Puerto Rico has enacted a new statute that prohibits gender transition surgeries and hormone therapies for individuals younger than 21—marking the highest age restriction of its kind in any U.S. territory or state.

The law, which was signed on Wednesday and will take effect in October, imposes strict penalties on medical professionals who perform such procedures or administer hormone therapy to those under 21. Offenders face up to 15 years in prison, a $50,000 fine, and permanent revocation of their licenses and permits. Additionally, the law bans the use of public funds for these types of treatments.

Legislators justified the measure by emphasizing the vulnerability of youth, stating that individuals below 21 may lack the mental, emotional, and physical maturity to make such significant decisions about their bodies.

The move has sparked outrage from LGBTQ+ advocacy groups. The LGBTQ+ Federation of Puerto Rico strongly condemned the law, calling it both harmful and discriminatory. Director Justin Jesus Santiago warned it would isolate transgender youth and possibly lead them to seek unregulated, unsafe alternatives. He also announced intentions to legally challenge the measure, arguing it clashes with Puerto Rico’s constitution.

The legislation echoes broader gender-related policies seen under U.S. President Donald Trump, who has made biological sex distinctions a core policy issue. Since entering office, Trump has signed executive actions that declare there are only two genders—male and female—and has removed support for transgender care among minors, ended federal funding for gender transition procedures, and rolled back DEI (diversity, equity, and inclusion) initiatives. He has also banned transgender individuals from women’s sports and military service.

While many U.S. states have passed similar laws, most limit the ban to minors under 18. Puerto Rico’s move to extend the age threshold to 21 now makes it the most stringent law of its kind in any U.S. jurisdiction.