Missouri attorney general issues order restricting gender-affirming care for trans youth

Missouri Attorney General Andrew Bailey (R) has issued an emergency regulation that uses a consumer protection law to require minors to undergo years of mental health assessment before they can access gender-affirming care.

Bailey’s order cherry-picks international research and reports to conclude that medical organizations have been “far too quick to recommend” gender-affirming care methods like reversible puberty blockers and hormone-replacement therapy.

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Minnesota will soon become “sanctuary state” for people fleeing trans healthcare bans

“Families who have fled are already here, and many more are planning to come,” the state’s only out trans lawmaker said.

His order calls it “unfair, deceptive, fraudulent, or otherwise unlawful” and harmful for medical providers to provide such”experimental” and “life-altering” care methods that “lack of reliable scientific evidence concerning [their] efficacy and the safety” without first assessing if minors have other mental health issues that can be mistaken for gender dysphoria; conditions like depression, social media addiction, autism, Bailey says.

As such, his order would require healthcare providers to show that minors have a “medically documented, long-lasting, persistent and intense pattern of gender dysphoria” for “at least the three most recent consecutive years” before they can undergo gender-affirming care. Minors would have to have “a full psychological or psychiatric assessment” over a minimum of 18 months, including at least 15 hours worth of therapy, The Missouri Independent reported.

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Contrary to the claims in Bailey’s order, the effects of puberty blockers are reversible and such treatments are considered safe and essential to the well-being of trans youth by the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, and other major U.S. and world health organizations.

His order would additionally require minor patients and their guardians undergoing gender-affirming care to sign an informed consent form for gender-affirming care once every three months until age 15, at which point they must sign such a form every two years. It would also require minor patients to be annually tested for gender dysphoria, something which Bailey’s order claims based on dubious science typically resolves itself without medical intervention.

All these requirements before accessing gender-affirming care could put such care out of reach from minors whose families cannot afford extensive therapy and who may need gender-affirming care to prevent suicidality or acute gender dysphoria caused by puberty’s physical and permanent changes.

Shira Berkowitz, senior director of public policy and advocacy for LGBTQ+ advocacy organization PROMO, said Bailey’s office is “stating that they know better than not only all of the major medical professional associations, but also all practitioners following these guidelines and caring for patients,” the Independent reported.

Lambda Legal and the American Civil Liberties Union of Missouri have criticized Bailey’s order, which is supposed to go into effect on April 27. Tony Rothert, director of integrated advocacy for the ACLU of Missouri, said that Bailey’s order goes far beyond consumer fraud protection and goes against traditional legal oversight of medical practice by “trying to fit [all patients] into one box.”

“These doctors are already doing exactly what they’re supposed to be doing and what every standard of care of every medical association in our country tells them to do. That is what they are doing,” Missouri House Minority Leader Crystal Quade (D) said. “It’s really fascinating that our attorney general thinks he is a lawmaker and that he can tell doctors how better to do their jobs.”

Bailey’s order was released as the state legislature is considering a ban on gender-affirming care for minors under the age of 18. The ban may require youth who are undergoing gender-affirming care to de-transition if it becomes law.

Bailey’s office is also investigating the Washington University Transgender Center at St. Louis Children’s Hospital, which provides gender-affirming care to youth for allegedly “not addressing patients’ mental health conditions… and not getting informed consent of patients and their parents” prior to treatment.

Planned Parenthood filed a lawsuit against Bailey’s investigation, calling it “politically motivated.”