Court battle begins over state's ban on gender-affirming health care for minors

COLUMBIA, Mo. -- Missouri's Republican Attorney General Andrew Bailey and the families of transgender children are in court this week fighting over whether a new law banning minors from receiving gender-affirming health care will take effect as scheduled Monday.

Lawyers last month sued to overturn the law on behalf of three families of transgender minors, doctors and two LGBTQ+ organizations. They asked a county judge to temporarily block the law as the court challenge against it plays out.

Hearings over pausing the law are taking place this week in Springfield, Missouri. A judge is expected to rule before Monday.

The law

The law, signed by Republican Gov. Mike Parson in June, would prohibit Missouri health care providers from providing puberty blockers, hormones and gender-affirming surgeries to minors. Minors prescribed puberty blockers or hormones before Aug. 28 would be able to continue to receive those treatments.

Missouri's Planned Parenthood clinics had been ramping up available appointments and holding pop-up clinics to start patients on treatments before the law takes effect.

Most adults would still have access to transgender health care under the law, but Medicaid wouldn't cover it and prisoners' access to surgeries would be limited.

Physicians who violate the law face having their licenses revoked and being sued by patients. The law makes it easier for former patients to sue, giving them 15 years to go to court and promising at least $500,000 in damages if they succeed.

The law expires in August 2027.

Legal arguments

Lawyers for the plaintiffs' wrote in a court filing that the law unlawfully discriminates against transgender patients "by denying them medically necessary care and insurance coverage because of their sex and because of their transgender status."

In court briefs, the attorney general's office argued that the law is not discriminatory because it "applies evenly to boys and girls."

"The only distinction made is based on the condition to be treated," lawyers for the office wrote. "Puberty blockers, testosterone, and estrogen can all still be used to treat various conditions (such as precocious puberty). They just cannot be used as an experimental response to gender dysphoria."

What health care providers say

The Food and Drug Administration approved puberty blockers 30 years ago to treat children 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 medications specifically to treat gender-questioning youth, but they have been used for many years for that purpose "off label", a common and accepted practice for many medical conditions. Doctors who treat trans patients say those decades of use are proof the treatments are not experimental.

Every major medical organization, including the American Medical Association, has opposed the bans on gender-affirming care for minors and supported the medical care for youth when administered appropriately. Lawsuits have been filed in several states where bans have been enacted this year.