Photo: People rally in support of trans rights outside the Nebraska State Capitol Building on Sunday, Oct. 1, 2023, in Lincoln, Neb. (By Rebecca S. Gratz)

This week, the Nebraska Department of Health and Human Services released their proposed regulations surrounding LB 574 and access to gender-affirming care for minors. These regulations are essentially unchanged from the temporary guidelines issued earlier this month.

“We are willing to work with our state government to codify best practices for gender-affirming care,” says Abbi Swatsworth, executive director for OutNebraska. “That being said, the practices outlined in these guidelines are far from the standard of care agreed upon by providers.”

The regulations in question create unnecessary barriers to care and introduce requirements that are uncommon in other healthcare settings, including 40 hours of required therapy in an “objective and non-biased” setting, explicit labeling of medications as “for the treatment of gender nonconformity or gender dysphoria” and in-office administration of injectable medications. 

Arbitrary requirements like these raise numerous ethical questions and concerns, as well as rule out many patients on the basis of financial status, level of acceptance in their respective communities, and geographic location. 

Advocates have voiced concerns on what exactly constitutes “objective and unbiased” therapy, and others have pointed out that the 40 hours required will be an added financial burden to many families. It is also important to note that no other medication prescription is labeled in the way required by these updated guidelines, which put a spotlight on individuals who are already targets of discrimination and harassment. There is also a notable lack of providers in certain parts of our state, and these regulations make telehealth a more difficult avenue of treatment.

“We’re continuing to urge our representatives to honor the expertise of healthcare providers and the rights of families to make private healthcare decisions,” says Swatsworth. “We are already seeing a chilling effect on access to care for both youth and adults as a result of this climate.”

A public hearing regarding the regulations is scheduled for November 28 at the Lancaster Event Center. OutNebraska encourages community members to attend and express their concerns. Comments can also be faxed to 402-742-2382, emailed to or mailed to the address below.

DHHS Legal Services

PO Box 95026

Lincoln NE 68509-5026

If you or someone you know is experiencing a crisis, contact Trans Lifeline at 877-565-8860 or The Trevor Project at 1-866-488-7386.


OutNebraska is a non-partisan organization working to empower, celebrate and grow LGBTQ+ communities in Nebraska. For more information visit