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MO AG Wants 18-Month Waiting Period for Trans Kids Seeking Gender-Affirming Care

Medical experts agree that gender-affirming care is safe, effective and life-saving.

Missouri Attorney General Andrew Bailey (R) announced on Monday that his office would be filing harsh new restrictions on gender-affirming care for transgender kids and teens in the state.

The restrictions, which as of Wednesday morning have not yet been formally adopted, directly contradict guidance from medical experts and health care organizations, including the American Academy of Pediatrics. Experts widely agree that gender-affirming care is highly beneficial for trans children.

Bailey’s announcement of the restrictions was riddled with anti-trans falsehoods. In his statement, he referred to gender-affirming treatment as “inhumane science experiments” — ignoring data that suggests that gender-affirming care for trans youth can often be lifesaving.

According to the World Health Organization, gender-affirming care is treatment that is “designed to support and affirm an individual’s gender identity” when it comes into conflict with the gender they were assigned at birth. Such treatment can involve surgery, medication like hormones, or therapeutic options, like speaking to a psychologist or dressing in a way that expresses a person’s gender identity.

For transgender children, gender-affirming care is mainly relegated to therapeutic options. On some occasions, providers may prescribe medication — in most instances, puberty blockers, which doctors say are both safe and completely reversible. In extremely rare circumstances, older adolescents may undergo surgery, though such options are generally reserved for those 18 or older.

The new regulations would limit all types of care for transgender kids, implementing an 18-month waiting period before any child or teen could receive gender-affirming treatment. During that time, trans and nonbinary youth would have to attend 15 separate hour-long therapy sessions, and receive treatment for any “mental health comorbidities” before physicians could recommend gender-affirming care. If mental health issues are discovered, gender-affirming treatment would be delayed until the issues are “treated and resolved.”

The attorney general would require autism screenings for those seeking gender-affirming care, and would subject trans youth to annual screenings for “social contagion with respect to the patient’s gender identity” — suggesting that Bailey believes that kids seeking such care are only doing so because of their peers.

“Bailey’s lack of medical expertise shows,” Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri, said to The St. Louis Post-Dispatch. “Scientific evidence shows — and the medical community agrees — that gender-affirming care is safe, effective and life-saving.”

PROMO, an LGBTQ advocacy organization in Missouri, condemned Bailey’s planned action, stating:

It is clear [Bailey’s] office does not respect the professional guidelines of every major medical association in our country, who agrees gender-affirming healthcare is the standard of care for transgender Missourians, and instead is abusing his political power by asserting his beliefs by stating access to lifesaving healthcare is part of a “woke, leftist agenda.”

Bailey’s proposal is a “gross and reprehensible action that puts the health, wellness, and very lives of transgender and gender-expansive youth at risk,” the group added.

Parents of transgender and nonbinary kids in the state expressed dismay at Bailey’s action.

“It’s absolutely horrifying that the attorney general would think he is better informed than medical professionals and parents who absolutely have the best interest of their children in mind,” Jennifer Goldring, the mother of a 16-year-old who is receiving gender-affirming care, told The St. Louis Post-Dispatch. “I’m terrified of what this means for my child and his mental health if he cannot get the gender-affirming care he needs.”

“A lawyer is now engaging in the direct regulation of private medical decisions of Missouri families,” Harvard Law clinical instructor Alejandra Caraballo wrote on Twitter. “This is an unconstitutional overreach.”

It’s likely that parents and LGBTQ organizations will sue the attorney general to block the measures once they are made official.

Health experts have long noted that the denial of gender-affirming care can result in negative consequences for transgender youth, as such care is incredibly beneficial for those who receive it.

In a study that was published in Pediatrics in 2020, gender-affirming care — and specifically, the use of puberty blockers — was directly associated with lowering the odds of lifetime suicidal ideation when trans teens became adults. Another study from the Williams Institute found that trans teens attempt suicide at significantly lower rates when they undergo gender-affirming care, or even when such care is simply available as an option. And a study published in February 2022 found that trans or nonbinary youth who receive gender-affirming treatment between the ages of 13 to 20 are 60 percent less likely to experience moderate or severe depression than those who do not.

“It is clear that these proposed laws have a drastically negative impact on TGNB youth and their families, compounding the prejudice, discrimination, violence, and other forms of stigma they continue to face in their daily lives … Tragically, many families are having to flee their home states to maintain appropriate medical care,” an analysis of anti-trans legislation from Columbia University’s Department of Psychiatry noted last year. “This is simply unacceptable: vulnerable [transgender and nonbinary] children and adolescents must continue to have access to affirming and evidence-based transgender health care, regardless of where they live.”

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