Clinics in the St. Louis region that provide hormones, surgery referrals and other medical services to transgender people have opened their appointment books to help as many new patients as they can before new state limitations on gender-affirming care take effect later this month.
Missouri Attorney General Andrew Bailey last week announced the emergency rule limiting the ability for transgender patients to obtain gender-affirming care would go into effect April 27 and last until early February.
Some of the rule’s restrictions don’t apply to providers treating people who have already begun receiving care, “so long as the person or health organizations promptly seeks to initiate the treatments and assessment."
Planned Parenthood and other organizations that provide such care are working to enroll new patients to keep them from being affected by the rule, which demands patients receive at least 15 hours of mental health care and exhibit three consecutive years of medically documented gender dysphoria before getting medical treatment, among other requirements. It also prohibits providers from offering care to people with unresolved mental health problems.
Those who are already receiving medical treatment are exempt from those requirements. But some providers say the emergency rule is vague about how its regulations will ultimately apply to existing patients.
Bailey last week said he was able to issue the emergency regulations because puberty blockers, hormone replacement therapy and other health care for transgender people are considered “experimental,” a claim that doctors and advocates dispute.
The attorney general has said the rule is designed to protect minors from hasty and harmful medical practices, but the emergency rule does not specify age restrictions. Clinic workers have assumed that means the limitations apply to those of all ages.
Planned Parenthood’s offices throughout Missouri and its Fairview Heights location on Monday began holding pop-up clinics that treat walk-in patients seeking hormones and other gender-affirming treatments.
The clinics have scheduled about 200 appointments with new transgender patients this week, said Colleen McNicholas, Planned Parenthood of the St. Louis Region and Southwest Missouri medical officer, who on Monday was seeing walk-in patients at the organization’s Central West End location.
Planned Parenthood had parked its tour bus-size mobile clinic in its parking lot to handle the extra patients.
“We’re seeing people at different points of their journey; we’ve seen folks who have been on HRT but lost access, people who have been saving money for years to start,” she said. “We’ve also seen folks who have been in care but whose doctors have ducked out because of the regulation. Lots have been planning for this and thinking about this for a long time, but there’s a particular urgency about these next two weeks because of the regulation.”
Harley Camryn had their first appointment at the Central West End clinic on Monday. They said they were planning to wait to start low-dose hormones but needed to take action before the new provisions kicked in.
“I was definitely going to go the route of talking to my mental health professionals and seeing what they suggested,” they said. “But since that is not going to be an option for much longer, this was the best option for me to make sure that I'm able to have the capability to receive the care that will make me comfortable in my body.”
Camryn has depression and “diagnoses that fall under the autism spectrum,” they said. The emergency rule would preclude them from getting the treatment they want.
Even those who are already receiving care are terrified they’ll be cut off from their doctors, said Camryn, who earlier this month helped organize a rally in downtown St. Louis to champion transgender people’s rights. Support from other queer people is helping them cope.
“When your life is the political talking point of almost every representative in your state right now, it's a lot to handle,” Camryn said.
Dr. Sam Tochtrop, who works at the Southampton Healthcare clinic in St. Louis, which provides hormone therapy and surgery referrals to transgender and gender-nonconforming people, also is seeing more patients.
Getting gender-affirming care in Missouri is already difficult, he said, and existing patients don’t trust that they’ll be able to continue care in the future.
“By the time they reach us, they are just so, so glad to finally have been able to reach the care that they need,” he said. “To now have that being threatened to be stripped away from them. You know, it just causes a panic, and I don't blame them at all.”
Tochtrop said he’s been reassuring people that the clinic plans to continue to grant care to transgender people, including as many new patients as possible.
“We knew that we would need to make a plan and we would need to make a plan very, very fast, because we only get a two-week window where this is going to go into effect,” he said.
Once the regulations are in force, the clinic will be crowded with more appointments for existing patients because of a provision that requires doctors to collect written informed consent every three months, instead of approximately once or twice a year, which is standard for established patients, he said.
The informed consent provision requires patients to sign off that they’ve received information about risks of certain treatments, among other disclosures.
“We try to convey that we are here to help,” Tochtrop said. “It puts them at ease a bit, but there’s still the fact they're being targeted politically. That’s the underlying scary part. We can’t entirely remove that fear.”
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