Proposition 135Prohibit Surgery on Minors in Response to Perception of Sex or Gender
Read the full text of the measure: on this page or in the Blue Book (PDF, page 94)
In plain words
Proposition 135 would ban surgery on anyone under 18 that changes their body's sex traits when it is done because of how the young person sees their own sex or gender. This includes gender-affirming surgery, which helps a transgender person's body match the gender they know themselves to be. It would also stop government money and health insurance from paying for these surgeries. source: Blue Book, p. 59
Before and after
| Question | Today | If Proposition 135 passes |
|---|---|---|
| Can a person under 18 have surgery to change sex traits because of how they see their sex or gender? | Yes. Colorado law protects access to these surgeries | No |
| Can health insurance or Medicaid (the public health plan for people with low incomes) pay for it? | Yes, if it is medically necessary | No. Not state or federal money, Medicaid or private insurance |
| Is male circumcision allowed? | Yes | Yes |
| Is treatment for medical conditions of sex development allowed? | Yes | Yes, for medically verifiable conditions |
| Are counseling and other non-surgical care allowed? | Yes | Yes. The measure does not limit them |
From the official analysis source: Blue Book, p. 59
Example
Illustration only: a 16-year-old transgender patient, their parents and their doctor all agree on a surgery to change the shape of the patient's body. Under Proposition 135 the surgery could not be done until the patient turns 18, and insurance could not pay for it. The patient could still get counseling. The Blue Book says the three large children's surgery providers in Colorado already do not do these surgeries on transgender patients under 18. source: Blue Book, p. 59
Biggest change
- Surgery on people under 18 to change sex traits because of how they see their sex or gender would be banned, and no insurance or government money could pay for it. The ban is based on the reason for a surgery, not a list of procedures, so the Blue Book says it may also limit some surgeries for minors who are not transgender. source: Blue Book, p. 59
Who it affects most: Transgender people under 18 and their families, and the doctors and insurers who would have to follow the ban.
Cost to the state: Unknown. The Blue Book does not give an amount. It says added costs to the state and local governments, and any savings from not paying for these surgeries, are both expected to be minimal.
Our plain-words summary at an 8th-grade reading level. Every line points to its source.
What your vote means
Doctors could not do these surgeries on anyone under 18, and insurance and government money could not pay for them.
Colorado law would keep protecting these surgeries for minors, and insurance and public health programs could keep paying for them.
Our plain-words summary.
The Blue Book's official wording of YES and NO (tap to open)
YES: A “yes” vote on Proposition 135 prohibits surgeries on minors that would alter their biological sex characteristics as a treatment in response to a minor’s perception of sex or gender, and prohibits the use of government funds or health insurance to pay for the surgeries.
NO: A “no” vote on Proposition 135 maintains Colorado law, which protects access to surgery altering minors’ biological sex characteristics and allows public and private health insurance programs to pay for these surgeries.
Why people want it, and why others object
Why this is on the ballot
- Citizens put this on the ballot by collecting signatures (a citizen initiative). It would change a state law (a statute), not the state constitution, so the legislature could change it later. source: Blue Book, p. 59
- The Blue Book says these surgeries on minors are rare in the U.S. A Harvard study of 2019 insurance claims found about 2.1 per 100,000 youths aged 15 to 17, 0.1 per 100,000 aged 13 to 14, and none at age 12 or younger. source: Blue Book, p. 59
Why supporters want it
- Minors lack the maturity to make permanent, life-altering medical decisions. Like many other age-restricted rights and activities, gender-affirming surgeries should require a heightened level of maturity and the ability to make fully informed decisions. Until an individual is a legal adult, less invasive, non-surgical methods of providing gender-related care should be used. This ensures that the most permanent interventions are reserved for when a person is able to fully understand the risks and benefits of surgery as an adult. source: Blue Book, p. 59
- More long-term data is needed to determine whether gender-affirming surgery is a necessary treatment option prior to adulthood. Some minors may regret undergoing irreversible gender-affirming surgical procedures. Surgeries have risks, and surgery on minors should only be contemplated if there are no other viable treatment options. Other states have limited gender-related treatment options available to minors, including surgical care. source: Blue Book, p. 59
Why opponents object
- The measure creates an overly broad ban on gender- and sex-based surgeries that interferes with needed care for both transgender and non-transgender minors. In addition to banning gender-affirming surgeries, the narrow exceptions under the measure could limit the ability of any youths to have surgeries for a range of reasons, both medical and cosmetic. The measure’s ban is based on a minor’s purpose in seeking treatment, which could lead to uncertainty for patients, source: Blue Book, p. 59
- The measure delays medically recommended care, even when parents, patients, and medical providers all agree the care is necessary. Medical care decisions for minors should be individualized based on a patient’s unique needs and well-established standards of care. Transgender youth already face stigmatization, harassment, and discrimination, and restricting gender-affirming surgical care may worsen mental health outcomes for minors, including anxiety, depression, social isolation, eating disorders, and risk for self-harm and suicide. Important medical decisions should be left to patients, families, and health care providers, not legislated at the ballot box. Information about the organizations supporting and opposing this measure is available on the Colorado Secretary of State's website: source: Blue Book, p. 59
Who backs each side
Most totals are through October 4, 2026 (Rocky Mountain Voice, Oct 6); some are as of September 21 (Colorado Politics). Spending grows until Election Day. These figures come from news reports of state campaign finance filings and were not checked line by line against the filings.
