED JOURNALS

The effect of hyperbaric oxygen on the bursting strength and rate of vascularization of skin wounds in the rat Meltzer TR and Myers MB American Surgeon, Vol 52, 12:659-662, 1986

Hemostasis parameters and survival in burn patients Meltzer TR, Miyakawa T, DePoli PA, Sachs R, Faraq A, Mammen EF, Heggers JP, Robson MCSurgical Forum 38:636-638, 1987

The effect of burn care on skin bacteria and burn wound sepsis Phillips LG, Robson MC, Heggers JP, Meltzer TR, Boertman JA, Manavalan K Australian and New Zealand Burns Bulletin Vol 1, 3:12-13, 1988

DRG-driven change in burn wound management: A success story Smith, Jr, DJ, Robson MC, Meltzer TR, Smith AA, McHugh TP, Heggers JP Plastic and Reconstructive Surgery 82:710-712, 1988

The effect of endogenous skin bacteria on burn wound sepsis Phillips LG, Heggers JP, Robson MC, Boertman JA, Meltzer TR, Manavalan K, Smith DJ Plastic and Reconstructive Surgery, 1989

A dressing for difficult topography Phillips LG, Jarlsburg C, Mathoney K, Gracia W, Meltzer TR, Smith DJ, Robson MC: Meshed Biobrane The Journal of Burn Care & Rehabilitation, Vol. 11, No. 4:347-351, 1990

The Western Journal of Medicine Meltzer TR: Basal Cell Carcinoma Vol. 158, No. 4: 403, April, 1993

The Role of Vascular Pedicle Thrombectomy in Management of Compromised Free Tissue Transfers Wheatley MJ and Meltzer TR The Annals of Plastic Surgery, Vol. 36, No. 4:360-4 April, 1996

The Management of Unsalvageable Free Flaps Wheatley MJ and Meltzer TR Journal of Reconstructive Microsurgery, Vol. 12, No. 4:227-229, May, 1996

A Safe, Reliable Method for Skin Graft Coverage of the Radial Forearm Donor Site Swift RW, Wheatly MJ and Meltzer TR Journal of Reconstructive Microsurgery, Vol. 13, No. 3:471-3, October, 1997

Radial Forearm Free Flap Tracheal Reconstruction after Parastomal Tumor Resection Wheatley MJ, Meltzer TR, Cohen JI Plastic and Reconstructive Surgery, Vol. 101. No. 5:1342-4, April, 1998

Procedures, Postoperative Care, and Potential Complications of Gender Reassignment for the Primary Care Physician Takata, LL and Meltzer, TR Primary Psychiatry, Vol, 7, No. 6:74- 78, June, 2000

Cricothyroid Approximation to Elevate Vocal Pitch in Male-to-Female Transsexuals: Results of Surgery Yang CY, Palmer AD, Murray KD, Meltzer TR, Cohen JI Ann Otol Rhinol Laryngol, Vol, 111 (6): 477-85, June 2002

AM:STARs Adolescent Medicine:State of the Art Reviews Surgical Options in Transgender Youth Ellie Zara Ley,MD, Toby R Meltzer, MD, Linda L. Takata,BS Spring 2018 Volume 29 Number 1

  The effect of hyperbaric oxygen on the bursting strength and rate of vascularization of skin wounds in the rat. Meltzer TR and Myers MB Southeastern Surgical Congress, New Orleans, Louisiana, March, 1986

  DRG-driven change in burn management: A success story. Smith DJ, Smith AA, Meltzer TR, McHugh TP, Robson MC, Heggers JP American Association of Plastic Surgery, 66th Annual Meeting, Nashville, Tennessee, Abstract #29, page 71, May, 1987

  The effect of burn care on skin bacteria and burn wounds sepsis. Robson MC, Phillips LG, Heggers JP, Meltzer TR, Boertman JA, Manavalan K Societe Internationale de Chirugie, Sydney, Australia, Abstract #1103, page 151, September, 1987

  The effect of endogenous skin bacteria on burn wound sepsis. Phillips LG, Heggers JP, Robson MC, Boertman JA, Meltzer TR, Manavalan K, Smith DJ American Association of Plastic Surgeons  Palm Beach, Florida, April, 1988

Effect of burn care on skin bacteria and burn wound sepsis. Phillips LG, Heggers JP, Robson MC, Boertman JA, Meltzer TR, Manavalan K American Society of Microbiologists, Miami Beach, Florida, Abstract #B83, page 76, May, 1988

Infection rates of burn patients treated on an air-fluidized bed compared with standard bed therapy. Phillips LG, Heggers JP, Boertman JA, Meltzer TR, Schileru R, Robson MC, Sachs R Midwestern Association of Plastic Surgeons Minneapolis, Minnesota, May, 1988

A dressing for difficult topography. Phillips LG, Jarlesburg C, Matheney K, Gracia W, Meltzer TR, Robson MC: Meshed Biobrane American Burn Association New Orleans, Louisiana, Abstract #56, 1989

The Role of Vascular Pedicle Thrombectomy in Management of  Compromised Free Tissue Transfers   Wheatley MJ and Meltzer TR The Annals of Plastic Surgery, Vol. 36, No. 4:360-4 April, 1996

A Safe, Reliable Method for Skin Graft Coverage of the Radial Forearm Donor Site Swift RW, Wheatley MJ and Meltzer TR Journal of Reconstructive Microsurgery, Vol. 13, No. 3:471-3, October, 1997

AM:STARs Adolescent Medicine: State of the Art Reviews  Surgical Options in Transgender Youth

Ellie Zara Ley,MD, Toby R Meltzer, MD, Linda L. Takata,BS Spring 2018 Volume 29 Number 1

New rules proposed for licensing electrologists, increasing gender affirming care access

New proposed electrology rules in Oregon seek to reduce barriers to becoming a licensed electrologist, to reduce the wait time of up to two years for hair removal for transgender individuals seeking gender reassignment surgery.

There are about 78 licensed electrologists in Oregon, and there are no electrology schools currently taking new students.

The new rules would allow for a new route to licensure through a 600-hour electrology training program at any licensed body art facility. Trainees would have a temporary license while working directly under an approved supervisor.

The rules also would make it easier for individuals licensed in other states to obtain an Oregon electrology license.

Transgender individuals seeking gender reassignment surgery typically first get hair removal before surgical procedures. But there is a one to two year wait for such electrolysis in Oregon because of the lack of providers, according to the proposal document.

Medicaid began allowing coverage for gender affirming healthcare in 2015, but with the lack of electrology providers in Oregon, finding one who takes Oregon Health Plan can be another barrier for some, said Seth Johnstone, transgender justice program manager at the health care advocacy organization Basic Rights Oregon.

In early 2022, Basic Rights Oregon , as well as electrology professionals and individuals seeking gender reassignment surgery, asked the Health Licensing Office and the Board of Electrologists and Body Art Practitioners to find ways to reduce barriers to accessing electrolysis.

A temporary order was issued in April 2022 allowing electrologists licensed in other states to practice in Oregon if the licensing examination they took was comparable to Oregon’s.

A hearing was held on Wednesday for public comment on the new proposed rules.

Multiple current providers attended, some saying there should be strict guidelines on the qualifications for becoming a supervisor for the proposed training program.

One current electrologist suggested supervisors have a minimum of five years of post-licensure work experience. She worried that rushing into this program would “take away from the integrity of the profession.”

Anyone wishing to provide comment on the new proposed rules can do so through noon Jan. 28 by emailing Samie Patnode at [email protected] or by mail at Attn: Samie Patnode Health Licensing Office, 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301-2192

Transgender health care

For many transgender individuals getting gender reassignment surgery is a part of the care they need to affirm their sense of self and increase their sense of safety, said Johnstone.

