What Transgender Measures Are on the 2026 Ballot in Colorado, Missouri, and Arizona?

TransHealthHub

Oct 26

9 min read

TransHealthHub | Reflects ballot information and reporting as of October 27, 2026

Voters in Colorado, Missouri, and Arizona will decide four 2026 ballot measures on transgender youth on November 3. Two concern medical care for minors (Colorado Proposition 135 and Missouri Amendment 3), and two concern school sports (Colorado Proposition 134 and Arizona Proposition 318, which also covers restrooms and locker rooms). In four other battleground states, the subject is reaching voters through candidate races rather than ballot questions, mostly in debates over school sports and medical care for minors.

At TransHealthHub, we explain what each measure would do if it passes or fails, and we check campaign claims against named sources and the law as it stands in each state. We do not endorse or oppose any candidate, party, or ballot measure.

Key Takeaways

Four 2026 ballot measures in Colorado, Missouri, and Arizona deal directly with transgender young people: Colorado Propositions 134 and 135, Missouri Amendment 3, and Arizona Proposition 318
Missouri already bans this medical care for minors by law. Amendment 3 would add a ban to the state constitution and would also repeal the abortion-rights amendment voters approved in 2024.
Colorado's official analysis says Proposition 135 does not restrict non-surgical support such as counseling or social transition.
In Iowa, Michigan, Pennsylvania, and Wisconsin, there is no transgender measure on the ballot, but care for transgender youth is being raised in U.S. Senate and governor races. PolitiFact rated one Iowa ad False.
A campaign message is not a change in the law. Iowa restricts this care for people under 18; Michigan, Pennsylvania, and Wisconsin do not.
Election Day is Tuesday, November 3, 2026. Each state's official ballot language is linked in the FAQ below.

This page reflects official ballot language, reporting, and state policy as of October 27, 2026, and will be updated after the election. It is not legal or medical advice, and TransHealthHub does not endorse or oppose any candidate, party, or ballot measure. Decisions about a young person's care belong to that young person, their family, and their clinicians.

Ballot measures on transgender healthcare issues, at a glance

State	Measure	A "yes" vote would	A "no" vote would	If passed, takes effect
Colorado	Proposition 134	Designate school and college teams as male, female, or coed by sex	Keep current school-by-school policies	January 1, 2027
Colorado	Proposition 135	Prohibit certain surgeries on minors and bar public money and insurance from paying for them	Keep current law	January 1, 2027
Missouri	Amendment 3	Repeal 2024 abortion rights and add a ban on medical care for transgender minors to the constitution	Keep 2024 abortion rights; current state-law ban on this care continues	December 3, 2026 (30 days after the election)
Arizona	Proposition 318	Extend sports rules to private schools and athletic associations, and limit private-space use by sex at birth	Keep current student-athletics law	January 1, 2027

Sources for this table appear in each measure's section below.

Colorado Proposition 134: school and college sports

Proposition 134 would require public and private K-12 schools and colleges to designate every team as male, female, or coeducational, according to Chalkbeat Colorado. Female students, as the measure defines sex, could join a male team only if no female team exists in that sport. It defines sex by reproductive biology and does not say how schools should confirm a student's sex, so each school would decide. It needs a majority vote, according to the Colorado Secretary of State.

Supporters: Protect Kids Colorado, which also backs Proposition 135.
Opponents: Families Not Politics, a coalition that includes One Colorado, Planned Parenthood of the Rocky Mountains, and the Transgender Law Center.
If it passes: The rules would start January 1, 2027. Transgender girls could still play on coed teams.
If it fails: Policies stay as they are now, which Chalkbeat reports vary by school district.
What families should know: No state agency tracks how many transgender students play school sports, and Chalkbeat reports the number is generally thought to be very small.

Colorado Proposition 135: surgery for minors

Proposition 135 would prohibit surgeries on minors "that alter their biological sex characteristics" when performed in response to a minor's perception of sex or gender, according to the state's official Blue Book analysis. It would also bar state or federal money, Medicaid, and private insurance from paying for those surgeries.

