Since the illegitimately stacked, right-wing Supreme Court struck down Roe v Wade just over a year ago, older state laws placing unfair restrictions on abortion clinics have become less meaningful.

After all, ‘red’ states dominated by the radicalised Republican Party can now simply pass draconian bans outright (although smarter Republicans understand that focus on the issue harms their electoral prospects at both state and national levels).

But although no longer as relevant, some of these restrictions – including allowing only doctors to administer medical (aka medication) abortions, even though physician assistants and nurse practitioners are more than qualified – are now being used as a blueprint for new legislative efforts to eliminate gender-affirming healthcare for as many transgender adults as possible.

Yes, you read that correctly: adults. Ever since right-wing states began banning age-appropriate gender-affirming healthcare for minors in 2021, trans people and LGBTIQ advocates have warned that they were not motivated by any kind of sincere concern for ‘the children’ and would not stop at restrictions on minors if allowed to go further.

The right paved the way for these once-unthinkable bans by first pursuing goals that were more palatable to the public, using bathroom bills and school sports bans to normalise hateful anti-trans rhetoric in the American public sphere. This tactic has been effective.

The logical next step is to begin to restrict adult access to gender-affirming care, while pretending you’re not pursuing outright bans that would likely be ruled unconstitutional.

This requires borrowing a page from the anti-abortion legislative playbook, where so-called TRAP (Targeted Regulation of Abortion Providers) laws became common in the early 21st century. State governments passed unnecessary building codes in ways that would cause abortion clinics to be in violation, or required abortion providers to have ‘admitting privileges’, meaning a person affiliated to an abortion clinic must have the right to admit patients to a hospital.

Before Roe was overturned, these laws would sometimes be struck down as unconstitutional, but they served their purpose. In many Republican-controlled states, particularly in the South, abortion was de facto unavailable or prohibitively difficult to access, with mandatory waiting periods (meaning multiple visits), ultrasounds and other heavy burdens placed on vulnerable women who often had to travel for hours to reach their nearest abortion provider.

This approach is now being applied to adult transgender care in – where else? – Ron DeSantis’s dystopian Florida, and we will likely see it implemented in other red states before long. According to Florida’s Senate Bill 254, which was passed and came into effect in May, only doctors are allowed to prescribe hormones for gender-affirming care, and only in person (previously, telehealth prescriptions were common).

The vast majority of transgender Floridians who need hormone replacement therapy have, in previous years, relied on nurse practitioners for their prescriptions. Now, those who run out of their current prescriptions are being left without access to hormones unless they can manage to see a physician willing to prescribe them, of which far too few are available to meet the need.

To add insult to injury, the new law also requires trans patients to sign consent forms that are riddled with disinformation, including false assertions that gender-affirming care is “speculative” and grounded in “limited, poor-quality research”.

This is another old trick from the right’s anti-abortion playbook. Abortion providers in Republican states are sometimes legally required, under “informed consent” laws, to tell patients that people who have abortions are at heightened risk of poor mental health outcomes and/or breast cancer, even though both claims are demonstrably false.

This spring, the Texas Senate passed a bill similar to Florida’s, though it never reached a vote in the House of Representatives before the Texas legislative session came to an end. Given Republican determination to continue persecuting transgender Americans, versions of the bill will probably be back though, both in Texas and other Republican-dominated states, along with a proliferation of bureaucratic and legislative efforts to defund gender-affirming care.

Legislators will be further emboldened by a recent legal decision by a federal appeals court, stacked by Donald Trump, which upheld a ban on transgender care for minors in Alabama, overturning a block on the law put in place by a lower court. The Eleventh Circuit Court of Appeals’ ruling in the Alabama case has already led to a Florida judge refusing to block SB 254 pending appeal.

Tellingly, in its ruling, the Eleventh Court cited the Supreme Court’s ruling in Dobbs v Jackson Women’s Health (which overturned Roe) to argue that access to gender-affirming care is not a protected right because it is not “deeply rooted in [our] history and tradition”.

This language directly echoes that of the majority opinion in Dobbs, written by Supreme Court justice Samuel Alito, in what seemed (to me and many other commentators) like a direct invitation to right-wing Christians and their allies to bring challenges to rights beyond abortion access before the Supreme Court.

The Supreme Court in its current illegitimately stacked and partisan form is highly unlikely to protect either children’s or adults’ access to gender-affirming care in the coming years, making state-level legislative battles all the more critical to protecting trans people’s rights.

This means that understanding Republicans’ plan to eliminate access to gender-affirming care for adults is crucial. As with abortion for the decades when Roe was in effect, many of their efforts will take the insidious form of achieving a de facto ban, while being able to argue that they have not technically banned anything – a strategy that must be exposed and countered.