“Leaving your home and not being able to look like your authentic self puts you in danger,” said Johnstone.

Without hair removal prior to gender reassignment surgery, people can face complications including infection and pain, so electrolysis is usually the first step. Some trans and non-binary people also seek electrolysis for facial hair removal, which is another form of gender affirmative healthcare.

About 80% of gender diverse male sex assigned at birth people in Oregon want hair removal services, according to a survey done in 2021 by Basic Rights Oregon. Some 43% of people using private insurance had received these services at the time of the survey, while 22% of those using Medicaid had received services.

Kate Kauffman, owner of Brave Space , a transgender and non-binary resource center and advocacy organization, said many clients who receive counseling talk about the stress of barriers to accessing hair removal. Not being able to access this care can increase anxiety and gender dysphoria in a gender diverse individual, Kauffman said.

“It is a poor use of mental health funding to address the issues of physical health care,” said Kauffman. “Better applying this funding to the right avenue to treat gender dysphoria would save the health insurers money in the long run.”

Sydney Wyatt covers healthcare inequities in the Mid-Willamette Valley for the Statesman Journal. Send comments, questions, and tips to her at [email protected] , (503) 399-6613, or on Twitter @sydney_elise44

The Statesman Journal’s coverage of healthcare inequities is funded in part by the M.J. Murdock Charitable Trust , which seeks to strengthen the cultural, social, educational, and spiritual base of the Pacific Northwest through capacity-building investments in the nonprofit sector.  

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Gender reassignment surgery is now available to oregon minors without parental consent.

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The topic of gender has been much discussed recently, especially with the high-profile case of Bruce Jenner transitioning to Caitlyn Jenner. It’s a very hot-button topic and will probably become even more so once the political debates of 2016 get into full swing.

Gender dysphoria is defined as the condition of feeling one’s emotional and psychological identity as male or female to be opposite to one's biological sex. Though there aren’t any major numbers stating just how many people have gender dysphoria, it is well known that struggling with one’s identity can be a burden not just for the one struggling, but for friends, family, classmates, colleagues, and more.

In Oregon, a controversial new law has been in place since the beginning of 2015 that has left residents of the seemingly forward-thinking state stunned.

Gender reassignment is a procedure that Bruce Jenner underwent to complete his transformation from male to female. While he is a consenting adult, the new law in Oregon allows for minors as young as 15 to get the surgery, even without consent from their parents.

Health Evidence Review Commission (HERC) was petitioned by Jenn Burleton, co-founder of the Portland-based Trans Active Gender Center, to include sex change operations, cross-sex hormone therapy, and puberty-inhibiting medications in the covered procedures for the management of individuals with gender dysphoria. The HERC 12-member panel includes doctors and medical professionals, all of whom are approved by the governor. The change to cover the procedures was settled in January without public debate.

The age of medical consent in Oregon is 15, but how far that consent goes depends on the topic. At 15, teens in Oregon are able to, without their parent’s consent, have sex, receive birth control, take a pregnancy test, and get an abortion. Conversely, according to an article published by IJ Review , 15-year-olds are unable to smoke cigarettes or marijuana, drive alone, send or receive sexts, vote, work more than 18 hours a week, drink, eat unhealthy foods at school, get tattoos, administer aspirin at school or use a tanning bed.

While the new law is very controversial, advocates for it state that it can help reduce suicides in teens with gender dysphoria. When questioned for more information about how many teens have enrolled in the program or how much it would cost the state, HERC distributed a frequently asked questions sheet/fact sheet . It details the background, criteria, medical evidence and what, why and how HERC came about their decision to cover procedures under the new law.

The sheet also states that, although they are certainly able to, at the time of the fact sheet’s publishing, zero teens and 10 adults under the Oregon Health Plan have undergone sex reassignment surgery.

• Alzheimer's
• Amputation/Prosthetics

• Dengue Fever
• Dental Health
• Dermatological Disorders
• Developmental Disorders
• Digestive Disorders
• Down Syndrome

• Gastrointestinal Disorders
• Genetic Disorders
• Genital Warts
• Geriatric care
• Gerontology
• Gum Disease
• Gynecological Disorders
• Head And Neck Cancer

• Kidney Cancer
• Kidney Disease
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• Lead Poisoning
• Liver Disease
• Low Testosterone
• Lung Cancer

• Macular Degeneration
• Men's Health
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• Pancreatic Cancer
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• Schizophrenia
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• Uterine Cancer
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• Women's Health
• Yeast Infection

TLDEF's Trans Health Project

Oregon health authority (oregon health plan), prioritized list of health services - gender dysphoria/transsexualism.

Policy: Prioritized List of Health Services - Gender Dysphoria/Transsexualism Policy Number: Line 312 Last Update: 2020-11-09 Issued in: Oregon

This policy applies to Medicaid

Breast Reconstruction:

Mammoplasty (CPT 19316, 19324-19325, 19340, 19342, 19350) is only included on this line when 12 continuous months of hormonal (estrogen) therapy has failed to result in breast tissue growth of Tanner Stage 5 on the puberty scale OR there is any contraindication to, intolerance of or patient refusal of hormonal therapy. Sex reassignment surgery is included for patients who are sufficiently physically fit and meet eligibility criteria. To qualify for surgery, the patient must: A) have persistent, well documented gender dysphoria B) for genital surgeries, have completed twelve months of continuous hormone therapy as appropriate to the member’s gender goals unless hormones are not clinically indicated for the individual C) have completed twelve months of living in a gender role that is congruent with their gender identity unless a medical and a mental health professional both determine that this requirement is not safe for the patient D) have the capacity to make a fully informed decision and to give consent for treatment E) have any significant medical or mental health concerns reasonably well controlled F) for breast/chest surgeries, have one referral from a mental health professional provided in accordance with version 7 of the WPATH Standards of Care.

Facial Reconstruction:

Individuals have received coverage for facial gender confirmation surgery under the Oregon Health Plan.

Permanent Hair Removal:

Electrolysis (CPT 17380) and laser hair removal (CPT 17110,17111) are only included on this line as part of pre-surgical preparation for chest or genital surgical procedures also included on this line. These procedures are not included on this line for facial or other cosmetic procedures or as pre-surgical preparation for a procedure not included on this line.

Youth Services:

Hormone treatment with GnRH analogues for delaying the onset of puberty and/or continued pubertal development is included on this line for gender questioning children and adolescents. This therapy should be initiated at the first physical changes of puberty, confirmed by pubertal levels of estradiol or testosterone, but no earlier than Tanner stages 2-3. Prior to initiation of puberty suppression therapy, adolescents must fulfill eligibility and readiness criteria and must have a comprehensive mental health evaluation. Ongoing psychological care is strongly encouraged for continued puberty suppression therapy. Cross-sex hormone therapy is included on this line for treatment of adolescents and adults with gender dysphoria who meet appropriate eligibility and readiness criteria. To qualify for cross-sex hormone therapy, the patient must: A) have persistent, well-documented gender dysphoria B) have the capacity to make a fully informed decision and to give consent for treatment C) have any significant medical or mental health concerns reasonably well controlled D) have a comprehensive mental health evaluation provided in accordance with Version 7 of the World Professional Association for Transgender Health (WPATH) Standards of Care (www.wpath.org).

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Updated on Nov 20, 2020

Gender Spender

Kim lacapria, published july 10, 2015.

FACT CHECK:   Does Oregon now allow young teenagers to obtain gender reassignment (sex change) surgery without the knowledge or consent of their parents?

