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“Nakedly Unconstitutional”: Missouri AG Limits Trans Health Care for All Ages

Trans advocates say the rule essentially functions as a ban that makes it impossible to receive gender-affirming care.

The Missouri Capitol Building is pictured in Jefferson City, Missouri.

In a move on Thursday that appears to be the first of its kind, conservative Missouri Attorney General Andrew Bailey issued a sweeping set of regulations on gender-affirming care for both children and adults, implementing restrictions that trans advocates say will almost certainly lead to the death of trans people across the state.

The emergency rule, chock-full of disinformation about trans health care, will essentially make obtaining gender-affirming care impossible, many trans advocates say.

The rule prohibits people from being able to access gender-affirming care without jumping through hoops, and deems it “an unfair, deceptive, fraudulent, or otherwise unlawful practice” for a provider to give care to a person before they have met a series of burdensome conditions, despite the fact that gender-affirming care can often be lifesaving.

Under the rule, trans people will be forced to document feelings of gender dysphoria for at least three years and go through a mandatory 18 months of therapy before receiving treatment — even though gender dysphoria is not a universal experience of trans people, and medical experts have long advocated against forcing trans people to obtain the diagnosis.

The rule will also force providers to give people seeking gender-affirming care documents warning against receiving the treatment. And, playing into dangerous misconceptions about trans people, the rule makes health care providers screen trans patients for social media addiction and autism to determine if they have been influenced by “social contagion” — heinously suggesting that trans people are merely hopping on a trend, rather than seeking to affirm their identities and, for many, bring an end to psychological torment.

The rule is slated to go into effect on April 27 and will be effective until next February. The American Civil Liberties Union (ACLU) of Missouri and Lambda Legal have pledged to sue to block the regulation.

“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 organizations said 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.”

According to The Associated Press, the regulation appears to be the most extreme in the country in restricting care not just for children, but for all ages.

Trans advocates have said that the move represents an escalation in the right’s all-out war on trans people.

In attempting to justify the restrictions, “Bailey’s rule cites debunked studies on social contagion, fearmongers about autism without attempting to justify the concern, and makes it effectively impossible for adults to transition,” said Ari Drennen, LGBTQ program director for Media Matters for America. “Everyone should worry about this nakedly unconstitutional escalation.”

Trans activist and journalist Erin Reed pointed out that prominent anti-trans figures were already criticizing the rule for not going far enough. “In response to Missouri AG’s move to ban gender affirming care for trans adults, Matt Walsh states, ‘You shouldn’t be allowed to change your gender at all,’” Reed wrote. “They have moved into the next step on transgender elimination. This is a new phase in their war against trans people.”

On the same day as Bailey’s rule, Republicans in the Missouri House voted to ban access to gender-affirming care for minors. The bill, unlike the Republican-controlled Senate’s version of the bill, provides no exceptions for children already undergoing gender-affirming treatment.

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