The November 2026 midterm elections are shaping up to be a referendum on LGBTQ+ policy in the United States. Seven states will present voters with ballot initiatives that directly affect transgender youth, from school athletics to medical treatment and constitutional protections. These measures arrive alongside heated campaign battles over the same issues, making the outcomes especially consequential for the next generation of queer Americans.
Since 2021, more than half of the nation has enacted laws that prevent transgender students from competing on sports teams that match their gender identity, and 27 states have already barred gender-affirming care for minors. The upcoming measures will either cement these trends or attempt to roll them back, depending on which way the electorate leans.
Sports participation bans: what each state proposes
Four states—Arizona, Colorado, Nebraska and Washington—are putting the question of transgender athletes directly to voters. In Arizona, a proposal backed by Rep. Selina Bliss would require K-12 teams to be labelled “male,” “female” or “coeducational” based on a student’s “biological status at birth.” The measure also seeks to bar transgender students from using restrooms and locker rooms that align with their gender identity. The state’s Democratic attorney general, Kris Mayes, has refused to defend the underlying law, and a court has allowed the initiative to stay on the ballot.
Colorado’s initiative, sponsored by Protect Kids Colorado, mirrors Arizona’s language but expands the definition to “biological reproductive systems” and applies to both K-12 and collegiate sports. The campaign gathered more than 168,000 signatures, pushing the proposal onto the November ballot. State medical groups, including the Colorado Academy of Family Physicians and the Colorado Medical Society, have publicly opposed it, arguing that medical decisions belong in the exam room.
In Nebraska, proponents have collected over 130,000 signatures to amend the state constitution so that public and qualifying private schools must designate athletic teams strictly by “biological sex,” explicitly stating that girls’ sports “shall not be open to students of the male sex.” A lawsuit filed by voter Cara Ulman claims the initiative misleads the public, but the secretary of state has already certified the measure for the ballot.
Washington’s high school sports governing body reports only about ten transgender middle- and high-school athletes out of more than 200,000 participants statewide. Voters there will decide whether to ban these students from joining teams that correspond with their gender identity, a decision that could set a precedent for the Pacific Northwest.
Restrictions on gender-affirming medical care
Colorado again appears on the list, this time with a separate question that would outlaw transition-related surgeries for minors and prohibit state, federal, Medicaid or private insurance funds from covering such procedures. While surgeries are already rare, the measure would also affect nonsurgical treatments, despite the initiative’s silence on the latter. The proposal runs counter to Colorado’s existing “shield laws” that protect access to gender-affirming health care and abortion services.
Missouri’s ballot combines an abortion amendment with language that enshrines a ban on gender-affirming medical care for minors into the state constitution. The abortion component would allow abortions only in cases of rape, incest (limited to the first trimester), and medical emergencies. The gender-affirming care ban echoes a 2023 state law already prohibiting such treatment, but embedding it in the constitution would make future reversals far more difficult. An ACLU-led challenge arguing that the measure violates Missouri’s single-subject rule failed to keep it off the ballot.
Broader constitutional and nondiscrimination measures
Beyond sports and health, several states are considering constitutional amendments that could either expand or contract protections for LGBTQ+ people. While the specific text varies, the common thread is a direct vote on whether to embed nondiscrimination clauses, repeal outdated language banning same-sex marriage, or adjust parental and student rights in schools. These proposals illustrate how the 2026 elections are not just about individual issues but about the legal architecture that governs everyday life for queer citizens.
Nationally, the Williams Institute estimates that a little over 300,000 Americans aged 13-17 identify as transgender, a small fraction of the overall student population. Yet the visibility of these young people in the political arena has surged, turning their futures into a centerpiece of state-level policy debates. As voters head to the polls, the outcomes will determine whether the next decade sees increased inclusion or further marginalization of transgender youth across the country.