Claim:     Oregon quietly enacted a taxpayer-funded policy that allows minors as young as 15 to undergo gender reassignment surgery without the knowledge or consent of their parents.

Example:   [Collected via Twitter, July 2015]

You’ve got to be kidding me! Oregon 15-yr-olds are now allowed to get sex-change operations—w/o parental notification https://t.co/Ldu0p2z3X7 — Franklin Graham (@Franklin_Graham) July 10, 2015

COMING UP: Oregon allowing 15 yr olds to get state-subsidized sex-change operations w/o parental consent-thoughts? @genemarks @DrDanielBober — Gretchen Carlson (@GretchenCarlson) July 10, 2015

Origins:    On 9 July 2015 Fox News published an article titled "Oregon allowing 15-year-olds to get state-subsidized sex-change operations," (accompanied by several broadcast segments) claiming that a recently approved policy in the state enables minors as young as 15 to undergo gender reassignment surgery without the knowledge or consent of their parents.

The article (subsequently aggregated to a number of web sites without additional investigation) stated:

The list of things 15-year-olds are not legally allowed to do in Oregon is long: Drive, smoke, donate blood, get a tattoo — even go to a tanning bed. But, under a first-in-the-nation policy quietly enacted in January that many parents are only now finding out about, 15-year-olds are now allowed to get a sex-change operation. Many residents are stunned to learn they can do it without parental notification — and the state will even pay for it through its Medicaid program, the Oregon Health Plan.

A Portland transgender advocate addressed the claims made in the article, indicating that the assertions were implausible with respect to the mechanics of gender reassignment surgery:

Jenn Burleton, the executive director of TransActive Gender Center in Portland, said the idea a 15-year-old can walk into a doctor’s office, say they want gender affirmation surgery and get it done without a parent’s consent is unrealistic. “It’s irrational,” she said. “It’s laughable.”

The Oregon Health Authority also released a statement about the such claims, explaining that the age of medical consent in Oregon (15) and coverage of gender dysphoria as a medical condition in no way suggested that teens of that age were in actuality undergoing surgery without the knowledge or consent of their parents:

In Oregon, the age of medical consent is 15 or older. Patients should be able to demonstrate the capacity to make a fully informed decision and to give consent to treatment, regardless of age. However, nothing in Oregon law requires a health care provider to provide medical services to a minor or safeguard the confidentiality of a minor. In most cases, providers will encourage (and in some cases require) family engagement and supports unless it would endanger the patient.

The documents to which Fox News referred (which purportedly "quietly" approved gender reassignment for teens) in actuality assessed aligning Oregon's public health coverage (for patients of all ages) with the general standard of treatment for gender dysphoria. Surgery was listed as one of several options available to patients under later revised guidelines and was not specific to minors:

Updating Oregon’s policy and bringing it into line with current major international treatment guidelines, the Health Evidence Review Commission (HERC) has voted to move gender dysphoria into the covered portion of the Prioritized List with the publication of the next biennial review List. Services already approved for this new, covered line include psychotherapy, medical visits, and medications to suppress puberty in gender questioning youth.

The only portion of the documents in question pertaining to minors did not mention parental consent and simply referenced "medications to suppress puberty in gender questioning youth." In terms of utilization estimates in the June 2014 document, Oregon's Health Evidence Review Commission stated that 175 total Oregonians (not specifically or even primarily teens) would likely be covered under the inclusion each year:

HERC staff estimate a utilization rate (of all treatments for gender dysphoria) in OHP of 175 persons in any 12 month period. HERC staff estimates that the total cost of adding all treatments for OHP will be less than $150,000 per year.

The numbers provided are not insignificant with respect to an estimated number of surgeries performed each year. A 2015 Washington Post article quoted two medical experts who estimated that "a woman who chooses the full range of surgical procedures available would spend $75,000 or more to transition to a male," but surgically transitioning "from male to female might cost in the $40,000 to $50,000 range." So even factoring in the lowest cited cost of $40,000 per individual surgery (and the fact that the estimates included all Medicaid patients in Oregon treated for gender dysphoria, not just minors), the "less than $150,000 per year" estimated spending would cover just three patients — with hardly anything left over for non-surgical treatments such as counseling and medication.

The Fox article also cited a 2008 study that stated "most children with gender dysphoria will not remain gender dysphoric after puberty," implicitly suggesting that children in Oregon who might opt for gender reassignment surgery (without any input from their parents regarding the serious health decision) would invariably come to regret their hasty course of action later in life. However, Fox elided the portion of the study that indicated the children presenting as gender dysphoric had an "age range [of] 5-12 years," meaning all study participants were well under the threshold age of medical consent in Oregon. That omission was in contrast to the wording of Fox's headline, which specifically cited minors aged 15 and over (none of which were included in the cited study).

It's true that the age of medical consent in Oregon is 15 (whether or not a minor is transgender), and in early 2015 the state of Oregon's HERC did opt to include gender dysphoria in a list of conditions covered by the state's Medicaid plans. But publicized claims misled readers and viewers into thinking that a new guideline had approved "sex changes" for teenagers by conflating extant Oregon state policies that were largely unrelated.

In fact, the age of medical consent in Oregon has been 15 since 1971, and gender dysphoria Medicaid coverage changes applied to all residents of the state (not teens specifically). The Fox article (and subsequent iterations) failed to consider the lengthy, arduous process gender reassignment entails or the likelihood that any medical provider would agree to begin such a process on a minor who lacked parental consent. Moreover, the policy change was not enacted "quietly" (i.e., without notice or disclosure), as the Associated Press had published an article announcing "Oregon Medicaid to Cover Gender Reassignment" nearly a year earlier.

We've asked out HERC whether additional details are available to determine whether any 15- to 17-year-olds have been affected by the policy update or have undergone gender reassignment in Oregon following the change.

Last updated:    10 July 2015

Originally published:    10 July 2015

By Kim LaCapria

Kim LaCapria is a former writer for Snopes.

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In Oregon, Medicaid Now Covers Transgender Medical Care

Kristian Foden-Vencil

When Alexis Paige lost her job, she was afraid she would have to discontinue her estrogen treatments. That can't happen now under the Oregon Health Plan. Cree Jude Gordon/Courtesy Alexis Paige hide caption

When Alexis Paige lost her job, she was afraid she would have to discontinue her estrogen treatments. That can't happen now under the Oregon Health Plan.

Oregon began covering the cost of reassignment surgery for transgender people on Medicaid in January. It also covers things like hormone therapy and puberty suppression.

By doing so, Oregon joins a handful of other states that have recently taken steps to help people with gender dysphoria , or the conflict between the gender people identify with and their physical gender.

Some question the validity of coverage, but people in the transgender community are thrilled.

When Alexis Paige was born 26 years ago, as far as doctors and family were concerned, she was a boy. But by 11, she began to grow breasts and wanted to be a girl, making school very difficult.

"It kind of culminated in an instance in which I was actually pressed against a wall by someone who groped my breasts to see if they were real and wanted to check if I was actually a male or female," she says.

By 16 her hips began to spread. She says she always felt different, as if she weren't in the right body. And it drove her to attempt suicide by riding her bike into oncoming traffic.

After years of suffering, a doctor prescribed the hormone estrogen last year. "Suddenly for the first time I had energy, I wasn't feeling sad all the time," she says. "I actually stopped getting sick. I stopped feeling sore. This was who I was supposed to be."

At the time, Paige had a job and insurance to cover medical expenses. But then she lost her job and became terrified that she'd have to end the therapy.

