New Hampshire Gov. Kelly Ayotte (R) signed a gender-affirming care ban into law on Friday that bans anyone under 18 from using puberty blockers or hormone treatments for gender transition care.

H.B. 377 – the first of its kind in New England – also prohibits minors from receiving gender-affirming surgery, despite the fact that it is already almost never performed on trans kids under 18.

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The agency’s acting chair has prioritized “defending the biological and binary reality of sex.”

Starting January 1, 2026, providers are barred from providing hormone care and puberty blockers only “if the performance or administration of the procedure or medication is for the purpose of altering or attempting to alter the appearance of or affirm the minor’s perception of his or her gender or sex, if that perception is inconsistent with the minor’s biological sex.”

The ban does not hold medical providers criminally liable for violations, but rather subjects them to administrative disciplinary action by the state board of medicine. It also allows minors already receiving treatment to continue doing so. Minors and their parents can also sue medical providers for violating the law.

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Ayotte also signed a second bill specially preventing minors from having top surgery except for “procedures needed to treat malignancy, injury, infection, or malformation and those needed to reconstruct the breasts after such procedures.”

“Medical decisions made at a young age can carry lifelong consequences,” Ayotte said in a statement, “and these bills represent a balanced, bipartisan effort to protect children.”

Despite Ayotte calling the legislation bipartisan, the bills passed overwhelmingly along party lines. Only two Democrats voted for H.B. 377, and only one voted for the top surgery bill.

While expressing support for the bill, State Sen. Kevin Avard (R) called trans identity a “craze” that “seems almost a cult-like following.”

“I do believe biology speaks volumes,” he said, according to NBC Boston.

Courtney Reed, policy advocate at the American Civil Liberties Union of New Hampshire, called the laws “merciless, cruel, and painful for transgender young people, their families, and their doctors.”

Chris Erchull, senior staff attorney at GLBTQ Legal Advocates & Defenders, said the legislation “epitomizes extreme government intrusion into the private lives and personal decisions of New Hampshire families.”

“The best way to protect the health and well-being of young transgender people is to ensure they have continued access to necessary, age-appropriate medical care provided by licensed physicians practicing in accordance with established standards of medical care,” he said.

Ayotte signed the bills despite the fact that earlier this Month, she vetoed several anti-LGBTQ+ bills, including an anti-trans bathroom bill, a book-banning bill, and a ban on teachers giving students “get to know you” questionnaires without parental permission. State Republicans lack the two-thirds majority needed in both the House and Senate to override the governor’s vetoes.

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