I think it is past time to start seriously pushing for constitutional amendment based protection, that way we can put a nail in any further attempts, a real push will show that we wont stand for this shit even if it doesn't get ratified, it will be automatic, yes there is the constant debate "how do you legally define gender identity, especially as some people would be harder for paperwork than an M or and F, there may need to at least be an O(or N) for other, for gender fluid or other non-binary, but an overarching constitutional protection against discrimination on the basis of sexual orientation and gender identity will help, of course every state has their own laws about changing the letter on the birth certificate, and because this would give therapists a degree of legal power they don't have in every state, this means that all of them in the field may have to gain additional law qualifications even if its in one specific aspect of the law, and their state already gave them the right to back a legal gender change, if only to add a barrier to entry to the field, likely in the form of a very specific additional certification, that would have been considered covered before. Yes there are benefits to this, such as the opportunity to reinforce certain ethical codes, such as those that should block abuses to change sexual orientation and gender identity, but from a pragmatic side, it will make everything cost more at the least, simply because it will mean an additional cert to qualify for and a periodic renewal of said certification, all of which costs money, and it has to come from somewhere, then more than likely, because each state will want to have its own definition of what the certification entails (which means its own cert with recognizing the certs from other states for a period after someone has moved, so they can re-certify) the states will have to arrange the colleges to provide the "educational material" and the exams, which costs money and depending on the political views of the state and the schools, the cost and availability of the certification will vary, as will "processing time". It is inevitable even when the Deplorable One and his cabinet is removed and his actions reversed, that every step will be a battle and by the end, at least until the political climate settles down on the issue, which will take decades, that some things may actually become harder then they are now, we have seen this in every major civil rights movement, and those ones didn't have any real medical angles to go by, with the possible exception of women in the military the medical excuse may have been used there too, LGBTQ+ does, and that means more opportunity for political assholes to interfere and generally make life difficult.