She says knowing the Oregon Health Plan now covers her hormones if she becomes unemployed again, is invaluable. "I know there will be some people who will question that, and question whether that's right or it's wrong. ... And the thing is, so what? I mean, you don't look at someone with cancer and go, 'Oh, your cancer wasn't caused by a genetic reason, it was environmental, so we're not going to treat you.' "

Oregon joins California, Massachusetts and Vermont as states where Medicaid covers medical treatments for gender dysphoria. Washington, D.C., offers coverage, too.

While new coverage begins this month, it may take a while to line up all the necessary services and doctors for the transgender therapies to run smoothly.

By looking at medical billing data, Oregon estimates at least 175 people will use the coverage this year. But there are those who question its validity and expense.

"To a large degree, I think the jury is still out on these procedures and whether or not they're legitimate," says Republican state Sen. Jeff Kruse, who sits on Oregon's Senate Health Care Committee. He says gender reassignment procedures are "elective" and "dubious at best."

Oregon's Health Evidence Review Commission decided to look into coverage for gender dysphoria last year. Until then, it had been lumped in with conditions like pedophilia and fetishism.

Dr. Ariel Smits, director of the commission, says now people who've been suffering for years are getting medical coverage for a real disorder. "People with gender dysphoria that did not receive treatment had a much higher rate of hospitalizations or ER visits or doctor visits for depression and anxiety," she says.

They also had a higher rate of suicide attempts. Some studies put it at about 30 percent.

"But folks when they received the treatment that they felt was adequate for their gender dysphoria, had an almost normal rate of depression and anxiety compared to the general population."

Their suicide rate also dropped.

But what about the cost?

Smits' best estimate is up to $200,000 — for the whole state.

"There's also the possibility that it'll be less, or even cost savings," she says. "Because, hopefully, these folks will no longer be going to the ER or being hospitalized for their severe depression or suicide attempts."

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Oregon lawmakers consider expanding insurance coverage for more gender-affirming care

A bill aimed at strengthening access to abortion and gender-affirming care would require insurers to pay for laser hair removal and facial feminization surgery..

Gender dysphoria can be a difficult feeling to explain to another person. But when Carolyn Ward senses the prickle of hair on her face, a sensation takes over: a deep self-loathing or disgust – an oppressive anxiety.

The facial hair is a constant reminder the gender she was assigned at birth doesn’t align with her sense of who she is.

Growing up in Kentucky, Ward didn’t have a clear understanding of why she felt different or why she buried herself in video games, often avoiding her peers and much of society. It wasn’t until her 20s – and a severe mental health breakdown in college – that she started to understand that she was assigned the wrong gender at birth.

Now, in her late 20s and living in Eugene, Ward said she has a lot more clarity about why she was so depressed. She’s in a better place now, both physically and emotionally, but her transition is not over.

“Getting electrolysis and not having the constant drain on me every single day, to be at peace and have comfort with that part of my body would help so, so much,” she said.

Legislators for the House Committee on Behavioral Health and Heath Care listen to testimony for HB 2002 at the Oregon State Capitol in Salem, March 20,. 2023. The bill would require health care plans in Oregon to include more reproductive and gender-affirming care.

Kristyna Wentz-Graff / OPB

While states across the country are considering ways to limit gender-affirming care or prevent insurance coverage from paying for it, a bill in the Oregon Legislature would require Medicaid and private insurers to expand coverage of gender-affirming care to include laser hair removal and facial feminization surgery. The measure, House Bill 2002 , also aims to protect access to abortions and protect providers from legal repercussions for providing reproductive care.

So far, it’s proven to be the most emotionally-charged measure of the 2023 legislative session. In a nearly five-hour hearing last week, the topic of gender-affirming care emerged as the biggest wedge issue.

“I hear a panic that we are opening up the gates, allowing young patients to come in and cajoling them and pressuring them to start pubertal suppression and pursue surgical procedures,” Dr. Christina Milano, a doctor who provides such care at Oregon Health & Science University, said in testimony.

She added that her team always works with a coalition of providers that also includes endocrinologists and psychologists. “Our teams work with exquisite caution and thoughtfulness,” she said.

Milano said surgery is reserved for a small population.

Since 2015, the Oregon Health Plan and private insurance have been required to cover many gender-affirming medical care, including hormone treatment and some surgeries. This measure would expand the list of what is covered.

The transgender community in the United States is estimated to include 1.3 million adults . A Washington Post-Kaiser Family Foundation poll released this week showed most people who identify as trans said their lives have improved post-transition. But what that means also looks very different person to person.

There is a social transition, such as changing names, clothing and outward appearance. Some people, like Ward, have used hormone replacement therapies to help with their transition, but far fewer, only about 1 in 6 people, have had surgery to alter their appearance, according to the poll.

The American Medical Association wrote that “evidence has demonstrated that forgoing gender-affirming care can have tragic consequences” and said prohibiting such treatment can harm people’s mental and physical health.

A similar measure to the one under consideration in Oregon passed the Washington Legislature and took effect in January 2022. Public and private insurers in Washington are now required to cover gender-affirming treatments, such as counseling, voice therapy and puberty blockers.

For Ward, of Eugene, the ability to transition has allowed her to start her life.

“I think it’s important for me to say that gender-affirming care is lifesaving care,” she said. “I wouldn’t be here today without it, and it’s allowed me to start living in the real world rather than hiding in it.”

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Oregon Medicaid To Cover Gender Reassignment Surgery, Hormone Therapy

August 14, 2014 / 9:02 PM PDT / CBS Sacramento

PORTLAND, Ore. (AP) - Oregon's Medicaid program will soon pay for gender reassignment surgery, hormone therapy and other treatments for transgender patients, becoming on Thursday the third state besides the District of Columbia to extend coverage to gender dysphoria treatments.

A panel of health experts added the condition to the list of treatments covered by the Oregon Health Plan, the state's version of Medicaid, which provides publicly funded health coverage for nearly 1 million people.

Officials estimate that about 175 Medicaid patients per year will seek treatment for gender dysphoria, in which a person identifies with the opposite gender they received at birth, at an annual cost of less than $150,000.

"This is an historic step forward toward fairness and equality for transgender Oregonians," said Danielle Askini, policy director for the advocacy group Basic Rights Oregon.

Oregon joins California, Vermont and Washington, D.C., in covering gender dysphoria treatments under Medicaid, Askini said.

The coverage for gender dysphoria, previously known as gender identity disorder, is set to begin Jan. 1. The Oregon Health Authority still must formally change its rules to eliminate a prohibition against covering gender reassignment surgery - a process that's has already started and will involve a public comment period, said Karynn Fish, an agency spokeswoman.

Oregon insurance regulators in 2012 ordered private insurance companies to cover treatments for gender dysphoria. A lawsuit forced the state to cover treatments for public employees.

With Medicaid patients gaining coverage, the last segment of Oregon's health insurance market not required to cover gender dysphoria treatments is the Oregon Educators Benefit Board, which covers school district employees, Askini said.

Oregon's Medicaid program operates under a waiver from the federal government that allows the state to determine which treatments are covered based on their cost-effectiveness. Advocates seeking insurance coverage of surgical and hormonal treatments say they significantly reduce the risk of suicide attempts and their associated medical costs while reducing depression.

"The reasons these exclusions have existed is purely discrimination," Askini said. "When you compare it to any other kind of medical intervention ... apples to apples, this is a very cost-effective intervention."

Copyright 2014 The Associated Press.

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Vatican Document Casts Gender Change and Fluidity as Threat to Human Dignity

The statement is likely to be embraced by conservatives and stir consternation among L.G.B.T.Q. advocates who fear it will be used as a cudgel against transgender people.

By Jason Horowitz and Elisabetta Povoledo

Reporting from Rome

The Vatican on Monday issued a new document approved by Pope Francis stating that the church believes that gender fluidity and transition surgery, as well as surrogacy, amount to affronts to human dignity.

