Colorado voters will decide this November whether to prohibit gender surgeries for minors and bar public funding or insurance coverage for procedures that alter children’s biological sex characteristics.

The measure qualified for the ballot amid a push by the federal government to halt such surgical procedures and hormonal treatment, a move that has begun to modify how hospitals across America approach gender services. Indeed, at least one hospital in Colorado has paused gender services— in particular, puberty blockers and hormone-based treatment — for children, saying it would wait for “federal court rulings and assess the rapidly evolving legal landscape.”

State election officials said proponents of Initiative No. 110 submitted nearly 165,000 signatures and a review of a sample confirmed they turned in a sufficient number to make it to the November ballot. Initiatives need about 124,000 to qualify.

The measure would bar health care professionals from prescribing, administering, or providing surgery to a child “for the purpose of altering biological sex characteristics.”

Additionally, it would prohibit the use of federal funds, Medicaid dollars or insurance coverage to pay for the medical interventions.

It defines “altering biological characteristics” as treatment “in response to a minor’s perception of sex or gender.” The prohibitions do not apply to children born with “medically verifiable disorder of sex development” or to treatments “for acquired physical or chemical abnormalities.”

It also excludes male circumcision.

The proposals is backed by Erin Lee, who is also behind another measure, which recently qualified for the ballot, that seeks to prohibit transgender girls from competing in girls’ sports.

The proponents have argued that children lack the maturity to decide “life-altering medical decisions” and noted that European countries have also halted gender surgeries for minors.

Several European countries, after embracing “gender affirming care,” have since emphasized psychological care over the transition of young people. In particular, the United Kingdom’s National Health Service said it will no longer prescribe “puberty blockers” — drugs that suppress sex hormones during puberty — to children and other young people seeking gender transitions, saying there is “not enough evidence of safety and clinical effectiveness.” 

Meanwhile, supporters of affirming transgender identity have often pointed to an Education Week report, citing research that said “affirming transgender students can improve their mental health and academic outcomes.”

“Colorado sets age limits for voting, drinking, and smoking because we recognize that children are not ready to make life-altering decisions,” said Lori Gimelshteyn of the Colorado Parent Advocacy Network. “When it comes to irreversible medical procedures on healthy bodies, children deserve the same protection. Initiative 110 ensures these decisions are delayed until adulthood.”

Rocky Mountain Equality, an LGBTQ+ advocacy organization based in Boulder, called the measure an attempt by outside interests to tell Colorado parents how to raise their children.

“In the coming months, we are going to hear intentional lies from anti-trans extremists about this ballot measure,” said the organization’s director, Bruce Parker. “They aren’t being honest about their agenda to erode privacy and access to credible medical care they don’t agree with. Their next targets are care for trans adults and abortion services if we let them get away with this.”

The White House’s position on gender services, which carries the threat of losing funding, has begun to alter the operations of hospitals in Colorado and elsewhere in the country.

Last year, several Colorado hospitals said they would halt transgender services, some of which cited the risk of losing federal dollars for its decision, after the Trump administration issued an order that mandates agencies to “defund chemical and surgical mutilation.”

In Colorado, many of the hospitals distinguished between providing gender surgeries and offering hormonal or chemical treatments.

The decision of one of those hospitals, Children’s Hospital Colorado, is now being litigated in court. This month, the Colorado Supreme Court ordered Children’s to explain why it should not direct the organization to resume providing certain types of services to transgender children in compliance with the state’s non-discrimination law.

Last month, a Denver judge had declined to require Children’s to continue providing hormone therapy and puberty blockers to the proposed class of transgender patients, reasoning that the potential consequences from the federal government could endanger patient care more broadly. Children’s Colorado earlier said it had never provided gender transition surgical services for patients under 18.

Children’s Colorado had announced in January that it is “pausing medical gender affirming care for patients under the age of 18 as we wait for any federal court rulings and assess the rapidly evolving legal landscape.”

A few days later, four transgender children, through their parents, sued Children’s Colorado, alleging the hospital was violating the Colorado Anti-Discrimination Act.

Besides voting on the surgery ban, Colorado voters will also decide whether transgender students can join girls’ sports after an initiative that would require student athletes to only join sports teams that correspond to their biological sex qualified for the November ballot.

At its core, Initiative No. 109 restricts participation in K-12 and collegiate school sports based on a student’s biological sex and requires schools and athletic associations to designate teams and sports as girls, boys or coed. It creates an exception that allows a female student to participate on a male team if no female team is available.

Rocky Mountain Equality called the ballot measure an attack on Colorado families, while supporters, such as Christian Home Educators of Colorado, argued that allowing transgender athletes to participate in girls’ sports is a mockery of federal laws meant to protect women.

Michael Karlik of Colorado Politics contributed to this article.