Kentucky’s transgender laws restrict gender-affirming healthcare for minors and adults on Medicaid, limit how public schools handle bathrooms, pronouns, curriculum, and sports, and require proof of gender-reassignment surgery along with a court order to change the gender marker on a birth certificate or driver’s license. Most of these rules came from Senate Bill 150 in 2023, Senate Bill 83 in 2022, and House Bill 495 in 2025. Federal law still protects transgender workers from being fired because of their gender identity, but the federal backstop in healthcare and schools has largely fallen away.
Gender-Affirming Care for Minors
KRS 311.372 bans healthcare providers from prescribing or performing a range of treatments on anyone under 18 when the purpose is to alter the minor’s appearance to be inconsistent with their biological sex. The pharmaceutical restrictions cover puberty-blocking drugs and testosterone, estrogen, or progesterone in amounts beyond what a healthy person of the same age and sex would naturally produce. The surgical restrictions cover sterilizing surgeries, procedures that construct tissue resembling different genitalia, and removal of healthy body parts or tissue.1Kentucky Legislative Research Commission. Kentucky Code 311.372 – Prohibition on Treatments to a Minor for Purpose of Attempting to Alter the Appearance or Perception of the Minors Sex
A provider already treating a minor with a prohibited drug or hormone when the law took effect is not required to stop abruptly. The statute allows a tapering period during which the provider systematically reduces the dosage, but only if the medical record documents that abrupt discontinuation would harm the patient.1Kentucky Legislative Research Commission. Kentucky Code 311.372 – Prohibition on Treatments to a Minor for Purpose of Attempting to Alter the Appearance or Perception of the Minors Sex
The penalty for a violation is mandatory revocation of the provider’s medical license or certification. There is no discretionary range: if a licensing board finds a violation, revocation follows.1Kentucky Legislative Research Commission. Kentucky Code 311.372 – Prohibition on Treatments to a Minor for Purpose of Attempting to Alter the Appearance or Perception of the Minors Sex
The U.S. Supreme Court’s June 2025 decision in United States v. Skrmetti upheld a similar Tennessee ban and held that these laws are subject only to rational-basis review under the Equal Protection Clause.2Supreme Court of the United States. United States v. Skrmetti, No. 23-477 A federal constitutional challenge to Kentucky’s law is very difficult after that ruling.
Civil Lawsuits Against Providers
SB 150 also created a private right of action. A person who received prohibited treatment as a minor can sue the provider for damages, and the filing deadline runs until the person turns 30, or three years from discovering that the injury was caused by the treatment, whichever is later.3Kentucky Legislative Research Commission. Kentucky 2023 Regular Session Senate Bill 150 That window is much longer than a typical medical malpractice claim, and it leaves providers exposed for well over a decade after treating a patient.
Medicaid Coverage for Adults
House Bill 495, enacted over the governor’s veto in March 2025, prohibits Kentucky Medicaid from paying for cross-sex hormones in amounts exceeding natural production for a person’s biological sex and age, and from paying for gender-reassignment surgery.4Kentucky Legislative Research Commission. Kentucky 2025 Regular Session House Bill 495 Adults with private insurance are not directly regulated by this statute, but Medicaid covers a large share of Kentucky residents, so the practical reach is wide.
There is no longer a federal backstop requiring coverage. The U.S. Department of Health and Human Services rescinded its earlier guidance interpreting Section 1557 of the Affordable Care Act to prohibit discrimination based on gender identity, federal courts had already enjoined enforcement of the 2024 final rule’s gender-identity provisions, and the current administration no longer takes the position that denying transgender healthcare coverage violates federal law.
School Bathrooms and Locker Rooms
KRS 158.189 requires every local school board and charter school board to adopt policies prohibiting students from using restrooms, locker rooms, or shower rooms designated for the opposite biological sex. The statute defines biological sex as the physical condition of being male or female, determined by chromosomes and identified at birth by anatomy.5Justia. Kentucky Code 158.189 – Legislative Findings, Policies for Use of Restrooms by Students of the Opposite Biological Sex, Requirements, Best Available Accommodation to Be Provided
If a student tells school officials their gender differs from their biological sex, and a parent gives written consent, the school must offer the best available accommodation. That could be a single-stall restroom or supervised use of a faculty bathroom. It cannot be access to the restroom or locker room designated for the opposite sex while other students are or could be present.5Justia. Kentucky Code 158.189 – Legislative Findings, Policies for Use of Restrooms by Students of the Opposite Biological Sex, Requirements, Best Available Accommodation to Be Provided A student cannot request the accommodation without parental consent.
Pronouns, Parental Notification, and Curriculum
KRS 158.191 bars school districts from requiring employees or students to use pronouns that do not match a student’s biological sex as shown on the original birth certificate.6Kentucky Legislative Research Commission. Kentucky Code 158.191 – Health and Mental Health Services Related to Human Sexuality, Contraception, or Family Planning The law stops districts from mandating preferred-pronoun use; it does not stop an individual teacher from choosing to use them.