The sex a person is assigned at birth, the document argued, was an “irrevocable gift” from God and “any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception.” People who desire “a personal self-determination, as gender theory prescribes,” risk succumbing “to the age-old temptation to make oneself God.”

Regarding surrogacy, the document unequivocally stated the Roman Catholic Church’s opposition, whether the woman carrying a baby “is coerced into it or chooses to subject herself to it freely.” Surrogacy makes the child “a mere means subservient to the arbitrary gain or desire of others,” the Vatican said in the document, which also opposed in vitro fertilization.

The document was intended as a broad statement of the church’s view on human dignity, including the exploitation of the poor, migrants, women and vulnerable people. The Vatican acknowledged that it was touching on difficult issues, but said that in a time of great tumult, it was essential, and it hoped beneficial, for the church to restate its teachings on the centrality of human dignity.

Even if the church’s teachings on culture war issues that Francis has largely avoided are not necessarily new, their consolidation now was likely to be embraced by conservatives for their hard line against liberal ideas on gender and surrogacy.

The document, five years in the making, immediately generated deep consternation among advocates for L.G.B.T.Q. rights in the church, who fear it will be used against transgender people. That was so, they said, even as the document warned of “unjust discrimination” in countries where transgender people are imprisoned or face aggression, violence and sometimes death.

“The Vatican is again supporting and propagating ideas that lead to real physical harm to transgender, nonbinary and other L.G.B.T.Q.+ people,” said Francis DeBernardo, the executive director of New Ways Ministry, a Maryland-based group that advocates for gay Catholics, adding that the Vatican’s defense of human dignity excluded “the segment of the human population who are transgender, nonbinary or gender nonconforming.”

He said it presented an outdated theology based on physical appearance alone and was blind to “the growing reality that a person’s gender includes the psychological, social and spiritual aspects naturally present in their lives.”

The document, he said, showed a “stunning lack of awareness of the actual lives of transgender and nonbinary people.” Its authors ignored the transgender people who shared their experiences with the church, Mr. DeBernardo said, “cavalierly,” and incorrectly, dismissing them as a purely Western phenomenon.

Though the document is a clear setback for L.G.B.T.Q. people and their supporters, the Vatican took pains to strike a balance between protecting personal human dignity and clearly stating church teaching, a tightrope Francis has tried to walk in his more than 11 years as pope.

Francis has made it a hallmark of his papacy to meet with gay and transgender Catholics and has made it his mission to broadcast a message for a more open, and less judgmental, church. Just months ago, Francis upset more conservative corners of his church by explicitly allowing L.G.B.T.Q. Catholics to receive blessings from priests and by allowing transgender people to be baptized and act as godparents .

But he has refused to budge on the church rules and doctrine that many gay and transgender Catholics feel have alienated them, revealing the limits of his push for inclusivity.

“In terms of pastoral consequences,” Cardinal Víctor Manuel Fernández, who leads the Vatican’s office on doctrine, said in a news conference Monday, “the principle of welcoming all is clear in the words of Pope Francis.”

Francis, he said, has repeatedly said that “all, all, all” must be welcomed. “Even those who don’t agree with what the church teaches and who make different choices from those that the church says in its doctrine, must be welcomed,” he said, including “those who think differently on these themes of sexuality.”

But Francis’ words were one thing, and church doctrine another, Cardinal Fernández made clear, drawing a distinction between the document, which he said was of high doctrinal importance, as opposed to the recent statement allowing blessings for same-sex Catholics. The church teaches that “homosexual acts are intrinsically disordered.”

In an echo of the tension between the substance of church law and Francis’ style of a papal inclusivity, Cardinal Fernández said on Monday that perhaps the “intrinsically disordered” language should be modified to better reflect that the church’s message that homosexual acts could not produce life.

“It’s a very strong expression and it requires explanation,” he said. “Maybe we could find an expression that is even clearer to understand what we want to say.”

Though receptive to gay and transgender followers, the pope has also consistently expressed concern about what he calls “ideological colonization,” the notion that wealthy nations arrogantly impose views — whether on gender or surrogacy — on people and religious traditions that do not necessarily agree with them. The document said “gender theory plays a central role” in that vision and that its “scientific coherence is the subject of considerable debate among experts.”

Using “on the one hand” and “on the other hand,” language, the Vatican’s office on teaching and doctrine wrote that “it should be denounced as contrary to human dignity the fact that, in some places, not a few people are imprisoned, tortured, and even deprived of the good of life solely because of their sexual orientation.”

“At the same time,” it continued, “the church highlights the definite critical issues present in gender theory.”

On Monday, Cardinal Fernández also struggled to reconcile the two seemingly dissonant views.

“I am shocked having read a text from some Catholics who said, ‘Bless this military government of our country that created these laws against homosexuals,’” Cardinal Fernández said on Monday. “I wanted to die reading that.”

But he went on to say that the Vatican document was itself not a call for decriminalization, but an affirmation of what the church believed. “We shall see the consequences,” he said, adding that the church would then see how to respond.

In his presentation, Cardinal Fernández described the long process of the drafting of a document on human dignity, “Infinite Dignity,” which began in March 2019, to take into account the “latest developments on the subject in academia and the ambivalent ways in which the concept is understood today.”

In 2023, Francis sent the document back with instructions to “highlight topics closely connected to the theme of dignity, such as poverty, the situation of migrants, violence against women, human trafficking, war, and other themes.” Francis signed off on the document on March 25.

The long road, Cardinal Fernández wrote, “reflects the gravity” of the process.

In the document, the Vatican embraced the “clear progress in understanding human dignity,” pointing to the “desire to eradicate racism, slavery, and the marginalization of women, children, the sick, and people with disabilities.”

But it said the church also sees “grave violations of that dignity,” including abortion, euthanasia, the death penalty, polygamy, torture, the exploitation of the poor and migrants, human trafficking and sex abuse, violence against women, capitalism’s inequality and terrorism.

The document expressed concern that eliminating sexual differences would undercut the family, and that a response “to what are at times understandable aspirations,” will become an absolute truth and ideology, and change how children are raised.

The document argued that changing sex put individualism before nature and that human dignity as a subject was often hijacked to “justify an arbitrary proliferation of new rights,” as if “the ability to express and realize every individual preference or subjective desire should be guaranteed.”

Cardinal Fernández on Monday said that a couple desperate to have a child should turn to adoption, rather than surrogacy or in vitro fertilization because those practices, he said, eroded human dignity writ large.

Individualistic thinking, the document argues, subjugates the universality of dignity to individual standards, concerned with “psycho-physical well-being” or “individual arbitrariness or social recognition.” By making dignity subjective, the Vatican argues, it becomes subject to “arbitrariness and power interests.”

Jason Horowitz is the Rome bureau chief for The Times, covering Italy, the Vatican, Greece and other parts of Southern Europe. More about Jason Horowitz

Elisabetta Povoledo is a reporter based in Rome, covering Italy, the Vatican and the culture of the region. She has been a journalist for 35 years. More about Elisabetta Povoledo

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Blair Peters, M.D. (he/they)

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Dr. Blair Peters is an Assistant Professor in the Division of Plastic and Reconstructive Surgery and Department of Urology at Oregon Health & Science University specializing in Gender-Affirmation Surgery and Peripheral Nerve Reconstruction. He obtained his medical degree from the University of Manitoba, Canada. Following this, he undertook residency training in Plastic and Reconstructive Surgery at the University of Manitoba with an emphasis on Microsurgery. Subsequently, Dr. Peters completed fellowship in Peripheral Nerve, Hand and Microsurgery at the prestigious Washington University in St Louis then became the first fellow in Advanced Gender Surgery at OHSU in 2020. He is board certified by both the Royal College of Physicians and Surgeons of Canada and the American Board of Plastic Surgery.

