Colorado voters will decide in November whether to prohibit gender-affirming surgeries for minors, even as the state’s largest pediatric surgical providers say they do not currently perform such procedures on transgender patients under 18.
Proposition 135, formally titled “Prohibit Surgery on Minors in Response to Perception of Sex or Gender,” would prohibit health care professionals from knowingly performing surgery on a minor for the purpose of altering the patient’s biological sex characteristics in response to their perception of sex or gender. The measure would also prohibit state and federal funds, Medicaid reimbursement, and private insurance from paying for procedures covered by the ban.
If approved by a simple majority of voters, the measure would take effect January 1, 2027.
But the campaign arrives with an important piece of context: Colorado’s three largest pediatric surgical providers, Children’s Hospital Colorado, Rocky Mountain Children’s, and Denver Health, report that they do not perform gender- or sex-based surgeries on transgender patients younger than 18.
Gender-affirming surgery among minors is also rare nationally. Colorado’s official voter guide cites research examining 2019 insurance claims that found an estimated 2.1 transgender or gender-diverse youths ages 15 to 17 per 100,000 received at least one gender-affirming surgery.
Supporters of Proposition 135 argue that minors should not undergo irreversible procedures before adulthood and that additional long-term research is needed regarding surgical interventions for transgender youth. The proposal includes exceptions for male circumcision, medically verifiable disorders of sex development, and certain acquired physical or chemical abnormalities. It does not prohibit counseling, social transition, or other nonsurgical gender-related care.
Opponents, including the Colorado Medical Society, warn that the wording could reach beyond transgender health care. The physician organization voted in September to oppose the proposition, citing concerns about government interference in medical decision-making and possible consequences for pediatric care more broadly.
Colorado’s official Blue Book similarly notes that because the measure does not identify specific prohibited procedures and instead focuses on why a surgery is performed, it could create uncertainty for patients, physicians, and insurers. Critics argue that providers could become more reluctant to offer some treatments out of concern that they could violate the law.
A “yes” vote would establish the new prohibition and funding restrictions. A “no” vote would leave current Colorado law in place, under which medically necessary gender-affirming care may be covered by public or private insurance and medical decisions remain subject to existing standards of care.
The vote comes as transgender youth health care remains a major political battleground nationally, but in Colorado, Proposition 135 asks voters to outlaw a category of care that the state’s major pediatric surgical centers say they are not currently providing to transgender minors in the first place.
