Blog

Jun 30, 2023

Judge denies request to halt Missouri’s gender

Gabrielle Hays Gabrielle Hays Leave your feedback ST. LOUIS – Missouri’s ban on gender-affirming medical care for minors is now in effect after a judge ruled against a legal challenge from civil

Gabrielle Hays Gabrielle Hays

Leave your feedback

ST. LOUIS – Missouri’s ban on gender-affirming medical care for minors is now in effect after a judge ruled against a legal challenge from civil rights advocates that sought to block it.

The new law in Missouri prohibits health care providers from prescribing or administering hormones or puberty blockers to patients under 18 unless they were already receiving these treatments prior to Aug. 28, when the policy went into effect.

Called the Missouri Save Adolescents from Experimentation (SAFE) Act, the law also prohibits any transition-related surgeries for minors. The law is set to expire in 2027, a concession made in Republican negotiations with state Senate Democrats.

READ MORE: Louisiana lawmakers overturn governor’s veto on gender-affirming care ban for minors

Gender-affirming care refers to a wide range of practices from using someone’s name and appropriate pronouns to medical treatments, such as hormone therapy and puberty blockers. Surgical interventions, another form of gender-affirming care, is much rarer and generally reserved for those 18 and older.

The ACLU of Missouri, one of the LGBTQ+ advocates who sued to overturn Missouri’s law, said that although this was not the ruling the group hoped for, this was not the end of the road.

“While we are disappointed in and disagree with the court’s ruling, we will not stop fighting to protect the rights of transgender people in Missouri. The case is not over and will go to a full trial on the merits,” said spokesperson Tom Bastian in an email.

Gender-affirming medical care is widely endorsed by major medical associations and has been studied by researchers for decades. Declining to block the ban, a judge ruled there was not sufficient evidence to justify a preliminary injunction and that the science and medical evidence that was presented was “conflicting and unclear.”

The groups challenging Missouri’s law, including Lambda Legal and Bryan Cave Leighton Paisner LLP, represent the families of three transgender youth, as well as medical providers and other organizations that support LGBTQ+ rights.

Missouri’s law prohibits MO HealthNet, the state’s Medicaid program, from covering gender-affirming care, and also restricts access to those treatments for people in prisons, jails, and correctional centers. Providers who violate SB 49 could have their licenses revoked and face legal action from patients.

“For Governor Parson, signing SB 49 was all about protecting kids, and he appreciates Attorney General Andrew Bailey’s efforts to successfully defend the law in court and keep Missouri’s children safe,” said Jonathan Shiflett, spokesperson for the governor’s office, in an email.

READ MORE: Kentucky’s ban on gender-affirming care takes effect as federal judge lifts injunction

Missouri is the latest state to pass a ban on gender-affirming medical care. More than 20 states have passed a law or policy banning that care, while seven states are considering it, according to the Human Rights Campaign.

Hours after the Missouri ruling, a judge in Texas granted an injunction to block a gender-affirming medical care ban, but the state attorney general filed an appeal that will allow the ban to go into effect Sept. 1. On the same day SB 49 went into effect, another law restricting trans athletes’ participation in sports in Missouri did as well.

About 35 percent of transgender youth aged 13 to 17 live in states with such a ban, according to Williams Institute, a research center at the UCLA School of Law that studies gender identity law and policy.

Data from a PBS NewsHour/NPR/Marist poll shows growing support for these kinds of restrictions. In a March poll, 43 percent of Americans said they support laws that criminalize providing gender-affirming care for minors, a 15-point jump from two years earlier. Yet about half of Americans, 54 percent, still oppose such laws.

Yamelsie Rodríguez, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, called the ruling a “shameful mark” on the state.

“Trans and gender-expansive young Missourians will have their rights stripped away — unless a higher court intervenes. They are terrified and furious that Missouri politicians are using ideology and junk science to deny them life-saving health care and erase their existence — and we are right alongside them,” she said. “Politicians have no business probing around or dictating what care can be provided in our exam rooms.”

State Republican officials have made multiple attempts to ban gender-affirming medical care this year.

Weeks after he took office in January, Republican Attorney General Andrew Bailey announced that several agencies would investigate allegations against the Washington University Transgender Center at St. Louis Children’s Hospital, based on claims from a whistleblower about experimental treatments and a lack of individualized assessments.

An investigation by the university later found that the allegations were unsubstantiated.

“Washington University physicians and staff at the Center follow appropriate policies and procedures and treat patients according to the currently accepted standard of care, as recommended by the American Academy of Pediatrics and other nationally recognized organizations,” the university’s report read.

In May, Bailey filed an emergency ruling setting restrictions on access to trans health care using a state consumer protection law. It was blocked by a St. Louis County Circuit judge.

At the same time, Gov. Parson was pressuring the state legislature to pass its own version of the attorney general’s ruling, threatening to call a special session. After that bill passed both chambers in the spring, Bailey withdrew his emergency ruling.