Presently he is the Director of the Advanced Gender-Affirming Surgery Fellowship at OHSU. Since 2021, he has also been entrusted with the responsibility of Research Director for the Division of Plastic Surgery. He has served as surgical lead for the United States Professional Association of Transgender Health (U SPATH ) meeting and was selected as the 2023 National John Fryer Lecturer in LGBTQ+ Health. He is a frequent nationally and internationally invited lecturer having served as a Visiting Professor for many prestigious institutions across the United States and Canada, focusing on fostering the development of new Gender-Affirming Surgery programs.

His unique training background, clinical research, advocacy work and community background have established him as a leader and expert in the field of Gender-Affirming Surgery. They are an international award-winning researcher with an extensive research portfolio regarding outcomes and techniques in gender-affirming surgery, genital surgery, novel nerve transfers, sensory outcomes in phalloplasty and extensive work on LGBTQ+ representation in surgical fields. He is a member and steadfast activist for the LGBTQIA+ community and advocates across the country for policy change and protections for LGBTQ+ people.

The core mission of his work is clinical and surgical innovation and improvement of outcomes and accessibility of care for the Transgender and LGBTQ+ community.

In terms of professional affiliations, Dr. Peters is a member of the World Professional Association for Transgender Health, American Society of Peripheral Nerve Surgery, American Society of Plastic Surgeons and Sexual Medicine Society of North America. He serves on the Editorial Board for "Plastic & Reconstructive Surgery - Global Open” and publishes frequently on sensory outcomes in gender-affirming surgery, genital surgery techniques, nerve transfers and work on LGBTQ+ representation in medicine.

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• B.S., 2010, University of Manitoba
• B.S., 2012, University of Manitoba
• M.D., 2014, University of Manitoba
• Plastic and Reconstructive Surgery, University of Manitoba, Winnipeg, Manitoba, Canada, 2019
• Peripheral Nerve Reconstruction, Microsurgery, Hand Surgery, Washington University School of Medicine, St. Louis, Missouri, 2019
• Gender Affirming Surgery, Oregon Health & Science University, Portland, OR, 2020

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• Medical Council of Canada Qualifying Examination Part II; Part I; Medical Council of Canada Certification Examination
• United States Medical Licensing Examination Step 3, Step 2 CK, Step 2 CS, Step 1
• American Heart Association Certification
• Board Certification - Royal College of Surgeons of Canada (FRCSC)
• Medical Council of Canada (LMCC)
• United States Medical Licensing Examination (USMLE)
• Certification of Advanced Trauma Life Support (ATLS)

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• Fellow of the Royal College of Surgeons of Canada (FRCSC); Board Certification in Plastic Surgery
• Principles of Surgery Examination; Royal College of Physicians and Surgeons of Canada

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Vatican says sex reassignment surgery, surrogacy and gender theory threaten human 'dignity'

The Vatican has declared gender confirmation operations and surrogacy as grave threats to human "dignity", putting them on par with abortion and euthanasia as practices that violate God's plan for human life.

The Vatican's doctrine office on Monday published a 20-page declaration titled Infinite Dignity that was in the works for the past five years.

It was approved for publication by Pope Francis on March 25 after substantial revision in recent months.

In its most eagerly anticipated section, the Vatican reiterated its rejection of "gender theory" or the idea that one's gender can be "a self-determination".

It said God created man and woman as biologically different, separate beings, and said they must not tinker with that plan or try to "make oneself God".

"It follows that any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception," the document said.

It distinguished between transitioning surgeries, which it rejected, and "genital abnormalities" that are present at birth or that develop later. Those abnormalities can be "resolved" with the help of health care professionals, it said.

The document's existence, rumoured since 2019, was confirmed in recent weeks by the new prefect of the Dicastery for the Doctrine of the Faith, Argentine Cardinal Víctor Manuel Fernández, a close confidante of Pope Francis.

He had cast it as something of a nod to conservatives after he authored a more explosive document approving blessings for same-sex couples that sparked criticism from conservative bishops around the world, especially in Africa.

While the new document rejected gender theory, it took pointed aim at countries — including many in Africa — that criminalise homosexuality.

It echoed Pope Francis's assertion in a 2023 interview that "being homosexual is not a crime", making the assertion now part of the Vatican's doctrinal teaching.

It denounced "as contrary to human dignity the fact that, in some places, not a few people are imprisoned, tortured, and even deprived of the good of life solely because of their sexual orientation".

The document restated well-known Catholic doctrine opposing abortion and euthanasia.

It also added to the list some of Pope Francis's main concerns as pope: the threats to human dignity posed by poverty, war, human trafficking and forced migration.

A child's right to 'a fully human origin'

In a newly articulated position, the declaration said surrogacy violated both the dignity of the surrogate mother and the child.

While much attention on surrogacy has focused on possible exploitation of poor women as surrogates, the Vatican document focuses more on the resulting child.

"The child has the right to have a fully human (and not artificially induced) origin and to receive the gift of a life that manifests both the dignity of the giver and that of the receiver," the document said.

"Considering this, the legitimate desire to have a child cannot be transformed into a 'right to a child' that fails to respect the dignity of that child as the recipient of the gift of life."

The Vatican published its most articulated position on gender in 2019, when the Congregation for Catholic Education rejected the idea that people can choose or change their genders.

It insisted on the complementary nature of biologically male and female sex organs to create new life.

Gender fluidity was described as a symptom of the "confused concept of freedom" and "momentary desires" that characterise post-modern culture.

The new document from the more authoritative Dicastery for the Doctrine of the Faith quoted from that 2019 education document but tempered the tone.

Significantly, it did not repurpose the 1986 language of a previous doctrinal document saying that homosexual people deserve to be treated with dignity and respect but that homosexual actions are "intrinsically disordered".

Francis has made reaching out to LGBTQ+ people a hallmark of his papacy, ministering to trans Catholics and insisting that the Catholic Church must welcome all children of God.

But he has also denounced "gender theory" as the "worst danger" facing humanity today, describing it as an "ugly ideology" that threatens to cancel out God-given differences between man and woman.

"It needs to be emphasised that biological sex and the sociocultural role of sex (gender) can be distinguished but not separated," the new document said.

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Vatican blasts gender-affirming surgery, surrogacy and gender theory as violations of human dignity

The Vatican has declared that gender-affirming surgeries and surrogacy are grave violations of human dignity. A new document from the doctrine office puts them on a par with abortion and euthanasia as practices that violate God’s plan for human life. In its most eagerly anticipated section, the Vatican flat-out rejected “gender theory” or the idea that one’s gender can be changed.

The Vatican on Monday declared gender-affirming surgery and surrogacy as grave violations of human dignity, putting them on par with abortion and euthanasia as practices that reject God’s plan for human life. The Vatican’s doctrine office issued “Infinite Dignity,” a 20-page declaration that has been in the works for five years. After substantial revision in recent months, it was approved March 25 by Pope Francis, who ordered its publication.

The prefect of the Vatican’s Dicastery for the Doctrine of the Faith, Cardinal Victor Manuel Fernandez, presents the declaration ‘Dignitas Infinita’ (Infinite Dignity) during a press conference at the Vatican, Monday, April 8, 2024. (AP Photo/Gregorio Borgia)

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A copy of the 20-page “Infinite Dignity” declaration issued by the Vatican’s doctrine office sits on a journalist desk as the prefect of the Vatican’s Dicastery for the Doctrine of the Faith, Cardinal Victor Manuel Fernandez, meets the journalists during a press conference at the Vatican, Monday, April 8, 2024. (AP Photo/Gregorio Borgia)

VATICAN CITY (AP) — The Vatican on Monday declared gender-affirming surgery and surrogacy as grave violations of human dignity , putting them on par with abortion and euthanasia as practices that it said reject God’s plan for human life.