Exceptions: Male circumcision and treatment for "medically verifiable disorders of sex development," according to the Blue Book.
What it does not cover: The Blue Book says non-surgical treatments, "such as social transition options and counseling," are not restricted.
Supporters and opponents: The same groups as Proposition 134. The Colorado Medical Society's board also opposes it; its president said the measure would interfere with physicians' independent clinical decisions, according to Colorado Newsline.
If it passes: These surgeries would be prohibited for anyone under 18, and public money and insurance could not pay for them. The measure's text says it would take effect January 1, 2027.
If it fails: Current law stays in place.
What families should know: The Blue Book says it is unknown how many minors receive the surgeries it would prohibit. It cites a Harvard study of 2019 U.S. insurance claims that estimated about 2.1 transgender or gender-diverse youths had at least one such surgery per 100,000 youths ages 15 to 17. Children's Hospital Colorado has never offered these surgeries to minors, and Denver Health stopped offering them in early 2025, Colorado Newsline reports.

Missouri Amendment 3: abortion and medical care for minors

Amendment 3 asks voters two questions in one. A "yes" vote would repeal the abortion-rights amendment approved in 2024, allow abortion only in listed cases, and "prohibit gender transition procedures for minors," according to the official ballot language from the Missouri Secretary of State. A "no" vote would leave the 2024 amendment in place and would not add this ban to the constitution.

Current law: Missouri already bans surgery, puberty-pausing medication, and hormone therapy for transgender minors. The surgery ban has no end date, and the medication and hormone restrictions expire in August 2027, according to KCUR. The Missouri Supreme Court upheld the law in January 2026 (St. Louis Public Radio).
Supporters: The Her Health, Her Future campaign and Missouri Right to Life's political action committee (Missouri Independent).
Opponents: The Stop the Ban coalition, whose donors include the Fairness Project, the ACLU Foundation, and PROMO (ABC17).
If it passes: Missouri would become the first state to place this ban in its constitution, with no expiration date, KCUR reports. Missouri amendments take effect 30 days after the election, as the 2024 amendment did, so this one would take effect December 3, 2026.
If it fails: The current state-law ban stays in effect. The medication and hormone restrictions would expire in August 2027 unless lawmakers extend them.
What families should know: Either way, this care remains unavailable to minors in Missouri for now. A St. Louis-area therapist told KCUR that families already "drive to Chicago and beyond" for care.

Arizona Proposition 318: sports and private spaces

Proposition 318 was referred to the ballot by the Arizona Legislature. According to the official ballot language from the Arizona Secretary of State, a "yes" vote would:

require private schools, public schools, and athletic associations to designate teams as male, female, or coed by sex;
prohibit them from letting anyone use "private spaces (such as restrooms)" not designated for that person's sex;
define sex "as recorded at birth on an original birth certificate"; and allow athletes to sue schools and athletic associations that knowingly violate the law.

A "no" vote keeps current student-athletics law. Arizona's 2022 Save Women's Sports Act already bars transgender girls from girls' school teams, and a lawsuit kept it from taking effect until this year, when the plaintiffs dropped the case, according to KTAR News. If passed, the measure takes effect January 1, 2027.

Supporters: Rep. Selina Bliss and state schools superintendent Tom Horne (KTAR), plus the Protect Girls Sports in Arizona campaign (Arizona Mirror).
Opponents: The ACLU of Arizona, which calls the measure unnecessary (KTAR). Gov. Katie Hobbs has vetoed several bills that would have limited transgender students' use of school facilities, the Arizona Mirror reports.
What families should know: KTAR reports the restroom and locker room limits apply to private spaces "integral to athletic engagement." Because voters would pass it, lawmakers could change it later only with a three-fourths vote, the Arizona Mirror reports. The Arizona Interscholastic Association approved 16 applications from transgender students between 2017 and 2022, according to the same report.

Candidate races where this care is being raised

Iowa, Michigan, Pennsylvania, and Wisconsin have no transgender measure on the November 3 ballot, but care for transgender young people is coming up in their U.S. Senate and governor races. Most of that discussion concerns school sports and medical care for minors, and one televised claim has been rated False.

