Missouri AG seeks to restrict gender-affirming care for minors

By Raja Razek and Shawna Mizelle, CNN

Missouri’s Republican attorney general is seeking to implement an emergency regulation to restrict gender-affirming care for minors.

“Because gender transition interventions are experimental, the regulation clarifies that state law already prohibits performing experimental procedures in the absence of specific guardrails,” Missouri Attorney General Andrew Bailey said in a news release on Monday.

Some of the “guardrails” include “prohibiting gender transition interventions when the provider fails to ensure that the patient has received a full psychological or psychiatric assessment, consisting of not fewer than 15 separate, hourly sessions over the course of not fewer than 18 months to determine, among other things, whether the person has any mental health comorbidities,” according to the release.

The rule will go into effect 10 days after it is filed with Missouri’s secretary of state office, which said it had not yet been filed as of late Tuesday morning.

Once it goes into effect, the regulation would last “30 legislative days or 180 days, whichever is longer,” the release said.

Republicans have expressed concern over long-term outcomes and question whether minors are capable of making such consequential decisions. LGBTQ advocates and many physicians, however, regard the treatment as medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender — the one the person was designated at birth — to their affirmed gender, the gender by which one wants to be known.

Major medical associations agree that gender-affirming care is clinically appropriate for children and adults with gender dysphoria, which, according to the American Psychiatric Association, is psychological distress that may result when a person’s gender identity and sex assigned at birth do not align.

Though the care is highly individualized, some children may decide to use reversible puberty suppression therapy. This part of the process may also include hormone therapy that can lead to gender-affirming physical change. Surgical interventions, however, are not typically done on children and many health care providers do not offer them to minors.

Bailey said Monday that his efforts are aimed at protecting children and that the care is a part of “a woke, leftist agenda” that results in “irreversible consequences.”

But Dr. Colleen McNicholas, chief medical officer at Planned Parenthood of the St. Louis Region & Southwest Missouri, called Bailey’s claims “medically false and harmful” in a series of tweets on Monday.

The emotional debate over gender-affirming care for transgender children has become a political flashpoint — especially among conservatives — at a time legislators across the country are advancing measures to restrict LGBTQ rights.

In February, CNN reported that more than 80 bills seeking to restrict access to gender-affirming care for trans youth has been introduced by Republican state lawmakers around the country this year, with debates around the issue reaching new heights due to proposals that would dramatically expand the scope of bans on such care.

Days ago, Republican lawmakers in Kentucky passed a bill that prohibits transgender minors from receiving gender-affirming care, allows educators to refuse to refer to transgender students by their preferred pronouns and would not allow schools to discuss sexual orientation or gender identity with students of any age.

A Tennessee bill that prohibits gender-affirming care for minors was also signed into law earlier this month. In February, South Dakota enacted a similar health care ban, and Utah put one on its books in January. Alabama, Arizona and Arkansas also enacted bans on gender-affirming care in recent years, though the laws in Alabama and Arkansas have been temporarily blocked by federal courts.

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CNN’s Devan Cole contributed to this report.