International › United States · Last reviewed 2026-05-16
United States
Summary
In the United States the Dutch Protocol is endorsed by the Endocrine Society (guideline 2017), the American Academy of Pediatrics (AAP, policy statement 2018, under revision 2023–2025) and WPATH. Since 2021 more than 25 states have passed legislation restricting medical interventions for minors. The 2024 legal context will be settled in later Supreme Court rulings.
1. Clinical guidelines
- Endocrine Society Clinical Practice Guideline (2017) — endorses the Dutch Protocol.1
- AAP Policy Statement (2018, Rafferty et al.) — revised early 2025.2
- WPATH SOC-8 (2022) — see WPATH SOC and the Dutch Protocol.
2. State legislation
Since 2021 more than 25 US states have passed legislation restricting medical interventions for minors with gender dysphoria. The laws range from a ban on specific procedures to a general moratorium up to age 18. Several federal lawsuits have partly tested these laws — see /debate/legal-cases/.3
3. Florida AHCA review 2022
The Florida Agency for Health Care Administration published a report in June 2022 concluding that the evidence base for gender care in minors is insufficient to justify Medicaid coverage. See /evaluations/florida-aapcs-review/.
4. United States v Skrmetti (Supreme Court 2024–2025)
The US Supreme Court heard arguments on 4 December 2024 in United States v. Skrmetti, a review of the Tennessee law restricting hormone treatment in minors. The judgment was expected in June 2025. See /debate/legal-cases/.4
See also
- Central US evaluation: Florida AHCA review 2022
- WPATH context: WPATH SOC, WPATH Files
- Legal context: Bell v Tavistock, US v Skrmetti
- Critics of American guidelines: Levine et al.
- Worldwide overview: Status 2025
- International comparison — US alongside other countries in table.
- Timeline — policy decisions chronologically.
- FAQ · Glossary.
Footnotes
- Hembree WC, et al. J Clin Endocrinol Metab. 2017;102(11):3869–903.
- Rafferty J. Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics. 2018;142(4):e20182162.
- Movement Advancement Project. Mapping Bans on Best-Practice Medical Care for Transgender Youth. 2024.
- United States v. Skrmetti, No. 23-477 (oral arguments 4 December 2024).
- Block J. The Endocrine Society's 2017 guideline reconsidered. BMJ. 2024.