HB 1038
In CommitteeHouse
Gender/health providers
Prohibiting puberty blocking medications, cross-sex hormones, and gender transition surgeries for minors.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill bans most gender-affirming medical treatments—including puberty blockers, cross-sex hormones, and surgeries—for people under age 18 in Washington State, unless specific exceptions apply. It defines sex strictly by biological characteristics present at birth and gender as psychological or social aspects, and it explicitly excludes care for minors with certain diagnosed disorders of sex development.
- Prohibits licensed health care providers from prescribing or administering puberty-blocking medications (e.g., GnRH analogues, antiandrogens) to minors for gender-affirmation purposes.
- Prohibits prescribing or administering testosterone, estrogen, or progesterone to minors in amounts exceeding what would naturally occur in a healthy individual of that age and sex.
- Prohibits gender-affirming surgeries that sterilize (e.g., hysterectomy, orchiectomy) or construct genitalia different from sex assigned at birth (e.g., phalloplasty, vaginoplasty).
- Prohibits removal of any healthy or nondiseased body part or tissue for gender-affirmation purposes.
- Includes exceptions for minors with medically verifiable disorders of sex development (DSD), treatment of complications from prior procedures, tapering off hormones, and emergency surgeries to prevent death or serious bodily harm.
Who is affected
- Minors and their families — Minors under age 18 would be prohibited from receiving certain gender-affirming medical treatments, including puberty blockers, cross-sex hormones (beyond typical physiological levels), and surgeries that alter genital appearance or remove healthy tissue.
- Health care providers (e.g., pediatricians, endocrinologists, surgeons) — Would be prohibited from providing or performing the listed medical interventions for gender affirmation or transition, unless an exception applies.
- Minors with disorders of sex development — May be affected if they require gender-affirming care for a minor with a diagnosed disorder of sex development (DSD); the bill includes specific exceptions for such cases.
- Medical licensing boards (e.g., Washington State Medical Association, nursing boards) — Would need to ensure compliance with the law and may face licensing consequences for violations.
Pro/Con Analysis
Stronger case for concerns
Potential Benefits (3)
The bill preserves access to emergency and complication-related care—including treatment of infections, injuries, or life-threatening conditions arising from prior procedures—ensuring continuity of essential medical services and avoiding avoidable harm from delayed intervention.
Public SafetyRef: Sec. 1(2)(d)-(e)Allowing providers to taper off puberty-blocking medications or hormones supports patient autonomy for those who change their minds or wish to discontinue treatment, preserving flexibility in care decisions without coercion.
HealthcareRef: Sec. 1(2)(c)The bill’s definitions clarify legal terms for statutory interpretation, reducing ambiguity in enforcement—though this clarity is used to restrict rights rather than protect them.
Rights & LibertiesRef: Sec. 1(3)(a)-(c)
Potential Concerns (5)
Prohibiting evidence-based gender-affirming care for transgender minors—including puberty blockers and cross-sex hormones—denies access to medically necessary treatment recommended by major medical associations (AAP, AMA, Endocrine Society), increasing risks of depression, anxiety, self-harm, and suicide. Clinical guidelines support these treatments as safe and effective for adolescents with gender dysphoria, and denial constitutes a direct harm to health outcomes.
HealthcarePeopleRef: Sec. 1(1)(a)Banning gender-affirming surgeries that sterilize or reconstruct genitalia—except in narrow exceptions—removes access to life-sustaining care for some transgender youth, particularly those with documented gender dysphoria and persistent distress. Medical literature shows such surgeries significantly reduce psychological distress and improve quality of life in carefully evaluated cases, and the prohibition forces minors to carry irreversible physical distress into adulthood.
HealthcarePeopleRef: Sec. 1(1)(c)-(e)The DSD exceptions are narrowly defined and require extensive diagnostic verification (genetic/biochemical testing), creating administrative barriers and potential delays in care for minors with intersex variations—many of whom require individualized, time-sensitive interventions. Ambiguity in eligibility criteria may lead to inconsistent application and denial of care even when clinically indicated.
HealthcarePeopleRef: Sec. 1(2)(a)-(b)Defining 'sex' strictly by biological characteristics at birth—and excluding psychological, social, or cultural aspects—legally erases transgender identity under state law, undermining bodily autonomy and equal protection. This redefinition contradicts established medical consensus and may expose minors to state-sanctioned discrimination in education, housing, and public accommodations.
Rights & LibertiesPeopleRef: Sec. 1(3)(c)By mandating a narrow biological definition of sex in law, the bill may create hostile school environments for transgender students, as educators and staff may interpret the law as requiring misgendering or denial of identity—even in nonmedical contexts—increasing bullying, isolation, and dropout risk.
EducationPeopleRef: Sec. 1(1)
Who Is Most Affected
Transgender and gender-divergent minors face severe harm: denial of medically necessary care increases psychological distress, suicide risk, and long-term health complications. Many will be unable to access care in-state and may delay or forgo transition entirely, worsening mental health outcomes.
Families of transgender minors will be forced to choose between relocating out of state for care (often at high cost), risking legal exposure, or withholding care—causing emotional, financial, and logistical strain. Parents may face state intervention if they seek care elsewhere.
Healthcare providers face ethical dilemmas: they must choose between adhering to clinical guidelines and risking license revocation, or complying with the law and violating standards of care. This erodes trust in the medical system and may drive providers out of state or out of pediatric endocrinology.
Intersex youth and families may benefit from the DSD exception—but only if they can meet the bill’s narrow, high-bar diagnostic requirements. Many intersex conditions do not fit the listed chromosomal or hormonal criteria, leaving them excluded and at risk of denied care.
State licensing boards and attorneys general will bear enforcement costs and legal liability. The bill may trigger lawsuits challenging its constitutionality (e.g., equal protection, due process), diverting state resources and exposing public officials to political and legal risk.