A growing number of states have introduced legislation that LGBTQ advocates say targets transgender youth and their access to school sports and gender-affirming health care.
At least two dozen states have introduced bills this year that would ban transgender girls and women from participating in sports consistent with their gender identity, compared to 18 last year, according to the American Civil Liberties Union. Sixteen states have also introduced bills that would prohibit and in some cases criminalize gender-affirming care for trans youth, such as puberty-blocking medications and hormones, up from 15 last year, according to the ACLU.
"I've been doing this work a long time, and frankly, never really seen anything like this, in terms of the nature of the rhetoric and the sweeping nature of the bills," Chase Strangio, deputy director for transgender justice at the ACLU, told ABC News.
LGBTQ advocates say the bills are discriminatory, transphobic and unnecessary measures that stem from previous attempts to impose "bathroom bills," restricting what facilities transgender individuals can use, and before that, overturn marriage equality.
"Now they're taking on trans kids -- some of the most vulnerable members of the LGBTQ community -- and trying to isolate them and prohibit them from accessing care and, frankly, pushing this narrative that being trans is something that is put on for some kind of advantage, that it's pushed on children by adults," Kate Oakley, state legislative director and senior counsel for the Human Rights Campaign, told ABC News. "It's really invalidating transgender identity."
Among the bills under consideration this session, one passed last week -- the so-called Mississippi Fairness Act, which would ban transgender girls and women from competing on female sports teams in schools and universities. The governor has announced his intent to sign it. Similar measures in Tennessee, North Dakota and Montana have so far passed out of one chamber.
The sponsor of the Mississippi bill, Republican state Sen. Angela Hill, told ABC News she was inspired to introduce the legislation after learning about two girls' championship-winning transgender high school runners in Connecticut, where state policy allows high school athletes to compete as the gender with which they identify. Mississippi does not have a policy regarding transgender high school athletes.
"When you talk about equality, you need to look at equality in female sports," she said. "And that's what we're trying to protect, is female sports from being destroyed."
Hill could not point to any instance of transgender girls competing on girls' sports teams in her state's high schools, but said she has heard concerns from coaches about Mississippi's lack of guidelines.
"This issue is imminent in Mississippi," she said. "We have to make a statement that women matter, female sports matter."
An Associated Press survey of more than 24 state lawmakers sponsoring similar bills found that they could not cite an example in their state or region where there have been issues over transgender students participating in sports.
States have yet to pass health care bills impacting trans youth, though one in Alabama that would make it a felony to treat minors with puberty-blockers, hormone therapy or surgery passed the state Senate last week.
"Children aren't mature enough to make these decisions on surgeries and drugs," Republican state Sen. Shey Shelnutt, who sponsored the bill, told the AP. "The whole point is to protect kids."
Oakley said that these types of bills are "inventing" a problem because transgender children are not making permanent changes to their bodies, but would typically first transition socially, such as by changing their names or pronouns. They then might take hormones or puberty blockers to delay puberty under the guidance of a doctor. These measures can be "life-saving," she said, for a youth suffering from gender dysphoria.
The American Academy of Pediatrics recommends that trans youth have access to "comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space."
Democratic Virginia Del. Danica Roem, the first openly transgender person elected and seated in a state legislature, said there is a lot of misunderstanding when it comes to the transgender community.
"When politicians who don't have lived experience are willfully ignorant on a subject because learning the facts would contradict the policy point they are trying to project, then they start interfering with health care between a doctor and their patient, or between a coach and their player," Roem told ABC News.
That interference can be dangerous, she said, pointing to a report from UCLA School of Law's Williams Institute that found that lack of access to gender-affirming medical care was associated with a higher prevalence of suicidal thoughts and attempts in transgender people. By "othering" trans people, violence is another concern, she said.
"The more they single out and stigmatize the very people they're elected to serve, especially the most vulnerable among their constituents, violence in their communities will follow," Roem said.
According to a recent Gallup poll, 1.8% of Generation Z (those born 1997-2002) identified as transgender in 2020 -- the highest of any age group.
Fox Schweiger, 18, a transgender college student from Tennessee, said he was not allowed to play sports at his private middle school and high school "so as to not upset the other students or their families."
"Experiencing discrimination every single day has extreme effects on a person's health," Schweiger told reporters on a press call earlier this week with the Human Rights Campaign. "I experienced both physical and mental health struggles that stemmed from the constant stress of existing in an environment that was explicitly opposed to my very existence."
Any bill targeting transgender youth that is signed into law will likely be met with legal challenges. Idaho became the first state to pass a law banning transgender women from competing in women's sports last year. A federal district court suspended the law and it has yet to be enacted.
But even if they aren't enacted, "the damage is done," Strangio said.
"I'm 38-years-old. I have been out as trans for a long time. I have been listening to these testimonies. It is really unbelievably damaging, even for me as an adult," he said. "Every trans person I know is really struggling with the state of the rhetoric right now."
"I think it's catastrophic just to have this level of bills being debated across the country," he said.