Puerto Rico Enacts Most Extreme Care Ban in America, Targeting Trans People Under 21

Civil rights groups aim to fight the wide-reaching ban in court, which outlaws most kinds of gender-affirming care for trans young people.

Photo by Frederick Rosa on Unsplash

Puerto Rican Governor Jenniffer González Colón, a Trump-aligned Republican, signed the most severe ban on gender-affirming care anywhere within the United States or its territories.

Act 63-2025, the title of which translates to an “Act for the Protection of the Health and Well-being of Minors in Puerto Rico," criminalizes the provision of gender-affirming hormone treatment or surgery for anyone under the age of 21, even with consenting parents. This can include 15 years in prison, a $50,000 fine, and the loss of any medical certifications.

President of the Puerto Rico LGBTQ+ Federation, Pedro Julio Serrano, told Erin in the Morning that because the law was intentionally “vague,” it opens up the very real possibility that not only doctors, but also affirming parents of trans people, could be prosecuted under this law—if they facilitate the provision of hormone replacement therapy (HRT) or affirming medical procedures like “top” surgery.

It also directs the Department of Education and Department of Health to wage an “educational” campaign focusing on the “risks” associated with trans-affirming health care, geared towards parents, medical providers, and the “general community.”

The law was pushed through the legislative process through a series of non-public hearings, Serrano said. At the recommendation of Puerto Rico’s Health Secretary, Víctor Ramos Otereo—who was appointed by the Governor herself—it was sent back to the legislature; Serrano said Otereo suggested adding amendments that would allow for puberty blockers as well as the continuation of care for trans Puerto Ricans already on HRT.

“[Ramos] vehemently told [Governor Colón] to include that language in the bill or not sign the bill,” Serrano said. “Then she signed the bill. So she ignored her own Health Secretary.”

This means adolescents and young adults currently on puberty blockers or HRT to treat gender dysphoria are legally required to medically detransition, the results of which could be dangerous and devastating for many young adults and their families.

However, organizations—including the LGBTQ_ Federation and the ACLU of Puerto Rico—hope to challenge the law in court. Like states, Puerto Rico has its own constitution, one that is more expansive than the enumerated rights listed in the federal Constitution. In Puerto Rico, this includes an explicitly articulated right to privacy—a premise which has been successfully used in states to strike down similar anti-trans policies.

Act 63 was made possible in part by Puerto Rico’s “age of majority” policies, which determine that a person doesn’t become a full, legal adult until age 21. In most states, this number is 18 or 19. But in Mississippi, where it is also 21, a judge ruled earlier this year that a trans person couldn’t even change their legal name until this age, even with parental consent. Like Puerto Rico’s anti-trans law, the Mississippi judge said that trans young people of this age group lack the “maturity” to make such a decision. Meanwhile, the ability of Mississippi teenagers who want to get married and take their spouse’s last name remains uncontested for girls as young as 15 and boys as young as 17.

At 18, it is also legal under federal law to vote, join the military, and be tried as an adult in criminal court, both in states and U.S. territories.

ACLU of Puerto Rico executive director Annette Martínez Orabona said the law establishes a double standard for parents of trans youth. It “creates two distinct categories of children in Puerto Rico—one that allows parents to access and authorize treatments if their children’s identity aligns with the sex assigned at birth, and another that prohibits parents from having the same right, if their child’s identity is different,” LGBTQ Nation reports.