Gender-affirming care ban for kids, trans bathroom bill are now Iowa law. What they do:

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Iowa doctors may not provide gender-affirming care to transgender minors, and transgender students may not use school bathrooms that align with their gender identity under two laws signed Wednesday by Gov. Kim Reynolds.

Iowa Republicans have introduced an avalanche of bills relating to LGBTQ issues this year, with a focus on transgender children.

The bills signed into law Wednesday will prohibit Iowa doctors from prescribing puberty blockers or cross-sex hormones to transgender minors, and will prevent transgender people from using school restrooms or locker rooms that do not align with their sex at birth.

Both bills take effect immediately, although doctors will have six months to cease gender-affirming care for their patients under 18.

A spokesperson for Reynolds said Tuesday the governor met with some parents of transgender children to discuss both bills.

"My heart breaks," Reynolds told reporters Tuesday. "I’ve sat down and met with them. It’s not easy. It’s not easy for me either. It’s not easy for our elected officials to make these decisions. So I just, I hope they know that."

More: Iowa LGBTQ families ask if they still belong after new laws restrict their rights

Iowa law prohibits gender-affirming care for minors

Senate File 538 prohibits Iowa doctors from prescribing puberty blockers, cross-sex hormones or gender-affirming surgeries to transgender people under 18.

Major medical groups, including the American Medical Association, American Psychological Association and the American Academy of Pediatrics, all recommend providing transgender youth with medical care that helps them live as the gender they identify with.

Iowa medical professionals told lawmakers last month these treatments can be life-saving for transgender children. Dr. Katie Imborek, co-founder of the University of Iowa LGBTQ clinic, said transgender teens receive medical intervention only after a "long, arduous and methodical" evaluation process and with full parental consent.

Republican supporters of the legislation argued that people under 18 aren't mature enough to fully comprehend the potential consequences of medically transitioning. Reynolds and leaders of the bill in the statehouse said they believe science is not conclusive on the issue, citing other countries that have restricted the treatments.

"We need to just pause, we need to understand what these emerging therapies actually may potentially do to our kids," Reynolds said Tuesday. "My heart goes out to them. I’m a parent, I’m a grandmother, I know how difficult this is. This is an extremely uncomfortable position for me to be in. I don’t like it. But I have to do what I believe right now is in the best interest of the kids."

More: Iowa ban on gender-affirming care for trans kids awaits Kim Reynolds' signature. The impact:

Civil rights and LGBTQ advocacy groups, medical professionals and Democrats condemned the law.

"This ban is not only discriminatory but also life-threatening," Human Rights Campaign State Legislative Director Cathryn Oakley said in a March 7 statement. "Transgender youth already face alarming levels of discrimination, and this would only further harm them. No parent or healthcare provider should have to choose between following best medical practices or facing legal consequences."

What does a ban on gender-affirming care mean for transgender kids in Iowa?

Health care professionals in Iowa are forbidden from prescribing transgender minors medication to delay the onset of puberty or any cross-sex hormones, like estrogen or testosterone.

That means transgender youth will go through biological puberty with no medical intervention to delay or change the process.

Doctors are also forbidden from performing surgeries on minors that sterilize or reconstruct genitalia to differ from the individual's sex at birth. Surgeries to remove "any healthy or nondiseased body part or tissue" are prohibited, if the surgeries are meant to affirm a transgender child's gender that differs from their sex.

Medical procedures on children's genitalia that are unrelated to affirming a transgender child are legal, including circumcisions.

Iowa doctors told lawmakers that they do not perform genital surgery on transgender minors, and they remove breast tissue only in rare cases.

What happens to transgender kids who are in mid-transition?

Transgender kids who are currently receiving gender-affirming treatments will have six months to taper off those medications.

Health care providers have 180 days after the law's passage to cease gender-affirming care for their patients.

The law does not prohibit doctors from referring their patients to out-of-state providers who still offer transition-related care for minors. LGBTQ advocacy group One Iowa advises families with transgender youth to ask their medical providers about referrals in other states and contact their insurance providers.

On the same day that the Iowa House passed the bill, Minnesota Gov. Tim Walz signed an executive order to protect access to gender-affirming care.

Bathroom bill prohibits transgender people from using a bathroom that does not align with birth sex

Senate File 482 prohibits people from entering a school restroom or changing room that does not align with their sex at birth. Students will need parental consent to request a special accommodation, such as using a faculty or single-occupancy restroom.

Schools are not permitted to grant transgender students access to a multiple-occupancy restroom that does not align with their birth sex.

The bill relies on citizen complaints to keep schools in compliance with the rules.

If someone believes a school is allowing people to use facilities that do not align with their birth sex, that person may file a written complaint to the school. The school has three days to address the violation.

If the school does not act, that citizen could file a complaint with the attorney general. The attorney general would investigate and, if necessary, pursue legal action.

More: Iowa lawmakers pass transgender 'bathroom bill' for schools. What it means

Republican supporters of the proposal say the restrictions are necessary to protect the privacy and safety of students who may feel uncomfortable sharing a facility with their transgender peers.

Democrats argued that there have been no issues with transgender students in Iowa using school restrooms that align with their gender. They contend the bill could cause additional harassment of transgender kids.

LGBTQ, civil rights and education groups decry new laws

Iowa LGBTQ advocacy groups, civil rights organizations and the state's teachers' union issued statements Wednesday afternoon criticizing the new laws.

The American Civil Liberties Union of Iowa said the bill will have "devastating consequences" for transgender children in Iowa.

"Unfortunately, politicians can pass laws that hurt kids and never look back, but it's transgender kids who have to live with increasing hostility against them from the government, including even monitoring where they go to the bathroom at school," said ACLU of Iowa Executive Director Mark Stringer.

LGBTQ advocacy groups, who have been vocal opponents of these bills and other LGBTQ-related proposals, lambasted Reynolds for signing the legislation into law.

“By signing these bills, the governor has shown that she doesn’t actually care about parental rights,” said Becky Tayler, executive director for Iowa Safe Schools. “The parental rights (of) LGBTQ families have been sidelined for the sake of the governor’s ill-fated power trip to national office."

Courtney Reyes, executive director of LGBTQ advocacy group One Iowa Action, said Reynolds "has forced the hand of many Iowa parents who will flee the state to keep their children safe and healthy."

The Iowa State Education Association, the state's largest teachers' union, also condemned the laws. Schools will be on the frontlines for the enforcement of the new bathroom restrictions.

"The Iowa Legislature and Gov. Reynolds have repeatedly targeted the most vulnerable students with rhetoric and legislation designed to suppress, out, target, ban, and censor Iowa’s LGBTQ+ student communities," ISEA President Mike Beranek said.

Beranek pledged, on behalf of the union, to stand with all students "today, tomorrow, and always."

Stephen Gruber-Miller contributed reporting.

Katie Akin is a politics reporter for the Register. Reach her at or at 410-340-3440. Follow her on Twitter at @katie_akin.

This article originally appeared on Des Moines Register: Gender-affirming care ban and transgender bathroom bill become Iowa law. What it means.