The Vatican’s doctrine office issued “Infinite Dignity,” a 20-page declaration that has been in the works for five years. After substantial revision in recent months, it was approved March 25 by Pope Francis, who ordered its publication.

From a pope who has made outreach to the LGBTQ+ community a hallmark of his papacy, the document was received as a setback, albeit predictable, by trans Catholics. But its message was also consistent with the Argentine Jesuit’s long-standing belief that while trans people should be welcomed in the church, so-called “gender ideologies” should not.

In its most eagerly anticipated section, the Vatican repeated its rejection of “gender theory,” or the idea that one’s biological sex can change. It said God created man and woman as biologically different, separate beings, and said people must not tinker with that or try to “make oneself God.”

“It follows that any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception,” the document said.

It distinguished between gender-affirming surgeries, which it rejected, and “genital abnormalities” that are present at birth or that develop later. Those abnormalities can be “resolved” with the help of health care professionals, it said.

Advocates for LGBTQ+ Catholics immediately criticized the document as outdated, harmful and contrary to the stated goal of recognizing the “infinite dignity” of all of God’s children. They warned it could have real-world effects on trans people, fueling anti-trans violence and discrimination.

“While it lays out a wonderful rationale for why each human being, regardless of condition in life, must be respected, honored, and loved, it does not apply this principle to gender-diverse people,” said Francis DeBernardo of New Ways Ministry, which advocates for LGBTQ+ Catholics.

“It needs to be emphasized that biological sex and the sociocultural role of sex (gender) can be distinguished but not separated”

Nicolete Burbach, lead expert in social and environmental justice at the London Jesuit Centre, said the document showed the Vatican continues to fail to engage with queer and feminist approaches to the body “which it simply dismisses as supposedly subjecting both the body and human dignity itself to human whims.”

“I think the main difficulty faced by the document is that it attempts to affirm the church’s authentic commitment to human dignity in the face of a troubling history on the part of the church itself around attacks on that dignity,” said Burbach, a trans Catholic theologian who researches transness and the Catholic Church.

The document’s existence, rumored since 2019, was confirmed in recent weeks by the new prefect of the Dicastery for the Doctrine of the Faith, Argentine Cardinal Víctor Manuel Fernández, a close Francis confidant.

Fernández had cast the document as something of a nod to conservatives after he authored a more explosive document approving blessings for same-sex couples that sparked criticism from conservative bishops around the world, especially in Africa.

And yet, in an apparent attempt at balance, the document takes pointed aim at countries — including many in Africa — that criminalize homosexuality. It echoed Francis’ assertion in a 2023 interview with The Associated Press that “being homosexual is not a crime .”

The new document denounces “as contrary to human dignity the fact that, in some places, not a few people are imprisoned, tortured, and even deprived of the good of life solely because of their sexual orientation.”

The White House said President Joe Biden, a devout Catholic, was “pleased” to see that the declaration “furthers the Vatican’s call to ensure that LGBTQ+ (individuals) are protected from violence and imprisonment around the world,” press secretary Karine Jean-Pierre said.

On the specifics involving gender theory, Jean-Pierre stressed that it was not Biden’s role to “litigate internal church policy.”

Asked how its negative take on trans people squared with Francis’ message of welcome, Fernández said the welcome remained but that the pope fervently believed that the idea that gender was fluid “rather than helping to recognize dignity, impoverishes the vision” of a man and woman coming together to create new life.

The document is something of a repackaging of previously articulated Vatican positions, read now through the prism of human dignity. It restates well-known Catholic doctrine opposing abortion and euthanasia, and adds to the list some of Francis’ main concerns as pope: the threats to human dignity posed by poverty, war, human trafficking, the death penalty and forced migration.

In a newly articulated position, it says surrogacy violates both the dignity of the surrogate mother and the child .

While much attention about surrogacy has focused on possible exploitation of poor women as surrogates, the Vatican asserts that the child “has the right to have a fully human (and not artificially induced) origin and to receive the gift of a life that manifests both the dignity of the giver and that of the receiver.”

“Considering this, the legitimate desire to have a child cannot be transformed into a ‘right to a child’ that fails to respect the dignity of that child as the recipient of the gift of life,” it said.

The Vatican had previously published its most articulated position on gender in 2019, when the Congregation for Catholic Education rejected the idea that people can choose or change their genders and insisted on the complementarity of biologically male and female sex organs to create new life.

The new document from the more authoritative Dicastery for the Doctrine of the Faith quotes from that 2019 education document, but tempers the tone. Significantly, it doesn’t repeat Vatican doctrine that homosexual people deserve to be treated with dignity and respect but that homosexual actions are “intrinsically disordered.”

In a news conference to introduce the document, Fernández acknowledged that the “intrinsically disordered” language was very strong. He suggested there might be a better way, “with other words,” to express the church’s vision of sex between husband and wife to create new life.

Francis has ministered to trans Catholics, including trans sex workers, and insisted that the Catholic Church must welcome all children of God.

But he has also denounced “gender theory” as the “worst danger” facing humanity today, an “ugly ideology” that threatens to cancel out God-given differences between man and woman. He has blasted in particular what he calls the “ideological colonization” of the West in the developing world, where development aid is sometimes conditioned on adopting Western ideas about gender.

Transgender activists immediately called the document “hurtful” and devoid of the voices and experiences of real trans people, especially in the distinction it makes between gender-affirming surgeries and surgeries on intersex people.

“The suggestion that gender-affirming health care — which has saved the lives of so many wonderful trans people and enabled them to live in harmony with their bodies, their communities and (God) — might risk or diminish trans people’s dignity is not only hurtful but dangerously ignorant,” said Mara Klein, a nonbinary, transgender activist who has participated in Germany’s church reform project.

Klein said the Vatican “hypocrisy” was furthered by the document’s approval of surgery on intersex people, “which if performed without consent especially on minors often cause immense physical and psychological harm.”

The document comes at a time of some backlash against transgender people, including in the United States where Republican-led state legislatures are considering a new round of bills restricting medical care for transgender youths — and in some cases, adults.

“On top of the rising hostility towards our communities, we are faced with a church that does not listen and refuses to see the beauty of creation that can be found in our biographies,” Klein said in an email.

AP writer Darlene Superville contributed from Air Force One.

Ohio judge blocks ban on gender-affirming care for transgender minors—for now

An Ohio judge on Tuesday temporarily blocked an impending law that would restrict medical care for transgender minors in the Buckeye State.

The decision came weeks after the American Civil Liberties Union filed a lawsuit challenging the state on behalf of two transgender girls and their families. The measure prevents doctors from prescribing hormones, puberty blockers, or gender reassignment surgery before patients turn 18.

Attorneys contend the law violates the state Constitution , which gives Ohioans the right to choose their health care.

“Today’s ruling is a victory for transgender Ohioans and their families,” said Harper Seldin, staff attorney for the ACLU. “Ohio’s ban is an openly discriminatory breach of the rights of transgender youth and their parents alike and presents a real danger to the same young people it claims to protect.”

The legislation was set to take effect on April 24 after House and Senate Republicans  voted to override  Gov. Mike DeWine’s veto. Proponents of the bill contend it will protect children, but critics say decisions about transition care should be left to families and their medical providers.

