Massachusetts legalised homosexual activity through a court ruling in 1974, although dormant sodomy laws still exist in its state laws.

Until 2004, there was no legal recognition provided to same-sex couples in Massachussetts. However, there was also never a ban on marriage.

Massachusetts requires a notarized statement proving that “the person has completed medical intervention, appropriate for that individual, for the purpose of permanent sex reassignment and is not of the sex recorded on the record. (Cited from NTCE)" All other documents are able to get apply freely and no other documentation is required. Minors under 18 will have to get parents approval.

In 2006, Massachusetts required proof of surgery for legal gender recognition.

Minors must get consent from both parents/guardian figures to get gender affirming care. Adults are able to get insurance under MassHealth for gender affirming care. Insurance explicitly states that anyone over 18 qualifies for their gender affirming care coverage.

Before 2019, Massachusetts did not legally recognize a third gender.

From July 6, 2025 onward, Coast Guard Reserve and Regular Coast Guard service members who were eligible for voluntary separation but did not elect or complete it, and who either have a current diagnosis or history of, or exhibit symptoms consistent with, gender dysphoria and do not receive a waiver, or have a history of cross-sex hormone therapy or sex reassignment or genital reconstruction surgery in connection with a sex transition, are placed into the involuntary administrative separation process.

From June 7, 2025 onward, Active Guard Reserve, Marine Corps Active Reserve, Regular Air Force, Regular Army, Regular Marine Corps, and Regular Space Force service members who were eligible for voluntary separation but did not elect or complete it, and who either have a current diagnosis or history of, or exhibit symptoms consistent with, gender dysphoria and do not receive a waiver, or have a history of cross-sex hormone therapy or sex reassignment or genital reconstruction surgery in connection with a sex transition, are placed into the involuntary administrative separation process.

On May 8, 2025, the United States Department of Defense (USDoD) began initiating administrative separation proceedings for service members who had already identified themselves for voluntary separation before March 26, 2025. On the same date, it reinstated the ban on transgender enlistment by directing that applicants who have a current diagnosis or history of, or exhibit symptoms consistent with, gender dysphoria and do not receive a waiver, or who have a history of cross-sex hormone therapy or sex reassignment or genital reconstruction surgery in connection with a sex transition, are denied entry into military service.

On May 9, 2025, the USDoD ended all surgical procedures related to sex reassignment for service members with gender dysphoria. All such procedures—whether planned, scheduled, or not yet scheduled—were canceled, and any previously approved SHCP waivers for these surgeries were revoked. New waiver requests are no longer processed, except in cases involving the necessary treatment of surgical complications, which require special review.

Service members aged 19 or older who were already receiving cross-sex hormone therapy prior to this memorandum may continue treatment temporarily if a provider deems it necessary to prevent harm, but only until their separation is completed. Moving forward, USDoD funding cannot be used to initiate any new hormone therapy treatments for gender dysphoria, though military department leaders may request case-by-case exceptions for non-surgical care if needed to protect a service member’s health, subject to review and approval.

Also on May 9, 2025, the USDoD directed military educational institution libraries to use a standardized set of subject-heading searches to identify post-2010 books potentially associated with “gender ideology,” transgender-related topics, and other targeted concepts, sequester those materials from normal access by May 21, 2025, and hold them for expert review and possible later disposition.

On May 15, 2025, the United States Coast Guard resumed implementation of its transgender service policy by immediately pausing new accessions for individuals with a history of gender dysphoria and pausing planned, scheduled, or unscheduled medical procedures related to gender transition.

By May 21, 2025, the US Naval Academy had returned all but about 20 of the 381 books removed on March 31–April 1, 2025, to its shelves, while US Air Force libraries, including the US Air Force Academy, had also pulled a few dozen books for review.

On June 5, 2025, the U.S. Coast Guard formally made members and applicants with gender dysphoria who did not receive a waiver ineligible for service and subject to separation or disqualification, while allowing temporary continuation of some preexisting hormone therapy until separation.

On June 6, 2025, US Coast Guard restored the Civil Rights Awards Program after completing a review and updating the Civil Rights Manual.

On 20 September 20, 2011, the repeal of the Policy concerning homosexuality in the armed forces, commonly known as “Don’t Ask, Don’t Tell” (DADT), took effect, ending the statutorily bar on open service and restoring open enlistment for lesbian, gay, and bisexual people in the United States (US) Armed Forces.

After DADT ended on 20 September 2011, former service members who had received less-than-honorable discharges solely because of DADT or earlier homosexuality policies could normally seek correction to an honorable discharge, a neutral narrative reason, and a favorable reentry code, so long as their records contained no misconduct or other aggravating factors.

Starting on 6 March 2015, the US armed services began limiting routine transgender-related discharges by elevating separation authority: in the Army, to the Assistant Secretary of the Army for Manpower and Reserve Affairs; effective 5 June 2015 in the Air Force, to the Secretary of the Air Force Personnel Council for recommendation and the Director of the Air Force Review Boards Agency for decision; and, effective 1 July 2015, in the Navy and Marine Corps, to the Assistant Secretary of the Navy for Manpower and Reserve Affairs.

On 9 June 2015, the US Department of Defense (DoD) added sexual orientation to its Military Equal Opportunity policy. On 13 July 2015, the US DoD effectively paused routine transgender-related administrative discharges by requiring all such separation decisions to be personally decided by Acting Under Secretary of Defense for Personnel and Readiness Brad Carson.

