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 which pronouns kids can use at school, which sports teams students can play on, and which bathroom 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.