The House of Representatives on Wednesday approved legislation that would criminalize gender transition treatments for minors, including surgeries and the provision of hormones or puberty blockers, and impose severe penalties on medical providers who offer such care. Under the bill, doctors and other health care professionals could face up to ten years in federal prison if convicted. The measure passed by a narrow margin of 216 to 211 in a sharply divided chamber, reflecting deep partisan disagreements over transgender health care and the role of the federal government in regulating medical decisions affecting children. Civil rights organizations quickly denounced the proposal, describing it as among the most extreme anti-transgender bills ever considered by Congress. Supporters, however, framed the legislation as a necessary step to protect children from what they view as irreversible medical interventions made too early in life.

The vote largely followed party lines, underscoring how polarized the issue has become. Democrats overwhelmingly opposed the bill, while most Republicans supported it, though a small number of lawmakers crossed party boundaries. The legislation is not expected to advance in the Senate, where passage would require bipartisan support that currently appears unlikely. Nevertheless, the bill’s passage in the House signaled the priorities of the chamber’s ultraconservative Republican faction and aligned closely with President Donald Trump’s stated agenda. During debate, Republicans repeatedly referenced Trump’s campaign pledges and executive actions aimed at restricting gender-affirming care for minors, portraying the bill as an effort to codify those policies into federal law rather than relying solely on executive authority.

Republican Representative Marjorie Taylor Greene of Georgia was the bill’s chief sponsor and its most vocal advocate. Earlier this month, Greene demanded that Speaker Mike Johnson bring the legislation to the House floor, tying her support for a must-pass defense policy measure to its consideration. Her pressure campaign proved successful, and she framed the bill’s passage as a fulfillment of one of Trump’s central campaign promises. Speaking on the House floor, Greene argued that most Americans believe children should not undergo major medical interventions related to gender transition. She cited examples of surgeries on minors, holding up a poster of a child who had received such treatment, and argued that Congress had a duty to intervene. Greene also suggested that the 2024 election results represented a public mandate to end gender transition treatments for minors.

Other Republicans echoed Greene’s rhetoric, characterizing gender-affirming care as harmful and ideologically driven. Representative Barry Moore of Alabama accused Democrats of indoctrinating children and falsely portraying such treatments as medically necessary. “It is not lifesaving care,” Moore said during debate. “It is child abuse.” Greene used provocative analogies to argue that adults should not unquestioningly affirm a child’s self-identified gender, suggesting that doing so was comparable to indulging other implausible childhood beliefs. At the same time, Greene has drawn occasional attention for breaking with Trump on unrelated issues, and she recently announced she would leave Congress a year before the end of her term. Despite these developments, her leadership on anti-trans legislation has solidified her standing among the party’s most conservative members.

Democrats responded forcefully, accusing Republicans of replacing medical expertise with political ideology and targeting a small, vulnerable population for political gain. They warned that the bill would intrude on deeply personal family decisions and threaten parents and doctors with prison for following established medical guidance. Representative Jamie Raskin of Maryland argued that the legislation undermined parental rights by placing decision-making authority in the hands of politicians rather than families and physicians. Representative Mark Takano of California emphasized that the surgeries cited by Greene were extremely rare and said the bill’s broader effect would be to ban medications widely regarded as safe and effective for transgender youth. Takano also warned that the measure could expose private medical records to investigation and fail to make children safer, while instead increasing fear and stigma.

The debate also featured remarks from Representative Sarah McBride of Delaware, the first openly transgender member of Congress, who criticized Republicans for what she described as an obsessive focus on transgender people. McBride argued that lawmakers were concentrating on a misunderstood and vulnerable one percent of the population while neglecting broader health care challenges facing Americans. “They think more about trans people than trans people think about trans people,” she said. In the final vote, three Democrats—Henry Cuellar and Vicente Gonzalez of Texas and Don Davis of North Carolina—joined Republicans in supporting the bill. Four Republicans—Gabe Evans of Colorado, Brian Fitzpatrick of Pennsylvania, Mike Lawler of New York, and Mike Kennedy of Utah—voted against it. A second bill backed by Greene, which would bar Medicaid coverage of gender-affirming care for transgender youth, is scheduled for a House vote later this week.