- The same committees as Proposition 134, on both sides.
Sources: Rocky Mountain Voice, Oct 6, 2026 · Colorado Politics, Sept 25, 2026 · Colorado Secretary of State: committees for and against 2026 measures · TRACER campaign finance search
Supporter and opponent arguments are the official ones printed in the Blue Book, written by the Legislative Council's nonpartisan staff after hearing from both sides. Who is registered for and against (Secretary of State) . We don't endorse either side.
At a glance
Our plain-words summary of the official Blue Book analysis. Every line points to its source.
Who it affects
- Minors (people under 18) who would seek surgery that changes biological sex characteristics in response to their perception of sex or gender. This includes gender-affirming surgeries for transgender minors. (Blue Book, p. 59 )
- Possibly other minors, including those who are not transgender, if a surgery is seen as being in response to how they perceive their sex or gender. (Blue Book, p. 59 )
- Surgeons and other health care professionals, who could not perform these surgeries on minors. (Blue Book, p. 59 )
- Health insurers, Medicaid and other state and federal programs, which could not pay for these surgeries. (Blue Book, p. 59 )
- State and local agencies that employ health care workers, such as the Department of Human Services and county hospitals, and the Department of Regulatory Agencies, which oversees health professionals and insurers. (Blue Book, p. 59 )
- Not affected: male circumcision, treatment for medically verifiable disorders of sex development or acquired physical or chemical abnormalities, and non-surgical care such as counseling and social transition. (Blue Book, p. 59 )
How many: Unknown for Colorado. A Harvard study of 2019 U.S. insurance claims found about 2.1 gender-affirming surgeries per 100,000 youths aged 15 to 17, 0.1 per 100,000 aged 13 to 14, and none at age 12 or younger. Colorado's three large pediatric surgical providers (Children's Hospital Colorado, Rocky Mountain Children's and Denver Health) report that they do not do these surgeries on transgender patients under 18.
Money: economic and budget impact
- State: a minimal increase in workload and costs for the Department of Regulatory Agencies to update rules and handle complaints. (Blue Book, p. 59 )
- State and local: more workload for agencies that employ health care workers to update their policies, and possible legal costs to respond to claims of noncompliance. If everyone complies, the Blue Book expects the effect on spending to be minimal. (Blue Book, p. 59 )
- State: possible small savings in Medicaid and state employee health insurance from no longer paying for these surgeries for minors. The Blue Book expects any savings to be minimal. (Blue Book, p. 59 )
- State and local governments: if private insurers stop covering these surgeries, it may minimally help lower health insurance premiums. (Blue Book, p. 59 )
- No new tax, no change in state revenue and no effect on TABOR refunds is listed. No dollar amounts or budget years are given. (Blue Book, p. 59 )
Surgery on minors to change biological sex characteristics in response to the minor's perception of sex or gender would be banned, with listed exceptions. State or federal money, Medicaid and private health insurance could not pay for these surgeries. The measure does not list specific procedures, so the ban depends on the reason for the surgery. This changes state statute, so the legislature can amend it later.
