Missouri attorney general issues rules to restrict gender-affirming care for transgender kids
The emergency regulations will require healthcare providers to tell patients about what Missouri Attorney General Andrew Bailey claims are health risks of gender affirming care — even though the treatments have been endorsed by dozens of leading U.S. medical groups. The rules will also prohibit providers from administering care to children with untreated mental health problems.
Updated at 6:45 p.m. with comments from an advocate for transgender people and the American Civil Liberties Union
Missouri Attorney General Andrew Bailey is issuing emergency regulations that aim to keep medical providers from providing gender-affirming care to transgender children unless the providers meet stringent state requirements.
In an announcement Monday, Bailey said hormone therapy, surgery and other treatments are “experimental and fall under laws governing deceptive business practices."
The emergency regulations will require that providers tell patients about what Bailey called health risks of gender-affirming care. They will also prohibit providers from administering care to children with untreated mental health problems.
Bailey said the regulations are necessary because an increasing number of children are seeking gender care.
“I am dedicated to using every legal tool at my disposal to stand in the gap and protect children from being subject to inhumane science experiments,” Bailey said in a statement.
Once put in place, the emergency regulations will last for 180 days or 30 legislative days, whichever is longer.
Under the regulations, which a department spokeswoman said are still being finalized, health workers will need to:
- Disclose to patients that the use of puberty-blocker drugs or hormones to treat gender identity disorder or gender dysphoria is "experimental and is not approved by the Food and Drug Administration."
- Inform patients that the FDA has warned that puberty blockers can lead to brain swelling and blindness.
- Ensure that patients have received full psychological or psychiatric assessments of at least 15 separate hourly sessions over at least 18 months, and that such conditions have been treated and resolved.
- Adopt and follow procedures to track for 15 years any adverse effects of gender transition for all patients.
The emergency rules also require providers to screen for autism before providing treatment.
The American Association of Pediatrics and other medical associations support gender-affirming care, which can encompass anything from changing one’s name and clothing to reflect one’s preferred gender to hormone therapy or surgery. The organizations’ members say patients, their parents and trusted medical professionals should decide the best course of care.
Critics of the proposed regulations said Bailey is “cherry-picking” data to support his claim that such care is unsafe and experimental.
‘They are picking and choosing statistics that, by and large, have all been debunked in the past already,” said Susan Halla, president of Transparent, an advocacy group for transgender people and their families.
For example, puberty blockers have been used by patients in the United States for years and could hardly be classified as experimental, she said.
It’s also difficult for the FDA to approve such treatments, since studies involving young people are rarely conducted, Halla said.
Halla wasn’t opposed to some of the regulations, such as informed consent. But she said others, like a requirement requiring providers to make sure a person wasn’t seeking care because of peer pressure, would be impossible to enforce.
“To be fair, something like having an actual signed consent agreement that's on file, I think that's a great idea,” she said. “But there are many things on there that are blatantly false, or impossible to quantify in some way. One of the items was to make sure that this child is not part of a social contagion. Like, how do you do that?”
Other advocates for LGBTQ people called Monday’s announcement a political ploy in which Bailey acted outside his authority.
Tom Bastian, a spokesman for the Missouri American Civil Liberties Union, called the regulations “dangerous and reckless.”
“The real threats to trans individuals are abuse and violence, which dramatically increase the risk of depression, substance abuse and suicide,” Bastian said. “Sadly, rather than addressing the real harm trans students face, Missouri’s General Assembly and attorney general are using their governmental powers to erase trans existence. These actions do not protect anyone; rather, they put an already marginalized group of children in greater danger.”
While Bailey’s announcement focused on transgender care for minors, it did not address whether it would affect medical care for people of all ages who receive hormones and other treatments through the state’s clinics.
That includes the Washington University Transgender Center at St. Louis Children’s Hospital, which provides gender care to children and teenagers.
Bailey in February launched an investigation into the center after a former staffer accused the clinic of providing treatments to children too quickly.
“We are aware of the attorney general’s press release and will review any proposed regulations when they are filed,” Washington University Vice Chancellor Julie Flory wrote in an email. “We take the care and safety of our patients very seriously. Our focus remains on our commitment to providing compassionate, family-centered care to all of the patients and families we serve.”
Copyright 2023 St. Louis Public Radio