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The suit in Ohio mirrors efforts in other states to challenge laws that restrict gender-affirming care for minors. A federal judge struck down a  similar policy in Arkansas , arguing it violates the constitutional rights of transgender youth and their families. The state is appealing that decision.

“We protect children with various restrictions that do not apply to adults − from signing legal contracts to buying alcohol and tobacco and more,” Attorney General Dave Yost posted on X , formerly known as Twitter, after the lawsuit was filed. “As I promised during the veto override, my office will defend this constitutional statute.”

What does the Ohio bill do?

The bill allows Ohioans younger than 18 who are already receiving hormones or puberty blockers to continue as long as doctors determine stopping the prescription would cause harm. Critics say that’s not enough to protect current patients because health care providers could be wary of legal consequences.

The legislation does not ban talk therapy, but it requires mental health providers to get permission from at least one parent or guardian to diagnose and treat gender dysphoria.

More: 6 jurors selected to serve in Donald Trump's hush money trial: Latest Trump trial news

The bill also bans transgender girls and women from playing on female sports teams in high school and college. It doesn’t specify how schools would verify an athlete’s gender if it’s called into question. Players and their families can sue if they believe they lost an opportunity because of a transgender athlete.

The lawsuit doesn’t specifically challenge the athlete ban. But it argues the legislation flouts the constitution’s single-subject rule, which requires legislation to address only one topic. House Republicans introduced separate bills on gender-affirming care and transgender athletes before  combining them into one .

In Tuesday’s decision, Franklin County Judge Michael Holbrook indicated that the law could be tossed out because of a single-subject violation.

“It is not lost upon this Court that the General Assembly was unable to pass the (Saving Ohio Adolescents from Experimentation) portion of the Act separately, and it was only upon logrolling in the Saving Women’s Sports provisions that it was able to pass,” Holbrook wrote.

Panel clears ban on gender reassignment surgery for minors

Tuesday’s decision came one day after a legislative panel cleared the way for an administrative rule that will ban gender reassignment surgery for minors. Ohio health care providers say they do not perform that procedure on patients under 18.

The rule will take effect May 3.

More: Supreme Court, in an emergency order, lets Idaho enforce ban on transgender care

The measure was among several that DeWine proposed to regulate gender-affirming care after he vetoed the legislation. In testimony for Monday’s meeting, opponents argued that the rules overstep the administration’s authority and conflict with federal law.

“The proposed administrative rule changes are based on biased definitions, ignore well-established best practices, and restrict countless patients’ access to gender-affirming care,” said Mallory Golski, civic engagement and advocacy manager for Kaleidoscope Youth Center.

DeWine’s other proposals are still working their way through the rulemaking process. That includes a requirement for transgender minors to undergo at least six months of counseling before further treatment occurs. Another rule would require providers to report non-identifying data on gender dysphoria diagnoses and treatment.

Haley BeMiller is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

Kansas governor vetoes a ban on gender-affirming care; GOP vows override

The Democratic governor of Kansas vetoed a bill Friday that would have banned gender-affirming care for minors, setting up a confrontation with the state’s Republican supermajority as it tries to join more than a dozen states restricting transgender care.

The Republican-led legislature is widely expected to attempt an override of the veto. The measure that Kansas Gov. Laura Kelly (D) quashed, Senate Bill 233, would ban hormone therapy, puberty blockers and gender reassignment surgery for people younger than 18.

Carrie Rahfaldt, a spokeswoman for Kansas House Speaker Dan Hawkins (R), told The Washington Post that she expects the Senate to begin voting sometime after a veto session begins April 29.

If two-thirds of the Senate votes to pass the bill, the measure would be kicked to the House, which also requires a two-thirds majority for an override. Hawkins said in a statement Friday that “House Republicans stand ready to override [the] veto to protect vulnerable Kansas kids.”

Kansas has 40 Democrats and 85 Republicans in its House and 11 Democrats and 29 Republicans in its Senate. The bill passed the House 82-39, and the Senate 27-13, largely along party lines. To override the veto, the House would need to add two yes votes and the Senate would not be able to lose any.

The success of the vote in the part-time legislature largely depends on attendance.

“Absences will change the number that they need to reach,” said Don Haider-Markel, a political science professor at the University of Kansas. “People have to leave and go home or some work-related or family-related issue. So, it very well could be that they don’t have enough votes in both chambers to override the veto.”

Kelly wrote in her veto message that she rejected the bill because it “tramples parental rights,” a phrase often used by conservatives to defend book restrictions at public libraries and schools.

“This divisive legislation targets a small group of Kansans by placing government mandates on them and dictating to parents how to best raise and care for their children,” Kelly said. “The last place that I would want to be as a politician is between a parent and a child who needed medical care of any kind. And, yet, that is exactly what this legislation does.”

House Republican leadership decried the veto.

“As we watch other states, nations, and organizations reverse course on these experimental procedures on children, Laura Kelly will most surely find herself on the wrong side of history with her reckless veto of this common-sense protection for Kansas minors,” Hawkins said in the Friday statement.

Last year, Kelly vetoed four bills that would have created restrictions on transgender people, including measures barring transgender girls and women from joining female K-12 and college sports teams, and ending the state’s legal recognition of transgender people’s gender identities. Republicans overrode vetoes on three of those measures, according to the Kansas City Star .

A record number of bills targeting transgender people have made their way through state legislatures in recent years. Lawmakers have introduced nearly 500 anti-LGBTQ+ bills during the 2024 legislative session, according to data compiled by the American Civil Liberties Union. By May 2023, legislators had introduced more than 400 such bills, compared with about 150 in 2022, according to The Washington Post.

Many of these bills target gender-affirming care for minors, the use of restrooms and other facilities such as locker rooms, pronouns and drag shows, according to the ACLU. Oklahoma, Missouri, Iowa and Tennessee have introduced the highest share of anti-LGBTQ+ bills this year, according to the ACLU.

In January, Ohio’s Republican supermajority banned gender-affirming care for minors, overriding Republican Gov. Mike DeWine’s December veto of the bill. The law prohibits hormone therapy, puberty blockers and gender reassignment surgery for people younger than 18. The measure also bans transgender girls from playing on sports teams designated for girls and women in high school and college.

Like Ohio’s bill, Kansas’s S.B. 233 would ban gender-affirming care for transgender youths. The bill also would restrict the use of state funds for gender-affirming care; ban the use of state property, including the University of Kansas Medical Center, on such care; and bar state employees who work with children from promoting or advocating for gender-affirming care. Under the measure, any health care provider who violates the ban would have their license revoked.

Major medical organizations such as the American Medical Association , the American Academy of Pediatrics , the American Psychological Association and the Endocrine Society oppose restrictions on gender-affirming care. The American Medical Association and the American Academy of Pediatrics have said gender-affirming care for transgender children is “medically necessary.”

Advocacy organizations warned state legislators that the “the bill’s extreme reach could have unintended consequences.”

“We cannot overstate the harm this bill will cause to some of our most vulnerable Kansas children and their families,” D.C. Hiegert, LGBTQ+ fellow of the ACLU of Kansas, said in a statement after the veto. “This bill attacks parents’ rights to access life-saving healthcare for their kids and threatens Kansas medical providers. And it is written so broadly, it could impact spaces like schools, therapist offices, or state agencies like the Kansas Department of Children and Families — and possibly every person who provides any kind of support or services to children in those places, as well as the youth who need them.”

Haider-Markel, who has written books about transgender rights and politics, predicts that the bill would prompt parents of transgender children to move out of the state to seek medical care.

The legislation would upend “the lives of young people and their families and really, I think, encourages many families with trans members to think about leaving the state because of the way in which they’ve targeted their families,” he said.