During debate in the state legislature, House members went back and forth about what the impact of the law could be. Some Republicans argued that it was time for the government “to get involved” in limiting gender-affirming medical care; Republican Rep. Brad Hudson said the care “alters children for no good reason.” Democrats pushing back on the legislation, among other state bills that target trans lives, said the measure is attacking an already vulnerable group. Rep. Joe Adams, a Democrat, said denying this care to trans children was to “deny them their very existence.”

After the judge denied the ACLU’s request for an injunction, Hudson told the NewsHour he was pleased with the decision and that it was “necessary and long overdue.”

READ MORE: Kansas must stop allowing trans people to change their driver’s licenses, judge says

A day before the law went into effect Rep. Peter Merideth, a Democrat who voted against the measure, took to X, formerly known as Twitter, with his reaction to the decision.

“Sad these guys act like banning healthcare for kids is protecting them. More baffling though when they also say they’re on the side of ‘freedom’ in the same breath. Freedom – except when they disagree with you and your doctor about what’s best for your kid,” he wrote in his post.

St. Louis Mayor Tishaura Jones called the judge’s decision “shameful.”

“We will continue to fight back against the legislature’s hateful attacks and lift up the diversity that makes St. Louis an inclusive community for all, no matter your identity,” she said in a statement.

At least 30 leading medical organizations have issued statements in support of gender-affirming medical care for trans people. That includes the American Academy of Pediatrics, which voted this month to reaffirm its policy on gender-affirming care for minors and expand guidance for pediatricians. The group’s board of directors originally passed the policy back in 2018 and noted in a release that it was renewing its support for this care in response to the growing number of restrictions across the country.

The AAP released a statement last year saying there was strong consensus among major medical associations worldwide that gender-affirming care is “medically necessary and appropriate. 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,” the group added.

The plaintiffs filed a preliminary injunction in July in the hopes of stopping the gender-affirming care ban from going into effect.

“We are frightened and outraged at Missouri’s assault on our rights as parents to seek necessary health care for our children,” the families said in the filing. “SB 49 is an attempt to interfere in our family relationships and it places the health and well-being of our children at great risk. It must be stopped.”

The petition laid out why a lack of treatment for young people experiencing could have dire repercussions, especially for those who experience gender dysphoria, which is the discomfort or distress caused when someone’s gender identity doesn’t align with their assigned sex. Not all trans people experience gender dysphoria.

“Decades of clinical experience and a large body of research have demonstrated that these treatments are safe and effective at treating gender dysphoria in adolescents, and consequently inform how this treatment is provided,” the suit read.

The FDA approved puberty blockers in 1993 for any children experiencing puberty early. The treatment has been considered safe by medical professionals in caring for trans youth as well.

A 2022 JAMA Network study found that gender-affirming medical interventions, puberty blockers included, were associated with lower rates of depression and suicidality over the course of a year.

Plaintiffs suing to stop Missouri’s law also argued that medical care for minors should be made by families based on recommendations from their providers.

In its care guidelines for trans and gender-diverse people, the World Professional Association for Transgender Health noted that such care for children requires “a multidisciplinary approach, which considers developmental stage, neurocognitive function, language skills; offers mental health support; discusses risks and benefits of social transition; and includes parental/guardian involvement.” The leading trans health association also provides guidance for training among health providers.

Elana Redfield, the Williams Institute’s federal policy director, said that people — who are trans, nonbinary and intersex — risk losing access to care, even if the courts ultimately reject the bans.

“We saw that the number of bills both introduced and passed increased exponentially over the past few years,” she said, “so one thing that we’re just looking at is what are the impacts of these laws going to be in the states where they were passed.”

This year, lawmakers in 41 states have filed more than 500 anti-LGBTQ bills, according to the Human Rights Campaign. Of those, more than 75 are now law.

READ MORE: Majority of Americans reject anti-trans bills, but support for this restriction is rising

Nearly one in three LGBTQ young people said anti-LGBTQ+ policies and legislation were detrimental to their mental health, according to the Trevor Project’s annual survey. Close to two in three LGBTQ young people also said that hearing about potential state or local laws banning people from discussing LGBTQ+ people at school worsened their mental health.

Redfield said Missouri isn’t unique in its use of executive power to pursue these kinds of restrictions.

She pointed to both Florida, where the governor pushed to prohibit Medicaid coverage for gender-affirming care, and Texas, where the attorney general and governor argued that the care was a form of child abuse that the state had an obligation to investigate.

Despite the substantial number of challenges to gender-affirming care, Redfield said the evidence strongly supports access and the benefits that come along with it.

“One thing that’s very depressing about all this policy is it’s completely separate from science and evidence,” she said. “The science and evidence doesn’t support the actions that these legislatures are taking.”

“Gender- affirming care is very well supported by science and documented to have very positive outcomes,” she said.

Left: Families and community members protest at Missouri's state capitol in March 2023. Photo courtesy of Be Lovely Photography

By Summer Ballentine, Jim Vertuno, Associated Press

By Andrew DeMillo, Lynne Sladky, Laura Bargfeld, Associated Press

By Kim Chandler, Associated Press

By Sudhin Thanawala, Associated Press

Gabrielle Hays Gabrielle Hays

Gabrielle Hays is a Communities Correspondent for the PBS NewsHour out of St. Louis.