CLAYTON, Mo. — A Missouri judge on Wednesday temporarily halted enforcement of a first-of-its-kind rule restricting access to gender-affirming health care for transgender children and adults, just hours before it would go into effect.
The rule instituted by Republican Attorney General Andrew Bailey sets requirements for both minors and adults before they are allowed to receive gender-affirming treatments, such as puberty blockers or hormones. It was scheduled to take effect Thursday, but Missouri transgender people and health care providers sued to prevent it from being enforced.
St. Louis County Circuit Judge Ellen Ribaudo said Wednesday that she would like more time to review the matter before deciding whether to issue a temporary restraining order. She delayed implementation of the rule until 5 pm Monday and said she anticipates ruling before then.
Bailey has touted the rule as a way to protect minors from what he describes as experimental medical treatments, even though puberty blockers and sex hormones have been prescribed for decades. But the lawsuit claims Bailey circumvented the GOP-led Legislature and acted beyond its authority by attempting to regulate gender-affirming health care under state consumer protection laws.
Attorney Tony Rothert of the Missouri American Civil Liberties Union told Ribaudo at a court hearing Wednesday that the regulations «will cause immediate, severe, and potentially irreparable harm» to people who could lose access to medicines. which include puberty blockers and sex hormones.
He and other attorneys said transgender people who cannot receive gender-affirming care are at risk of committing suicide.
Assistant Attorney General Joshua Divine argued that Bailey’s order does not prohibit gender-affirming care.
The rule will require people to have experienced a documented «intense pattern» of gender dysphoria for three years and have received at least 15 hourly sessions with a therapist for at least 18 months before receiving puberty blockers, hormones, surgery or other treatment. Patients should also first be screened for autism and «social media addiction,» and any psychiatric symptoms of mental health issues should be treated and resolved.
Some people may be able to keep their prescriptions while undergoing required testing.
Divine said the rule provides «basic procedural guardrails.» He cited studies showing that a high percentage of children looking to transition are dealing with mental health issues. He said that instead of transitioning, they should undergo «talk therapy.»
The plaintiffs argue that Bailey sidestepped the GOP-led Legislature and acted beyond its authority,
“We don’t allow attorneys general to legislate and we don’t allow doctors to play games,” Rothert said.
Emily Wales, president and CEO of Planned Parenthood Great Plains, said that with the delay, transgender and nonbinary people in Missouri will still be able to receive treatment Thursday. “And while this is a temporary relief, our patients always deserve the highest level of care, without the intervention of politicians who have no medical background,” she said.
Bailey issued the restrictions following an investigation that began in February at the Washington University Transgender Center at Children’s Hospital in St. Louis. The investigation was prompted by a former employee who alleged that the center was providing gender-affirming care to children without informed consent, insufficient individualized case review, and comprehensive mental health services. An internal review by the university found no misconduct and determined the former employee’s claims were unsubstantiated.
Bailey’s efforts to crack down on gender-affirming health care come as Republican lawmakers across the country have proposed hundreds of laws targeting transgender people. At least 13 states have enacted laws restricting or prohibiting gender-affirming care for minors.
The Food and Drug Administration approved puberty blockers 30 years ago to treat boys with precocious puberty, a condition that causes sexual development to begin much earlier than usual. Sex hormones, synthetic forms of estrogen and testosterone, were approved decades ago to treat hormone disorders or as birth control pills.
The FDA has not approved the drugs specifically to treat youth who question their gender. But they have been used for many years for that «off-label» purpose, a common and accepted practice for many medical conditions. Doctors who treat transgender patients say those decades of use mean the treatments are not experimental.
Critics have raised concerns about the children’s change of heart. However, the evidence suggests that detransition is not as common as opponents of transgender medical treatment for youth claim, although few studies exist.
Missouri House Minority Leader Crystal Quade said Wednesday that she sent letters to President Joe Biden and the Center for Medicare & Medicaid Services earlier this week requesting an executive order to extend coverage for Missourians seeking gender-affirming care in other states. She also sent letters to the governors of Kansas and Illinois, requesting that their health care systems accept Missouri patients for care.