Voters in five states decided six ballot measures related to sex-based sports eligibility and medical procedures for transgender minors in 2026. Here are the results and what they mean.
As of 2:15 PM EST on Nov. 4, of the four measures to establish sex-based requirements for school sports, two passed, and two were not called yet. Of the two measures to prohibit certain medical or surgical procedures for transgender minors, one passed, and one was not called yet.
Measures to establish sex-based requirements for school sports:
- Arizona Proposition 318: Approved. Voters approved a measure to restrict access to school restrooms, locker rooms, and other private spaces based on sex recorded on an original birth certificate, and prohibit girls from participating on boys’ sports teams.
- Colorado Proposition 134: Too close to call. Voters decided a measure to require students to participate on school and collegiate athletic teams matching their sex, defined by biological reproductive systems. As of 2:15 PM EST, 52% of voters approved the measure, and 48% opposed it.
- Nebraska Initiative Measure 442: Approved. Voters approved a constitutional amendment to prohibit students of the male sex from participating on school and college athletic teams designated for females, women, or girls.
- Washington Initiative 638: Too close to call. Voters decided a measure to prohibit male students from competing in female school sports and require students seeking to participate in female sports to provide healthcare documentation verifying their sex. As of 2:15 EST, 57% of voters approved the measure and 43% defeated it.
- Measures to prohibit certain medical or surgical procedures for transgender minors:
- Colorado Proposition 135: Too close to call. Voters decided a measure to prohibit healthcare professionals from providing surgeries to minors to alter sex characteristics in response to their perception of sex or gender, and prohibit state or federal funding for those procedures. As of 2:15 EST, 52% of voters approved the measure and 48% defeated it.
- Missouri Amendment 3: Defeated. Voters defeated a constitutional amendment to prohibit gender transition surgeries, cross-sex hormones, and puberty-blocking drugs for minors, with an exception for treatment unrelated to gender transition. The measure also sought to repeal the constitutional right to reproductive freedom approved in 2024 and prohibit abortion with limited exceptions.
How this year compares: These were the first statewide ballot measures on either issue. States first enacted sex-based school sports requirements in 2020 and bans on surgical procedures for transgender minors in 2021. Before the election, 29 states had laws, regulations, or interscholastic association rules limiting participation on female school sports teams to students of the female sex, and 27 states had passed laws prohibiting surgical procedures for transgender minors.
See Ballotpedia’s full results and analysis for measure summaries, campaign finance, endorsements, polls, legislative voting patterns, and historical context.
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