Schools must also notify parents within two business days if a student’s health or mental health services related to human sexuality, contraception, or family planning change. Parental consent is required before a school provides those services or refers a student to an outside healthcare provider.6Kentucky Legislative Research Commission. Kentucky Code 158.191 – Health and Mental Health Services Related to Human Sexuality, Contraception, or Family Planning
SB 150 also amended KRS 158.1415 to restrict classroom content:
- In grades K through 5, no instruction on human sexuality or sexually transmitted diseases is permitted through any curriculum or program.
- At all grade levels, no student may receive instruction or presentations with a goal of studying or exploring gender identity, gender expression, or sexual orientation.
The second restriction is the one that is easy to miss. It reaches every grade in the district, not just elementary school.7Kentucky Legislative Research Commission. Kentucky Senate Bill 150 – Enrolled Bill Text For grades six and up, instruction on human sexuality and sexually transmitted diseases is allowed only after advance parental notification and written consent.
School and College Sports
Senate Bill 83, the Save Women’s Sports Act, took effect in 2022. It requires schools with interscholastic athletics to designate every team as boys, girls, or coed, and closes girls’ teams to students of the male sex.8Kentucky Legislative Research Commission. Kentucky Senate Bill 83 – Save Womens Sports Act Eligibility is determined by the student’s original birth certificate issued at birth or adoption.9Kentucky Legislative Research Commission. Kentucky Code 156.070 – Powers and Duties of Kentucky Board of Education
For grades six through twelve, the Kentucky Board of Education and the Kentucky High School Athletic Association enforce the rules through regulations and bylaws. SB 83 extends the same framework to public and private postsecondary institutions that belong to a national intercollegiate athletic association.10Kentucky Legislative Research Commission. Kentucky 2022 Regular Session Senate Bill 83 Schools and universities that fail to enforce these standards risk disqualification from state-sanctioned competition.
Changing the Gender Marker on a Birth Certificate
Amending a Kentucky birth certificate under KRS 213.121(5) requires two things, both mandatory: a sworn statement from a licensed physician confirming that your gender has been changed by surgical procedure, and a certified copy of a court order changing your name.11Kentucky Cabinet for Health and Family Services. Request to Amend a Kentucky Birth Certificate A clinical diagnosis or ongoing hormone therapy is not enough. Proof of surgery is required.
You submit the amendment request to the Office of Vital Statistics in Frankfort. A birth certificate search and certified copy costs $10, and each additional certified copy is $10.12Kentucky Legislative Research Commission. 901 KAR 5:050 – Fees for Searches, Certified Copies of Certificates and Records
Changing the Gender Marker on a Driver’s License
To update a Kentucky driver’s license, you visit a Transportation Cabinet regional office and bring one of the following: a court order changing your gender marker, a letter from the surgeon who performed your gender-reassignment surgery, or an updated birth certificate reflecting the corrected gender.13Kentucky Transportation Cabinet. Frequently Asked Questions – Driver’s License Replacing or updating the credential costs $15.14Kentucky Transportation Cabinet. Pricing – Driver’s License
Legal Name Change
A Kentucky name change goes through circuit court under KRS Chapter 401. File a Petition for Name Change (form AOC-295) at the circuit clerk’s office in the county where you live.15Kentucky Court of Justice. Petition for Name Change The petition asks for your current legal name, desired new name, birthdate, birthplace, current address, and the reason for the change. Sign it before a notary and swear that you are not seeking the change to dodge a legal obligation or evade prosecution. The court will schedule a hearing.
The base circuit court civil filing fee is $150, plus a $20 court technology fee. Local courts may add a facility fee or library fee.16New York Codes, Rules and Regulations. Circuit Civil Fees and Costs Because a court order changing your name is one of the two documents needed to amend a birth certificate’s gender marker, many people pursue the name change and the amendment together.
Workplace Protections
Kentucky has no statewide law explicitly prohibiting employment discrimination based on gender identity, though the Kentucky Commission on Human Rights states that it accepts complaints of discrimination based on sexual orientation and gender identity.17Kentucky Commission on Human Rights. Frequently Asked Questions The strongest protection comes from federal law. The U.S. Supreme Court’s 2020 decision in Bostock v. Clayton County held that Title VII’s ban on sex discrimination in employment covers gay and transgender workers. Firing, refusing to hire, or denying a promotion to someone because they are transgender violates federal law.
Bostock is still binding for hiring, firing, and promotion decisions, but federal enforcement has narrowed. In January 2026, the EEOC voted to rescind its 2024 anti-harassment guidance, which had read sex-based harassment protections to include harassment based on gender identity. The current EEOC majority takes the position that “sex” is binary and immutable for federal workplace law. That rescission does not overrule Bostock‘s core holding, but it signals less federal willingness to pursue gender-identity harassment claims.
The Supreme Court has also separated Title VII from other legal contexts. In Skrmetti, the Court said it had “not yet considered whether Bostock’s reasoning reaches beyond the Title VII context.”2Supreme Court of the United States. United States v. Skrmetti, No. 23-477 A transgender worker in Kentucky can still bring a Title VII claim for being fired because of their transgender status. They cannot use Bostock to challenge the state’s healthcare restrictions or school policies.