Missouri’s Attorney General Andrew Bailey recently announced new restrictions on gender-affirming care for transgender individuals, making it the first state to do so. The move, which applies to both adults and minors, has sparked backlash from advocacy groups who have threatened legal action. The rule requires a mandatory 18 months of therapy before receiving gender-affirming healthcare, and will come into effect on April 27, expiring next February.
Bailey’s order is in response to allegations of mistreatment at a transgender youth clinic in St. Louis run by Washington University, which is currently being investigated by the Attorney General’s office. Critics of the rule claim it is based on debunked claims and ignores the overwhelming body of scientific and medical evidence supporting gender-affirming care.
The ACLU and Lambda Legal have released a joint statement condemning the rule and urging those affected to call them. LGBT rights groups have also expressed their concerns, stating that the order is essentially attacking the entire trans community. Robert Fischer, a spokesperson for PROMO, an LGBT rights group, stated that he was not aware of similar restrictions elsewhere.
Moving forward, healthcare providers who offer gender-affirming health care will need to provide patients with a lengthy list of potential negative side effects and warnings against treatments. Physicians must also screen patients for social media addiction, autism, and signs of “social contagion with respect to the patient’s gender identity.” Health care providers will need to ensure that any psychiatric symptoms from existing mental health comorbidities of the patient have been treated and resolved before providing gender-affirming treatments under the new rule.
The new restrictions have been criticized by the National Center for Transgender Equality, which called the order “deeply wrong” and added that “trans people of all ages across the state of Missouri deserve access to health care.” At least 13 other states have enacted laws restricting or banning gender-affirming care for minors. Bills are awaiting action from governors in three other states. Federal judges have blocked enforcement of laws in two states, and nearly two dozen states are considering bills this year to restrict or ban care.
The debate over gender-affirming care has become increasingly polarized. Missouri’s Republican-led House recently voted to ban access to transgender-related health care for minors. The House proposal is stricter than what was passed by the GOP-led Senate, where Democrats have more influence through the use of stall tactics. Senators compromised to exempt care for minors whose treatment is already underway. The Senate bill also would expire after four years, whereas the House version includes no exceptions for current treatments and would remain in effect indefinitely.
The Human Rights Campaign has condemned the legislation, describing gender-affirming care as medically necessary. Meanwhile, some Democrats have criticized the ban on healthcare, stating that it will hurt transgender children. Despite the intense debate, Republican Senate leaders have stated that it is unlikely that the House version will make it through the Senate.