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Rules Limiting Gender-Affirming Care in Missouri Abruptly Removed by State AG

Observers said the removal of the rules was because the state attorney general knew he couldn't defeat legal challenges.

A person waves a trans flag in the sky during an outdoor protest on July 4, 2020, in Madrid, Spain.

On Tuesday, an emergency rule that sought to ban almost all gender-affirming care in the state of Missouri (for both children and adults) was abruptly removed from a state website, signaling it was no longer applicable.

State Attorney General Andrew Bailey’s office confirmed to St. Louis Public Radio later in the day that the rule was eliminated.

In a subsequent statement, Bailey claimed that the rule was only necessary to fill in “the gap” in time between now and when another state law banning gender-affirming care for transgender children would be enacted. “The General Assembly has now filled that gap with a statute,” he said.

But the rule and that bill, which has not yet become state law, are not congruent with one another, as Bailey’s rule had placed blanket restrictions on gender-affirming care at all ages, while the bill passed by the state legislature focuses on transgender minors and only some adults (those that receive Medicaid benefits).

The more likely explanation, observers opined, was that Bailey recognized that he couldn’t win against legal challenges to his rule. Bailey had used a power within his role as attorney general, typically used to regulate consumer protections, to impose his restrictions on gender-affirming care, a move many considered to be blatantly unconstitutional.

“It appears they do not feel confident they can defend this ban in court. As a result, the rule will not go into effect,” noted Erin Reed, a journalist who tracks anti-trans state legislation and actions across the U.S.

“It isn’t surprising he withdrew his unconstitutional rule knowing another embarrassing court defeat was inevitable,” Missouri state House Minority Leader Rep. Crystal Quade (D) said in response to the action on Tuesday.

The rule would have required transgender individuals from all age groups to jump through an additional series of hoops before being treated. It would have mandated patients seeking gender-affirming care to document three years of medically diagnosed gender dysphoria, in spite of the fact that dysphoria isn’t an experience shared by all trans people and that doctors recommend against imposing such regulations. It would have also forced trans people to endure an additional 18 months of therapy before they could receive gender-affirming treatments.

The rule also imposed limits on providers, requiring them to provide errant information on the supposed harms of gender-affirming care. Providers would also have to screen patients for autism and determine whether they were influenced by “social contagion” under Bailey’s now-scrapped rules, a requirement that wrongly suggests that most transgender people seeking care are merely hopping on a trend rather than legitimately seeking necessary and beneficial treatment.

A judge had placed a hold on the emergency rule, which was initially issued by Bailey last month, while consideration over its legality was being considered.

While the move to scrap the rule is seen as a victory against unnecessary and burdensome restrictions on trans people in general, the state is still moving toward a more restrictive stance, with the legislature passing a bill last week that will continue to ban all gender-affirming care for trans minors.

That bill, which is expected to be signed into law by Gov. Mike Parson (R), forbids the prescribing of puberty blockers and hormones, and also bars surgery as an option for treatment, which is only used rarely and in extreme cases, generally for older transgender teens and only after careful consideration of other options by their doctors. The bill also does target some transgender adults in the state, by barring the use of Medicaid funds for gender-affirming treatments.

The passage of legislation targeting transgender Missourians is “devastating” for them and their families, Shira Berkowitz, senior public policy director for PROMO, a Missouri-based LGBTQ rights organization, said in a video statement last week. “However, we have not lost our fight yet,” Berkowitz added, encouraging activists to message the governor’s office directly with appeals for Parsons to reconsider signing the bill into law.

Gender-affirming care for children, which is being restricted in a number of other states controlled by Republican lawmakers, is deemed by nearly every credible medical organization as not only beneficial but also life-saving treatment. The American Academy of Pediatrics (AAP), for example, outlined recommendations for such care for transgender minors in 2018.

In the fall of 2022, AAP also responded to a small group of detractors within the organization, reaffirming that gender-affirming care is safe and immensely helpful.

“There is strong consensus among the most prominent medical organizations worldwide that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate,” the organization’s president Moira Szilagyi said in a blog post last year.

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