State	Race	What is being raised	Law on care for minors
Iowa	U.S. Senate	An ad about medical care for minors, rated False	Restricted since 2023
Michigan	U.S. Senate	Insurance coverage of care for minors	No restriction
Pennsylvania	Governor	School sports and school facilities	No restriction
Wisconsin	Governor and attorney general	Sports, facilities, funding for care	No restriction

State law status comes from the Movement Advancement Project's state map, which lists Iowa among the restricting states and not the other three.

Iowa: a U.S. Senate ad rated False

PolitiFact rated False an ad from Republican nominee Rep. Ashley Hinson saying Democratic candidate Josh Turek supports "sex changes for kids," in a June 5, 2026 fact-check. Its August 28 analysis of campaign messaging notes that surgery for minors is "exceedingly rare."

Iowa law already restricts this care, under legislation signed in 2023. A U.S. Senate race does not change that, since the restriction was set in Des Moines.

Michigan: coverage under a federal health plan

Republicans have criticized Democratic candidate Abdul El-Sayed over his support for covering care for minors under a single-payer health plan, PolitiFact reports, without rating the exchange. El-Sayed has said doctors, parents, and patients should make those decisions.

Michigan does not restrict supportive care for minors, so the disagreement concerns a future federal program, not current access.

Pennsylvania: the governor's race and school sports

Pennsylvania's race centers on schools, not clinics. Republican nominee Stacy Garrity has said she would "protect girls' sports" and "girls' spaces" as governor, according to Spotlight PA. Gov. Josh Shapiro, the Democratic incumbent, has called politicians backing such a ban "extremist" without committing to veto one, and has sued the Trump administration over a federal policy restricting care for people under 19, Spotlight PA reports.

The Republican-led state Senate passed a sports ban last year that House Democrats have not brought to a vote, the same report says. Pennsylvania has no restriction on supportive care for minors.

Wisconsin: two statewide races

In the governor's race, Republican nominee Tom Tiffany told Milwaukee Neighborhood News Service that "public money should not be used for that, including for adults, and it should not happen to minors," and that he would cut state funding to medical facilities that provide those surgeries to minors.

Democratic nominee David Crowley, the Milwaukee County executive, told the same outlet he would not narrow those protections: "I am not going to limit our LGBTQ community from what they currently have."

Tiffany has also opposed transgender participation in girls' and women's sports, and Republican attorney general candidate Eric Toney has criticized Democratic incumbent Josh Kaul over a school district restroom policy. Kaul joined a multistate lawsuit challenging federal limits on this care, saying in a December 2025 statement that the federal health secretary "must not be permitted to exercise major influence by decree over what health care is available."

Gov. Tony Evers has vetoed Republican-backed restrictions on this care and on school sports, Our Lives reports, so Wisconsin currently has none.

Reading claims about this care

Nationally, 27 states have enacted laws or policies limiting young people's access to this care, according to the KFF policy tracker, last updated September 29, 2026. Where a family lives, not how a race is covered, determines what is available.

Much of supportive care is social and psychological, such as using a new name and pronouns or working with a counselor. Our guide to social transition explains what that can look like; our explainer on this care covers what it does and does not involve, and research on family support applies regardless of state law.

Where medical care is concerned, the American Medical Association has said decisions "belong within the sanctity of the patient-physician relationship" and called state bills barring this care for minors "a dangerous intrusion into the practice of medicine" in a 2021 statement.

Frequently asked questions

Which states have transgender ballot measures in 2026? Colorado has two (Propositions 134 and 135), and Missouri and Arizona have one each. Iowa, Michigan, Pennsylvania, and Wisconsin have none.

Would any of these 2026 ballot measures ban puberty-pausing medication? Only Missouri Amendment 3 would, by moving restrictions already in state law into the constitution without an expiration date (ProPublica). Colorado Proposition 135 addresses surgery.

Can a Senate race change my state's law on this care for minors? Those restrictions are set by state legislatures, so a Senate seat does not change them directly, though federal insurance rules can affect coverage.

Where can I read the official ballot language or check a campaign claim? Each state's election office publishes its ballot language: Colorado, Missouri, and Arizona. PolitiFact publishes its rating and sources for each claim it checks, and the KFF tracker lists each state's status.