By Andrew DeMillo and Hannah Schoenbaum, Associated Press

Republican-led state legislatures are considering a new round of bills restricting medical care for transgender youths — and in some cases, adults — returning to the issue the year after a wave of high-profile bills became law and sparked lawsuits.

As legislatures begin their work for the year, lawmakers in several states have proposed enacting or strengthening restrictions on puberty-blocking drugs and hormone treatments for minors. Bills to govern the pronouns kids can use at school, which sports teams students can play on, and the bathrooms they can use are back, as well, along with efforts to restrict drag performances and some books and school curriculums.

LGBTQ+ advocates say that most of the states inclined to pass bans on gender-affirming care have done so, and that they now expect them to build on those restrictions and expand them to include adults. With legislatures in most states up for election this year, transgender youths and their families worry about again being targeted by conservatives using them as a wedge issue.

They include Mandy Wong, a mother in Santa Barbara, California, who said she’s tired of conservative politicians using transgender children as “campaign fuel.” While she doesn’t expect such a policy to pass in her Democrat-led state, Wong said, her child and his friends feel emotionally drained.

“It was just heartbreaking to tell him … I don’t think this is going away anytime soon,” she said. “All the negative attention trans kids, even us as parents, have gotten because of these proposals doesn’t seem to be dying down.”

At least 22 states have enacted bans on gender-affirming care for children, with most of them approved in the past year. Those who support the bans say they want to protect children and have concerns about the treatments themselves. Major medical groups, including the American Medical Association and the American Academy of Pediatrics, oppose the bans and have endorsed such care, saying it’s safe when administered properly.

Last year’s limits included a Florida law that has made it nearly impossible for many transgender adults in the state to receive gender-affirming care. Florida Gov. Ron DeSantis has promoted that ban as one of his accomplishments as he seeks the Republican presidential nomination.

“They’ll stop at nothing, so we don’t know what exactly to anticipate (in 2024),” said Katy Erker-Lynch, executive director of PROMO, an advocacy group in Missouri, where lawmakers have proposed more than 20 bills targeting LGBTQ+ people.

Nationwide, challenges to laws already in place are moving closer to the U.S. Supreme Court. The American Civil Liberties Union has asked the court to block restrictions on care for youths in Kentucky and Tennessee.

The full 8th U.S. Circuit Court of Appeals is also considering Arkansas’ request to reverse a ruling that struck down the state’s first-in-the-nation ban on gender-affirming care for youths.

Federal rulings against the bans so far have come from judges appointed by both Democratic and Republican presidents.

DeMillo reported from Little Rock, Arkansas, and Schoenbaum from Salt Lake City. Contributing to this report were Associated Press writers David Lieb and Summer Ballentine in Jefferson City, Missouri; Margery Beck in Omaha, Nebraska; Sean Murphy in Oklahoma City; and Sophie Austin in Sacramento, California.