Current Colorado law stays. It protects access to these surgeries for minors, and medically necessary gender- and sex-based surgeries may be covered by private insurance or a public health program, or paid for out of pocket.
Not yet known
- How many Colorado minors have these surgeries each year. The Blue Book gives only national rates and says the number is unknown.
- Which specific procedures, beyond gender-affirming surgery, would be limited, since the ban is based on the reason for surgery.
- A dollar estimate for state costs or savings.
- When the ban would take effect. The Blue Book does not give a date.
Can it actually be enforced?
Short answer: Partly. The surgery ban would bind health care professionals and insurers regulated by Colorado, and a 2025 Supreme Court ruling makes a federal equal protection challenge harder. How far the insurance ban reaches into some employer health plans governed by federal law is less clear.
- This is a change to state statute, not the constitution. The legislature could amend or repeal it later without another statewide vote. (Blue Book, p. 59 )
- Who carries it out: the Department of Regulatory Agencies, which regulates health care professionals and insurers, would update rules and handle complaints. Public employers such as county hospitals would update their policies. (Blue Book, p. 59 )
- Federal constitutional challenge: in United States v. Skrmetti (June 2025) the U.S. Supreme Court ruled 6-3 that Tennessee's ban on puberty blockers and hormones for minors for gender transition did not violate the Equal Protection Clause. Tennessee's law also covered surgery, but the Court did not rule on that part. The ruling suggests a similar federal challenge to Proposition 135 would face a high bar. (supreme.justia.com )
- Insurance limit: the federal ERISA law overrides state laws that 'relate to' employer benefit plans, while keeping state laws that regulate insurance (29 U.S.C. 1144). So the state can regulate insurance companies, but how far the coverage ban reaches into employer health plans covered by ERISA is a question a court may have to decide. (law.cornell.edu )
- Scope is unclear. The ban is based on the reason for a surgery, not a list of procedures. The Blue Book says this could affect other surgeries on minors, and opponents say it could leave patients, doctors and insurers unsure what is allowed. Regulators or courts may end up drawing the lines. (Blue Book, p. 59 )
- Practical effect may be small: the three large pediatric surgery providers in Colorado told the Blue Book they do not perform these surgeries on patients under 18. (Blue Book, p. 59 )
Not yet known
- What penalty a doctor or insurer would face for breaking the ban. The Blue Book mentions complaints but no specific penalties.
- Whether lawsuits would be filed under the Colorado Constitution.
This is our reading of the cited law, not legal advice. Court outcomes are uncertain.
Official ballot wording
Official ballot wording, word for word (tap to open)
The ballot title, word for word from the 2026 Blue Book.
Shall there be a change to the Colorado Revised Statutes modifying existing law by prohibiting surgery on a minor for the purpose of altering the minor’s biological sex characteristics, and, in connection therewith, prohibiting any health-care professional or other person from knowingly performing, prescribing, administering, or providing any surgery to a minor for the purpose of altering the minor’s biological sex characteristics and prohibiting the use of state or federal funds, Medicaid reimbursement, or insurance coverage to pay for this type of surgery?
The official analysis
The full Blue Book analysis, word for word (tap to open)
Everything in this section is quoted from the nonpartisan Legislative Council's 2026 State Ballot Information Booklet (the Blue Book). Charts are described in words. Read the full Blue Book (PDF)
Proposition 135 proposes amending the Colorado statutes to:
- prohibit surgeries on minors that alter their biological sex characteristics as a treatment in response to a minor’s perception of sex or gender, with certain exceptions; and
- prohibit the use of state or federal funds or insurance coverage to pay for these surgeries.
Summary and Analysis of Proposition 135
What medical treatments are prohibited by Proposition 135?
The measure prohibits surgery on minors for the purpose of altering biological sex characteristics as a treatment in response to a minor’s perception of sex or gender. The measure does not list specific surgical procedures that are prohibited; instead, the prohibition is based on the reason that a surgery is performed on a minor. The prohibition includes gender-affirming surgeries, which are a range of procedures that may be provided to transgender individuals to make their physical appearance match their gender identity. Examples include altering, removing, or reconstructing sexual and reproductive organs; modifying body shape; changing facial appearance; or altering vocal characteristics. The measure may also limit other surgeries for minors, including non-transgender minors, if the treatment is interpreted as being in response to the minor’s sex or gender perception.
