Missouri is sued over ban on gender-affirming care for minors

A group of parents, LGBTQ+ civil rights organizations and health care providers are suing the state of Missouri over its ban on gender-affirming care for minors.

The plaintiffs argue the law, scheduled to go into effect Aug. 28, is cruel and unconstitutional and that it will cause irreparable harm to trans minors in Missouri should it be allowed to stand.

“The Act was passed over the objection of medical professionals who testified in opposition, and the pleas of families who, like the Family Plaintiffs, stood to lose access to essential and often lifesaving medical care,” the lawsuit says. “So insistent were Missouri’s legislative and executive branches on rolling back transgender rights that, in the midst of a quibble between Missouri’s House and Senate chambers over exactly how far the Act should go, Governor [Michael] Parson threatened to call a special legislative session if the two chambers did not resolve their dispute and send him a bill.”

S.B. 49 bans health care providers in the state from prescribing puberty blockers or hormone treatments — which it calls “cross-sex hormones” — to anyone under the age of 18 if they are intended to be used in gender transition. It provides an exception for minors who are intersex or have what the bill calls “medically verifiable disorders of sex development.” The law also allows minors who were receiving treatment before its effective date to continue doing so.

The plaintiffs in the lawsuit, which was filed July 25 in the Circuit Court of Cole County, Missouri, are the families of three transgender Missourians; St. Louis-based Southampton Community Healthcare and two of its providers; and LGBTQ+ ally group PFLAG and LGBTQ+ health provider group GLMA: Health Professionals Advancing LGBTQ Equality. The lawsuit was filed by LGBTQ-focused legal group Lambda Legal, the ACLU of Missouri, and the law firm Bryan Cave Leighton Paisner LLP.

“SB 49 is the latest chapter in Missouri’s relentless attacks on transgender people, and the stories of the families challenging the law demonstrate the immense, devastating harm it is already inflicting on their lives,” Nora Huppert, a staff attorney at Lambda Legal, said in the group’s joint press release with the ACLU of Missouri. “SB 49 would deny adolescent transgender Missourians access to evidence-based treatment supported by the overwhelming medical consensus. This law is not just harmful and cruel; it is life-threatening.” 

Called the Missouri Save Adolescents From Experimentation (SAFE) Act, the law also bars the state’s Medicaid program, as well as prisons, jails and correctional centers, from covering or providing transition surgeries, hormone treatments or puberty-blocking drugs.

Despite the law’s reference to experimentation, gender-affirming care is widely seen as medically necessary for youth living with gender dysphoria. Without such care, adolescents with gender dysphoria can experience anxiety, depression and suicidal thoughts.

“There is strong consensus among the most prominent medical organizations worldwide that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate,” Moira Szilagyi, the 2022 president of the American Society of Pediatrics, wrote last year. “It can even be lifesaving. The decision of whether and when to start gender-affirming treatment, which does not necessarily lead to hormone therapy or surgery, is personal and involves careful consideration by each patient and their family.”

In the joint statement with Lambda Legal, a representative of the ACLU of Missouri called S.B. 49 a clear example of the state’s intention to discriminate against trans individuals and unnecessarily intrude on private medical decisions.

“On its face, the law enshrines discriminatory practices in our health care system by specifically denying transgender Missourians under the age of eighteen access to evidence-based gender-affirming medical care while stripping parents of their fundamental right to make medical decisions for their children,” said Gillian Wilcox, deputy director of litigation at the ACLU of Missouri.

The fight over gender-affirming care in Missouri has been brewing for months. In April, state Attorney General Andrew Bailey filed an emergency rule restricting access to such care for all trans Missourians, including adults. Bailey eventually rescinded his rule after a judge blocked it, and shortly afterwards the Legislature passed S.B. 49. Parson signed it into law on June 7.

Missouri is the latest state to be sued over a ban on gender-affirming care for minors. Lambda Legal and the ACLU of Kentucky are currently battling to block that state’s law, which is already in effect. The U.S. Sixth Circuit Court of Appeals allowed Tennessee’s ban on gender-affirming care to go into effect before it renders a final decision on both Tennessee’s and Kentucky’s laws by Sept. 30. Meanwhile, district judges in Arkansas and Indiana have blocked those state’s bans on gender-affirming care pending appeals.

Published with permission of The American Independent Foundation.