Proposition 135: Prohibit Surgery on Minors in Response to Perception of Sex or Gender

Oct 3, 2026

Proposition 135 would amend Colorado statutes to prohibit surgeries on minors that alter biological sex characteristics when performed in response to a minor’s perception of sex or gender, with specified exceptions. The measure also bars state and federal funds and restricts private insurance coverage for these prohibited surgeries. The analysis explains what treatment types are targeted, how coverage would change, and discusses reported prevalence and arguments for and against the proposition.

LanguageEnglish

CategoryExam

FormatPDF

Pages36

Reading Time1 h 31 min

AccessFree to download

Proposition Overview

What Your Vote Means

Summary and Analysis of Proposition 135

Arguments For Proposition 135

Arguments Against Proposition 135

Proposition 135: Prohibit Surgery on Minors in Response to Perception of Sex or Gender Placed on the ballot by citizen initiative • Passes with a majority vote 1 Proposition 135 proposes amending the Colorado statutes to: 2 ● prohibit surgeries on minors that alter their biological sex characteristics as a treatment in 3 response to a minor’s perception of sex or gender, with certain exceptions; and 4 ● prohibit the use of state or federal funds or insurance coverage to pay for these surgeries. 5 What Your Vote Means 6 YES 14 NO 7 A “yes” vote on Proposition 135 prohibits 15 A “no” vote on Proposition 135 maintains 8 surgeries on minors that would alter their 16 Colorado law, which protects access to 9 biological sex characteristics as a treatment 17 surgery altering minors’ biological sex 10 in response to a minor’s perception of sex 18 characteristics and allows public and 11 or gender, and prohibits the use of 19 private health insurance programs to pay 12 government funds or health insurance to 20 for these surgeries. 13 pay for the surgeries. 21 Summary and Analysis of Proposition 135 22 What medical treatments are prohibited by Proposition 135? 23 The measure prohibits surgery on minors for the purpose of altering biological sex 24 characteristics as a treatment in response to a minor’s perception of sex or gender. The measure 25 does not list specific surgical procedures that are prohibited; instead, the prohibition is based on 26 the reason that a surgery is performed on a minor. The prohibition includes gender-affirming 27 surgeries, which are a range of procedures that may be provided to transgender individuals to 28 make their physical appearance match their gender identity. Examples include altering, 29 removing, or reconstructing sexual and reproductive organs; modifying body shape; changing 30 facial appearance; or altering vocal characteristics. The measure may also limit other surgeries 31 for minors, including non-transgender minors, if the treatment is interpreted as being in 32 response to the minor’s sex or gender perception. 33 Proposition 135 allows male circumcision and treatments for medically verifiable disorders of sex 34 development or acquired physical or chemical abnormalities. Non-surgical gender-related 1 treatments, such as social transition options and counseling, are also not restricted by the 2 measure. 3 How does Proposition 135 change coverage for these procedures? 4 Currently in Colorado, gender-and sex-based surgeries that are medically necessary may be 5 covered by private health insurance or a public health care program, or be paid for out-of- 6 pocket. The measure bans the use of state or federal money, Medicaid reimbursements, and 7 private health insurance to pay for the prohibited surgeries. 8 How often are these procedures performed on minors in the United States? 9 It is unknown how many minors receive gender-and sex-based surgeries that would be 10 prohibited under the measure. However, one study found that gender-affirming surgery for 11 transgender minors in the United States is rare. The study, from researchers at Harvard 12 University, examined 2019 health insurance claim data and found that for every 100,000 youths 13 aged 15 to 17, an estimated 2.1 youths who identified as transgender or gender diverse had at 14 least one gender-affirming surgery. For youths aged 13 to 14, these surgeries are even more 15 rare, with 0.1 youths having a surgery per 100,000 youths (or 1 in a million). Researchers found 16 no cases of gender-affirming surgeries being performed on youths aged 12 and younger. 17 The three large pediatric surgical providers in Colorado—Children’s Hospital Colorado, Rocky 18 Mountain Children’s, and Denver Health—report that they do not perform gender-or sex-based 19 surgeries on transgender patients under 18 years of age. 20 Arguments For Proposition 135 21 1) Mino

FAQs

What surgeries does Proposition 135 prohibit?

It prohibits surgeries on minors that alter biological sex characteristics when performed in response to a minor’s perception of sex or gender, including a range of gender-affirming procedures. The prohibition is based on the reason for the surgery and includes exceptions for certain treatments and medically verifiable disorders.

How would Proposition 135 change funding and insurance coverage?

The measure bans the use of state or federal money, including Medicaid reimbursements, and private health insurance to pay for the prohibited surgeries. It would restrict coverage even when coverage exists for medically necessary gender- and sex-based surgeries.

What do proponents and opponents say are the key impacts?

Supporters argue minors lack maturity for permanent, life-altering decisions and that less invasive options should be used until adulthood. Opponents argue the ban is overly broad, may interfere with needed care, could create uncertainty for patients and providers, and may delay medically recommended treatment.

Oct 3, 2026

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