Missouri attorney general restricts gender-affirming care for people of all ages

Missouri Republican Attorney General Andrew Bailey issued an “emergency regulation” Thursday afternoon that appears to restrict gender-affirming care for people of all ages within the state.

Bailey’s office released a statement announcing the new regulation at 12:13 p.m. on April 13. While the announcement makes repeated references to protecting minors from harm allegedly caused by gender-affirming care, the rule itself includes several requirements that patients of any age must meet before they can receive what the regulation refers to as “gender transition interventions.”

The order defines gender transition interventions as “the provision or prescription of any puberty-blocking drugs, cross-sex hormones, or surgery, for the purpose of transitioning gender, decreasing gender incongruence, or treating gender dysphoria,” and declares it “an unfair, deceptive, fraudulent, or otherwise unlawful practice” for any health care provider to provide such care unless a patient goes through a checklist of assessments and evaluations.

Specifically, it requires anyone seeking transition-related care to have a documented diagnosis of gender dysphoria for at least three consecutive years and receive a “full psychological or psychiatric assessment” consisting of at least 15 separate hour-long sessions over 18 months to explore “whether the person has any mental health comorbidities.” Any existing “mental health comorbidities” must be treated and resolved before the patient can receive gender-affirming care.

The regulation also requires patients to receive screening for autism and “social contagion with respect to the patient’s gender identity,” stipulates that patients who are minors must be screened for “social media addiction or compulsion,” and requires providers to create a procedure to “track all adverse effects” of gender-affirming care for a period of at least 15 years from the start of treatment.

Bailey cites authority for the regulation under the state’s Merchandising Practices Act of 2020, which prohibits fraud in advertising.

“As Attorney General, I will always fight to protect children because gender transition interventions are experimental,” Bailey says in his office’s statement. He adds, with no evidence to support the claim, “My office has uncovered a clandestine network of clinics across the state who are harming children by ignoring the science.”

The regulation is set to go into effect April 27, exactly two weeks after it was announced, and expire Feb. 6, 2024.

The rule will apply to patients currently receiving gender-affirming care in Missouri. It states that medical providers may continue to issue prescriptions in cases in which treatment has already begun, but only as long as the provider or patient “promptly seeks to initiate” compliance with the various requirements in the regulation.

Not all gender-affirming care is restricted by the regulation. It specifically exempts treatment for precocious puberty and of intersex people.

Asked why the regulation applies broadly to trans people of all ages seeking gender-affirming care when its stated purpose is to protect children, Madeleine Sieren, a spokesperson for the Missouri attorney general’s office, told the American Independent Foundation via email: “We have serious concerns about how children are being treated throughout the state, but we believe everyone is entitled to evidence-based medicine and adequate mental health care.”

The emergency regulation appeared likely to face swift legal challenges. Just a few hours after it was announced, the ACLU of Missouri and pro-LGBTQ legal advocacy organization Lambda Legal announced they would sue to stop it.

“The Attorney General’s so-called emergency rule is based on distorted, misleading, and debunked claims and ignores the overwhelming body of scientific and medical evidence supporting this care as well as the medical experts and doctors who work with transgender people every day,” the two groups said Thursday in a joint statement. “This rule is a shocking attempt to exploit Missouri’s consumer protection laws in order to play politics with life-saving medical care.”

Published with permission of The American Independent Foundation.