Proposition 135 allows male circumcision and treatments for medically verifiable disorders of sex development or acquired physical or chemical abnormalities. Non-surgical gender-related treatments, such as social transition options and counseling, are also not restricted by the measure.
How does Proposition 135 change coverage for these procedures?
Currently in Colorado, gender- and sex-based surgeries that are medically necessary may be covered by private health insurance or a public health care program, or be paid for out-of-pocket. The measure bans the use of state or federal money, Medicaid reimbursements, and private health insurance to pay for the prohibited surgeries.
How often are these procedures performed on minors in the United States?
It is unknown how many minors receive gender- and sex-based surgeries that would be prohibited under the measure. However, one study found that gender-affirming surgery for transgender minors in the United States is rare. The study, from researchers at Harvard University, examined 2019 health insurance claim data and found that for every 100,000 youths aged 15 to 17, an estimated 2.1 youths who identified as transgender or gender diverse had at least one gender-affirming surgery. For youths aged 13 to 14, these surgeries are even more rare, with 0.1 youths having a surgery per 100,000 youths (or 1 in a million). Researchers found no cases of gender-affirming surgeries being performed on youths aged 12 and younger.
The three large pediatric surgical providers in Colorado—Children’s Hospital Colorado, Rocky Mountain Children’s, and Denver Health—report that they do not perform gender- or sex-based surgeries on transgender patients under 18 years of age.
Arguments For Proposition 135
1) Minors lack the maturity to make permanent, life-altering medical decisions. Like many other age-restricted rights and activities, gender-affirming surgeries should require a heightened level of maturity and the ability to make fully informed decisions. Until an individual is a legal adult, less invasive, non-surgical methods of providing gender-related care should be used. This ensures that the most permanent interventions are reserved for when a person is able to fully understand the risks and benefits of surgery as an adult.
2) More long-term data is needed to determine whether gender-affirming surgery is a necessary treatment option prior to adulthood. Some minors may regret undergoing irreversible gender-affirming surgical procedures. Surgeries have risks, and surgery on minors should only be contemplated if there are no other viable treatment options. Other states have limited gender-related treatment options available to minors, including surgical care.
Arguments Against Proposition 135
1) The measure creates an overly broad ban on gender- and sex-based surgeries that interferes with needed care for both transgender and non-transgender minors. In addition to banning gender-affirming surgeries, the narrow exceptions under the measure could limit the ability of any youths to have surgeries for a range of reasons, both medical and cosmetic. The measure’s ban is based on a minor’s purpose in seeking treatment, which could lead to uncertainty for patients,
physicians, and insurers. Insurers may use this ban to limit their coverage for a wide variety of treatments, and medical professionals may reduce the care they are willing to provide for fear of legal repercussions.
2) The measure delays medically recommended care, even when parents, patients, and medical providers all agree the care is necessary. Medical care decisions for minors should be individualized based on a patient’s unique needs and well-established standards of care. Transgender youth already face stigmatization, harassment, and discrimination, and restricting gender-affirming surgical care may worsen mental health outcomes for minors, including anxiety, depression, social isolation, eating disorders, and risk for self-harm and suicide. Important medical decisions should be left to patients, families, and health care providers, not legislated at the ballot box. Information about the organizations supporting and opposing this measure is available on the Colorado Secretary of State's website:
www.coloradosos.gov/pubs/elections/Initiatives/ballot/contacts/2026.html
Fiscal Impact of Proposition 135
State and Local Government Spending
Proposition 135 will minimally increase workload and costs for the Department of Regulatory Agencies, which regulates health care professionals and insurers, to update rules and materials pertaining to gender- and sex-based surgeries and to handle complaints if prohibited surgeries are performed or paid for. Similarly, various state and local government agencies that employ health care professionals, such as the Department of Human Services and county hospitals, among others, will have additional workload to update their policies to ensure that their employees follow the measure. Legal costs may also increase for the state and local governments to respond to any allegations of noncompliance. Assuming health care professionals, insurance companies, and government agencies comply with the measure, any impact on state and local spending is expected to be minimal.