From 15 July 2011 to 20 September 2011, the United States (US) Court of Appeals for the Ninth Circuit’s partial stay allowed the military to refuse new openly lesbian, gay, and bisexual recruits, but it continued to block investigations, discharge proceedings, and discharges under the Policy concerning homosexuality in the armed forces, commonly known as Don't Ask, Don't Tell (DADT), against current servicemembers. On 22 July 2011, US President Barack Obama, US Secretary of Defense Leon Panetta, and Chairman of the Joint Chiefs of Staff Admiral Mike Mullen certified that repeal could be implemented, triggering the final 60-day waiting period.

From 6 July 2011 to 15 July 2011, the United States (US) Court of Appeals for the Ninth Circuit’s order again barred enforcement of the Policy concerning homosexuality in the armed forces, commonly known as Don't Ask, Don't Tell (DADT), against both serving personnel and new applicants, but on 15 July 2011 the court partially stayed the injunction to let the military refuse new openly lesbian, gay, and bisexual recruits while still blocking DADT investigations, discharge proceedings, and discharges against current servicemembers.

On 20 October 2010, the United States (US) Court of Appeals for the Ninth Circuit temporarily stayed the injunction, making the Policy concerning homosexuality in the armed forces, commonly known as Don't Ask, Don't Tell (DADT), enforceable again. On 21 October 2010, the US Department of Defense changed its discharge-approval process, requiring DADT separation cases to receive higher-level civilian review before a discharge could be finalized. On 1 November 2010, the court replaced the temporary stay with a stay pending appeal, allowing enforcement to continue while the case proceeded. Although US President Barack Obama signed the Don’t Ask, Don’t Tell Repeal Act on 22 December 2010, repeal was not immediate, and DADT remained legally enforceable until certification and final implementation. During this renewed-enforcement period, at least four confirmed DADT discharges occurred. On 6 July 2011, the Ninth Circuit lifted the stay and ordered the government to stop enforcing DADT again, and the Department of Defense said it would comply.

On 12 October 2010, the United States (US) District Court for the Central District of California, in Log Cabin Republicans v. United States, issued a worldwide injunction barring enforcement of the Policy concerning homosexuality in the armed forces, commonly known as Don't Ask, Don't Tell (DADT), ordering the US Department of Defense (DoD) to suspend investigations, discharges, separations, and other proceedings under the law. In response, DoD issued 15 October 2010 guidance allowing openly gay men and lesbian women to apply to join the military, while warning applicants that the legal situation could change if the injunction were stayed or reversed.

On 28 February 1994, the Policy concerning homosexuality in the armed forces—commonly known as Don't Ask, Don't Tell (DADT)—took effect, allowing gay, lesbian, and bisexual people to serve only if they remained closeted, did not disclose their sexual orientation, did not engage in, attempt to engage in, or solicit another person to engage in prohibited same-sex sexual conduct—except under a narrow exception for conduct found to be a departure from the member’s usual behavior and unlikely to recur—and did not enter, attempt to enter, or claim to be in a same-sex marriage or any similar same-sex union.

Transgender people were excluded separately under United States Department of Defense (DoD)-wide and DoD branch-specific medical and administrative policies rather than under DADT itself.

From May 19, 1941 until September 20, 2011, LGB people were banned from enlistment and service in the United States Army, US Coast Guard, US Marine Corps, and US Navy, and, beginning September 18, 1947, in the Air Force. From October 1, 1982, to September 19, 2011, when homosexuality was the sole basis for separation and no aggravating circumstances were present, the characterization of service was determined by the member’s overall record and could be Honorable or General (under honorable conditions), with entry-level cases receiving an uncharacterized separation.

By May 17, 1963, in the United States Army; by 1982, in the United States Air Force; from March 31, 1986, on a U.S. Department of Defense-wide accession basis covering the United States Army, United States Navy, United States Marine Corps, and, by agreement, the United States Coast Guard; by August 12, 2005, in the United States Navy and United States Marine Corps; and by April 29, 2011, in the United States Coast Guard, transgender people were banned from enlistment and service until open service was authorized on June 30, 2016.

By February 22, 1956, in the United States Coast Guard; by February 10, 1961, in the United States Army; by January 11, 1962, in an Air Force-specific accession standard; from March 31, 1986, on a Department of Defense-wide accession basis covering the Army, Navy, Marine Corps, Air Force, and, by agreement, the Coast Guard; and, from December 20, 2019, in the United States Space Force through inherited Air Force and DoD standards, applicants with intersex-related conditions identified in military rules as “hermaphroditism,” and later as “hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis,” were disqualified from accession under military medical standards.

The FDA announced changes to the blood donor eligibility policy in April 2020, reducing the MSM deferral period from 12 months to 3 months. The change came amid the beginning of the COVID-19 pandemic, where blood was needed urgently.

After a series of recommendations, the FDA has moved to a 12 months deferral.

Starting in 1983, the United States implemented a full ban on blood donations from gay men. The primary justification for the ban was the perceived high risk of HIV transmission, with health regulators identifying men who have sex with men (MSM) as a significant risk to the safety of the blood supply.

Conversion Therapy is currently legal. No law currently bans it, despite organizations such as the American Psychological Association denouncing it.