Missouri Judge Cites Outdated Studies to Uphold Gender-Affirming Care Ban

A Missouri judge has upheld a ban on gender-affirming care for transgender youth and some adults in the state, citing outdated studies and the errant belief that the science behind such care is “unsettled.”

Circuit Court Judge Craig Carter issued his ruling on Monday, siding with state Republican lawmakers who passed the ban into law in 2023. The deceptively titled Save Adolescents From Experimentation (SAFE) Act forbids doctors and other medical professionals from providing hormone therapy, puberty blockers and surgical options to anyone under the age of 18. It also bans state funds, such as the Missouri Medicaid program, from providing gender-affirming care to adults.

Within his order, Carter complained about having to perform the functions of his job, claiming that he had too much information from opposing sides to make a formal decision.

“The court reporter’s transcript in this case is several thousand pages. … Attorneys provided the Court with so many binders of evidentiary documents that were piled so high on the bench that the Court’s vision was at times obscured,” Carter wrote in his order, stating that courts like his are “not equipped to choose” between opposing medical viewpoints.

“That is a job for the legislature,” Carter insisted.

Contrary to Carter’s claim that the science behind youth-based gender-affirming care is “entirely unsettled,” gender-affirming care — for both adults and youth — is safe and effective. Such treatments are approved by the vast majority of health organizations, and are recognized by many experts as potentially life-saving.

Notably, Carter’s ruling cited outdated (and debunked) research from the Endocrine Society, which wrongly stated that most children who identify as transgender change their minds later in life. (The Endocrine Society has since changed its position, and while it has a more conservative approach than other organizations, now endorses gender-affirming care options for transgender youth.)

In fact, multiple studies have found that children who identify as transgender or nonbinary very rarely “revert” to the gender they were assigned at birth as adults, with one study finding that regret over receiving gender-affirming care occurred in fewer than 1 percent of all cases.

In citing the outdated studies, Carter bogusly asserted that a doctor providing gender-affirming care to a transgender child is equivalent to a doctor prescribing a child hazardous drugs.

“Any person — including a minor — would be able to obtain anything from meth, to ecstasy to abortion so long as a single medical professional were willing to recommend it,” Carter said, falsely insinuating that the studies showing the benefits of gender-affirming care were not to be trusted.

Missouri Republican lawmakers, including state Attorney General Andrew Bailey, hailed the ruling, falsely claiming that gender-affirming care for trans youth is a form of “mutilation.”

In reality, the vast majority of treatments for youth center around therapy. Occasionally, a youth receiving gender-affirming care is also prescribed puberty blockers, or in some instances, hormone treatment, both of which are safe when used under the advisement of health care providers. Only in extremely rare cases is surgery presented as an option, and never for younger patients. Indeed, one study found that surgical options related to gender-affirming care accounted for just 0.0021 percent of treatment plans for transgender teens across the U.S.

In response to Carter’s ruling, Lambda Legal and the ACLU of Missouri — which is representing health care providers and families suing the state to block the law — said that an appeal was imminent.

“We are extremely disappointed in this decision, but this is not the end of the fight and we will appeal,” the joint statement said.

The organizations added:

The court’s findings signal a troubling acceptance of discrimination, ignore an extensive trial record and the voices of transgender Missourians and those who care for them, and deny transgender adolescents and Medicaid beneficiaries from their right to access to evidence-based, effective, and often life-saving medical care.

“This ruling sends a chilling message that, for some, compassion and equal access to health care are still out of reach,” the joint statement concluded.