Proposition 135 may also slightly decrease state spending on health programs and employee health insurance from no longer paying for certain surgeries for minors related to gender perception. Specifically, to the extent the state Medicaid program covers these surgeries for minors, spending will decrease. Similarly, if private insurance companies no longer cover these surgeries, it may minimally contribute to lower health insurance premiums for state and local governments. Overall, any savings are expected to be minimal.
Latest news
Recent reporting from a range of outlets, newest first. We link to it; we don't endorse it.
- 2026-10-06 The Colorado Sun: Meet the woman behind the Colorado ballot measures this year on transgender youth
- 2026-10-04 The Colorado Sun: Proposition 135: Colorado voters will decide whether to ban gender-related surgeries for kids
- 2026-10-02 Colorado Newsline: Ballot measure to ban youth gender-affirming surgeries could disrupt other forms of healthcare
- 2026-10-02 Colorado Politics: Proposition 135
- 2026-09-25 CPR News: Proposition 135: Prohibit Certain Surgeries on Minors
- 2026-09-23 Complete Colorado (opinion): The bodily integrity case for yes on Colorado's Prop 135
Coverage of all the statewide measures
- 2026-10-06 Rocky Mountain Voice: What's on your 2026 Colorado ballot: all 14 statewide measures
- 2026-09-25 Colorado Politics: Major donors fuel Colorado ballot measure fights across the state
- 2026-09-25 CPR News: 2026 Colorado state ballot measures voter guide
Full text of the measure
Word for word from the Blue Book, pages 94 to 95 (PDF ). Where the measure changes existing statutes, new wording is in CAPITAL LETTERS, as in the printed booklet.
Show the full text
Be it enacted by the people of the State of Colorado:
SECTION 1. Legislative Declaration. (1) The people of Colorado do hereby find and declare that:
(a) Children lack the maturity to make permanent, life-altering medical decisions;
(b) Medical treatments or interventions that attempt to surgically alter a minor child’s biological sex often result in serious, irreversible consequences, including sterility;
(c) European nations, including Sweden, Finland, and the United Kingdom, have halted surgery due to the serious and widespread harm resulting from that intervention; and
(d) Colorado law already protects children from other, permanent and potentially life-altering decisions, such as consuming alcohol and smoking. The same protections should apply to irreversible medical interventions related to biological sex.
SECTION 2. In Colorado Revised Statutes, add 12-30-125 as follows: 12‑30‑125. Prohibition on surgery for minors – prohibition on state funding for surgery ‑ short title – definitions.
(1) Short title. The short title of this section is the “Protect Children From Irreversible Sex Change Surgery Act”.
(2) Definitions. As used in this section, unless the context otherwise requires:
(a) “Altering biological sex characteristics” means treatment in response to a minor’s perception of sex or gender. It does not include treatment for persons born with a medically verifiable disorder of sex development or treatment for acquired physical or chemical abnormalities. “Altering biological sex characteristics” does not include male circumcision.
(b) “health-care professional” means any person licensed in this state or any other state to practice medicine, chiropractic, nursing, physical therapy, podiatry, dentistry, pharmacy, optometry, psychiatry, psychology, mental health therapy, or other healing arts. The term includes any professional corporation or other
professional entity comprised of such health-care providers as permitted by the laws of this state.
(c) “Minor” means an individual who is under eighteen years of age.
(3) Prohibition on medical interventions on minors. A health-care professional or other person shall not knowingly perform, prescribe, administer, or provide any surgery to a minor for the purpose of altering biological sex characteristics.
(4) No state or federal funds, medicaid reimbursements, or insurance coverage may be used to pay for any prohibited medical interventions described in subsection (3) of this section.
(5) Severability. If any section of this section is found unconstitutional or invalid, the remaining sections shall remain in effect.
SECTION 3. Effective date ‑ applicability. This measure shall become effective on January 1, 2027, and apply to violations occurring on or after the effective date.
Read more
- 2026 Blue Book (PDF) , including the full legal text of the measure
- Colorado Secretary of State: who is registered for and against
- TRACER: Colorado campaign finance filings
What people are saying
Official campaign accounts on each side, and public posts. Links only: nothing here loads from social media sites. We link to posts; we don't endorse them.
Protect Kids Colorado – Issue Committee
X ↗ · Facebook ↗ · Instagram ↗
Families Not Politics
X ↗ · Bluesky ↗
Other voices