Introduction <p>The United States has seen a remarkable increase in legislative attacks on LGBTQ + rights over the past few years. Proposed bills have targeted transgender healthcare access in particular, with 127 state and federal bills during 2024 attempting to restrict or prohibit hormones, surgeries, and other gender affirming care, especially for children.</p> Methods <p>A content analysis of the text of these bills explores the potential effects of language used by those who seek to craft “the transgender problem.” By focusing directly on the proposed legislative texts, this study centers potential legal ramifications for affected populations as well as the issues that are considered most important by policymakers.</p> Results <p>The analysis identifies themes of traditional gendered appearances and “appearance of genitalia,” and an interest in preserving fertility. The analysis also provides additional evidence for motivations identified in earlier research, including morality, affective drift, and threatened masculinity. Drafters of these bills take a concertedly narrow view that considers “biological sex” exclusive of psychological or social influences, even though individual and social perceptions of gender are understood as being of primary importance to gender identity.</p> Conclusions <p>This study is a first step toward understanding what has become a significant attempt at changing public healthcare policy. While some narratives mirror well-established anti-trans sentiments, healthcare may be a unique avenue for defining and controlling gender identity and expression.</p> Policy Implications <p>Understanding the narratives underlying anti-trans policies helps LGBTQ + advocates craft effective messaging directed at the core issues important to those who may support anti-trans legislation.</p>