Missouri to restrict gender-affirming care for minors

JEFFERSON CITY, Mo. -- Missouri's Republican attorney general Monday said he will limit access to gender-affirming care for minors, sidestepping the GOP-led Senate as it struggles to pass a law banning the practice for children completely.

As hundreds of activists rallied at the Capitol to pressure lawmakers to act on the bill, Attorney General Andrew Bailey announced plans to file an emergency rule.

The rule will require an 18-month waiting period, 15 hourlong therapy sessions and treatment of any mental illnesses before Missouri doctors can provide that kind of care to transgender children, according to Bailey's office.

"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.

The emergency rule also requires disclosure of information about puberty blocker drugs, including that they are experimental, not approved by the FDA and that the FDA has warned they can lead to brain swelling and blindness, Bailey said.

Julia Williams holds a sign in counterprotest during a rally in favor of a ban on gender-affirming health care legislation, Monday, March 20, 2023, at the Missouri Statehouse in Jefferson City, Mo. (AP Photo/Charlie Riedel)

Julia Williams holds a sign in counterprotest during a rally in favor of a ban on gender-affirming health care legislation, Monday, March 20, 2023, at the Missouri Statehouse in Jefferson City, Mo. (AP Photo/Charlie Riedel)

While puberty blockers and hormones often prescribed in transgender treatment are not FDA approved for transgender care, they are used in those cases "off-label," which is an accepted and permitted practice.

This is not the first time Bailey has weighed in on transgender health care since taking office in January.

In February, Bailey announced an investigation of a transgender youth clinic in St. Louis run by Washington University, following allegations of abuse by a former employee. He asked the university to shut down the clinic, but it refused.

Bailey's spokesperson did not say when the new health care rule will be filed and did not provide a copy.

Maysa Akbar, chief diversity officer for the American Psychological Association, called the rule "a disturbing development for transgender and gender-nonconforming youth in Missouri."

People listen to a speaker during a rally in favor of a ban on gender-affirming health care legislation, Monday, March 20, 2023, at the Missouri Statehouse in Jefferson City, Mo. (AP Photo/Charlie Riedel)

People listen to a speaker during a rally in favor of a ban on gender-affirming health care legislation, Monday, March 20, 2023, at the Missouri Statehouse in Jefferson City, Mo. (AP Photo/Charlie Riedel)

"This emergency order flies in the face of the scientific consensus, which is that, with appropriate psychological screening, treatment approaches should affirm an adolescent's gender identity, not deny it," Akbar said. "Research shows that discrimination has adverse effects on the health and well-being of transgender people."

The rule appears to be aimed at helping children who might regret transitioning, said Dr. Jack Drescher, section editor of the gender dysphoria chapter of the DSM-5, the most recent edition of the American Psychiatric Association's mental illness manual.

"However it does so at the expense of those children who would indeed benefit from transition services," Drescher said. "Sacrificing the well-being of the latter for the presumed benefit to the former is an ethically troubling intervention by the state into clinical practice."

Missouri LGBTQ-rights group PROMO called Bailey's rule an abuse of power and said his office "does not respect the professional guidelines of every major medical association in our country, who agrees gender-affirming health care is the standard of care for transgender Missourians."

The rule comes amid a national push to restrict transgender health care, drag shows, bathroom access and how LGBTQ topics are discussed in schools.

Glenda Starke wears a transgender flag as a counterprotester during a rally in favor of a ban on gender-affirming health care legislation Monday at the Missouri Statehouse in Jefferson City, Missouri.Charlie Riedel ~ Associated Press

Glenda Starke wears a transgender flag as a counterprotester during a rally in favor of a ban on gender-affirming health care legislation Monday at the Missouri Statehouse in Jefferson City, Missouri.Charlie Riedel ~ Associated Press

Erin Reed, a researcher who tracks transgender legislation, said Bailey is among Republican elected officials in state executive offices across the nation who are finding ways to limit gender-affirming care when legislatures fail to act.

"An action like this taken to sidestep the legislature and sidestep the democratic process is in and of itself undemocratic and is going to harm trans youth in Missouri," Reed said.

Florida state medical officials last year banned transgender children from receiving hormones or undergoing surgeries to treat gender dysphoria at the urging of Republican Gov. Ron DeSantis, who is widely considered to be weighing a run for the Republican presidential nomination.

Texas went farther than any state last year when Republican Gov. Greg Abbott issued a first-of-its-kind order that instructed child welfare officials to investigate reports of gender-confirming care for kids as abuse.

A couple hundred people rallied Monday at the Capitol in hopes of pushing lawmakers to pass a law to ban all gender-affirming treatment for children, while several came in opposition. The rally featured a diverse collection of speakers, including Republican state officials such as Secretary of State Jay Ashcroft, Christian leaders and several gay and transgender activists who said only adults should be able to access gender-affirming care.

Catherine Dreher, vice chair of the Missouri Libertarian Party, said her 18-year-old son has dealt with mental health issues, recently left home and wants to transition to a woman, which distresses her. She opposes allowing that for minors, calling it "child abuse."

Debate on the Missouri bill stalled when the conservative sponsor, Republican Sen. Mike Moon, struggled to negotiate with Democrats on the legislation. The GOP-led Senate ultimately failed to pass any legislation dealing with the topic before lawmakers left for their annual spring break.

"Protecting Missouri's children is not up for negotiation," Moon wrote in a public letter signed by seven other Republican senators, who vowed to take any action necessary to bring Moon's bill to a vote this week.

The issue threatens to derail the Senate. Several Republican senators on Monday spoke against another Republican lawmaker's attempt to combine Moon's bill with a ban on transgender girls competing on school girls' sports teams, fearing that merging the issues might make the legislation unconstitutional.

Meanwhile, Senate Democrats have indicated that they may filibuster to encourage compromise, a stall tactic that involves senators talking nonstop.

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Associated Press writer David A. Lieb contributed to this report.