Colorado voters this November will decide on Proposition 135, a ballot measure that seeks to ban gender-affirming surgeries for minors statewide. The proposition, if approved, would prohibit health care professionals from knowingly performing any surgery on a minor “for the purpose of altering biological sex characteristics.” It would also block state and federal funding, including Medicaid, from being used to pay for such procedures.
Proposition 135 is one of two ballot measures backed by Protect Kids Colorado, an organization led by anti-LGBTQ+ activist Erin Lee. Lee did not respond to questions regarding the measure's goals or how it could affect non-transgender children receiving gender-related surgeries. The other measure supported by Protect Kids Colorado would ban transgender youth from participating in gendered sports teams.
Opposition to Proposition 135 comes from Families Not Politics, a coalition of LGBTQ+ advocacy groups including One Colorado, Rocky Mountain Equality, the Transgender Law Center, Inside Out Youth Services, Planned Parenthood of the Rocky Mountains, and Cobalt, an abortion-rights organization. Many other organizations and Democratic elected officials across the state also oppose the measure.
Jax Gonzalez, political director at One Colorado, who is trans, expressed concerns that the measure's language is unclear and could make healthcare provision too complex for providers. Gonzalez highlighted the ambiguity of phrases like a minor’s “perception of sex or gender,” questioning if it could prevent a provider from treating any patient who discusses their own gender, regardless of their identity.
Gender-affirming surgeries for minors are rare, according to Gonzalez, and are typically considered only in extreme cases involving suicidality. Such surgeries are discussed as an option only after years of therapy and consultation with family, as well as multiple doctors and medical experts. A 2024 Harvard study reviewed 2019 insurance claim data and found that no transgender youth age 12 and under received surgeries as part of their gender-affirming care, aligning with medical guidance against intervention prior to puberty. For teenagers aged 15-17, the rate of gender-affirming surgeries was 2.1 per 100,000 transgender or gender-diverse individuals. The study also found that higher rates of cisgender people, both minors and adults, received surgeries often associated with gender-affirming purposes; for example, 97% of breast reduction procedures performed on teenagers were for cisgender boys.
The Colorado Medical Society (CMS) board voted to oppose Proposition 135, citing concerns about governmental interference with physicians' independent clinical decisions. Dr. Sean Pauzauskie, president of the CMS board, stated that the organization, which represents over 6,000 physicians, believes “medical decisions belong in the exam room.” He clarified that the board’s opposition is based on the principle of protecting a medical provider’s ability to use their own judgment, not specifically on the measure’s relation to gender-affirming care.
Major hospitals that have historically provided gender-affirming care to minors have adjusted their services. Children’s Hospital Colorado has never provided gender-affirming surgeries for minors and does not have a position on the measure. Denver Health, which also does not take positions on ballot measures, stopped offering gender-affirming surgeries for youth in early 2025. The hospital also paused other forms of gender-affirming care for minors following “escalating actions” from the U.S. Department of Health and Human Services (HHS). Deydra Bringas, a spokesperson for Denver Health, noted that these changes, necessitated by HHS actions, substantially affect access to critical health services and disrupt patient-provider relationships. These actions included a December declaration from U.S. Health and Human Services Secretary Robert F. Kennedy threatening to pull Medicaid funding from facilities providing gender-affirming care to minors, a policy that an Oregon judge ruled unlawful in March.
Dr. Mary Fairbanks, a retired family physician who worked with transgender patients, though mostly adults, expressed her bafflement at the negative political attention on transgender individuals, who represent a small percentage of the population. Fairbanks remarked that “Someone who’s transgender really isn’t trying to impact other people. They just want to live their lives.” She noted that many transgender individuals do not seek gender-affirming surgery, partly due to cost, and some socially transition without medical intervention. Fairbanks worried that Proposition 135, by not naming specific procedures but instead banning surgeries based on approach, could create confusion for providers and potentially disrupt any surgery for young transgender patients if their gender identity arises in conversation. She emphasized that any policy interfering with the practice of medicine will cause trouble.
Ballots were mailed to Colorado voters on Friday, and Election Day is November 3. The proposition requires approval from a majority of voters to become law.
