What your vote means
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.
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.
Summary and analysis
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 and against
For
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.
Against
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.
Fiscal impact
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.
From the Legislative Council Staff's The Blue Book: State Ballot Information Booklet, pages 59 to 61.
The ballot question135
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?
Issue committees registered with the state
- In favor
- Protect Kids Colorado - Issue Committee; Protect Our Children
- Opposed
- The People's No; Families not Politics; No on 134 and 135; Protect Trans Kids; Vote Common Sense; People for a Fair Colorado; Make Good Change; Watchdog for the People
Issue committees’ money
What each committee for or against this measure has raised and spent, from its filings since Jan. 1, 2025. A committee working on several measures reports its money once, and it is shown beside each. A donor is named here when any one gift was $200 or more.
| Committee | Raised | Raised, drawn to scale | Spent |
|---|---|---|---|
| ForPROTECT KIDS COLORADO - ISSUE COMMITTEE | $470,744 | $449,236 | |
| AgainstFAMILIES NOT POLITICS | $3,693,752 | $3,135,074 | |
| AgainstNO ON 134 AND 135 | $6,300 | $3,491 | |
| AgainstTHE PEOPLE'S NO | $365,737 | $300,000 | |
| AgainstVOTE COMMON SENSE | $1,069,903 | $1,038,432 | |
| AgainstWATCHDOG FOR THE PEOPLE | $26,388 | $0 |
PROTECT KIDS COLORADO - ISSUE COMMITTEE
- PROTECT KIDS COLORADO, 501(C)4, COLORADO SPRINGS$242,000
- ATHLETES FOR ACTION, BLUE BELL$50,250
- CHURCH FOR ALL NATIONS, COLORADO SPRINGS$35,000
- PIKES PEAK CITIZENS FOR LIFE, COLORADO SPRINGS$15,000
- FAMILY POLICY ALLIANCE FOUNDATION, COLORADO SPRINGS$10,000
From donors not named here: 334 gifts, $19,402.
FAMILIES NOT POLITICS
- ROCKY MOUNTAIN PLANNED PARENTHOOD, DENVER$480,000
- AMERICAN CIVIL LIBERTIES UNION, INC., NEW YORK$304,273
- ACLU OREGON, PORTLAND$300,000
- COBALT ADVOCATES, DENVER$279,000
- PLANNED PARENTHOOD FEDERATION OF AMERICA INC., NEW YORK$250,000
From donors not named here: 1,062 gifts, $46,830.
NO ON 134 AND 135
- LAUREN MOORE, DENVER$450
- D3 ARTS, DENVER$370
- KELLY CORRIGAN, BOULDER$320
- KERRY MANLEY, NIWOT$307
- KATIE BLAKEY, DENVER$300
From donors not named here: 149 gifts, $4,323.
THE PEOPLE'S NO
- AMERICAN CIVIL LIBERTIES UNION OF COLORADO, DENVER$258,133
- COLOR ACTION FUND, DENVER$105,141
- COLORADO CRIMINAL JUSTICE REFORM COALITION (CCJRC), DENVER$2,464
VOTE COMMON SENSE
- GREEN ADVOCACY PROJECT, WASHINGTON$225,000
- COLORADO FUND FOR CHILDREN & PUBLIC EDUCATION, DENVER$115,000
- COBALT ADVOCATES, DENVER$105,000
- MERLE CHAMBERS, DENVER$100,000
- CONSERVATION COLORADO, DENVER$90,833
WATCHDOG FOR THE PEOPLE
- COLORADO COMMON CAUSE, DENVER$26,388
As printed in the document it was read from. Money from TRACER, the Secretary of State's campaign finance system (read 4:01 a.m.).