A Missouri judge on Wednesday temporarily halted enforcement of a first-of-its-kind rule that restricts access to gender-affirming healthcare for transgender children and adults, hours before it was set to take effect.
The rule, introduced by Andrew Bailey, the Republican state attorney general, would place requirements on minors and adults before they are allowed to receive gender-affirming treatments such as puberty blockers or hormones. It was set to take effect on Thursday, but transgender Missourians and healthcare providers sued to stop it.
A St Louis county circuit judge, Ellen Ribaudo, said she would review the matter before deciding whether to issue a temporary restraining order. She delayed implementation of the rule until 5pm on Monday, saying she anticipates she will rule before then.
Bailey has touted the rule as a way to shield minors from what he describes as experimental medical treatments, though puberty blockers and sex hormones have been prescribed for decades. The lawsuit claims Bailey sidestepped the Republican-led legislature and acted beyond his authority in attempting to regulate gender-affirming healthcare under consumer-protection laws.
Tony Rothert, an attorney with the American Civil Liberties Union of Missouri, told Ribaudo at a hearing the regulations “will cause immediate, severe and potentially irreparable harm” for people who could lose access to medications. He and other attorneys said transgender people who cannot get gender-affirming care are at risk of suicide.
The assistant attorney general, Joshua Divine, argued that Bailey’s order does not ban gender-affirming care.
The rule will require people to have experienced an “intense pattern” of documented gender dysphoria for three years and to have received at least 15 hourly sessions with a therapist over at least 18 months before receiving puberty blockers, hormones, surgery or other treatment. Patients must be screened for autism and “social media addiction”. Any psychiatric symptoms from mental health issues would have to be treated and resolved. Some would be able to maintain prescriptions while undergoing assessments.
Divine said the rule provides “basic procedural guardrails”. He cited studies showing that a high percentage of children seeking to transition deal with mental health issues. Rather than transition, he said, they should undergo “talk therapy”.
Rothert said: “We don’t allow attorneys general to legislate, and we don’t allow them to play doctor.”
Emily Wales, president and chief executive of Planned Parenthood Great Plains, said transgender and non-binary Missourians would still be able to receive treatment on Thursday, adding: “And while this is temporary relief, our patients always deserve the highest standard of care, without the intervention of politicians who have no grasp of medicine.”
A spokesperson for Bailey said the office will “continue fighting for all patients to have access to adequate healthcare”.
Bailey issued the restrictions following an investigation of the Washington University Transgender Center at St Louis Children’s hospital, prompted by a former employee who alleged the center was providing children with gender-affirming care without informed consent, not enough individualized case review and mental health services. An internal review by the university found no misconduct and determined the claims were unsubstantiated.
Republican lawmakers across the US have proposed hundreds of laws aimed at transgender people. At least 13 states have restricted or banned gender-affirming care for minors.
The US Food and Drug Administration approved puberty blockers 30 years ago to treat children with precocious puberty: a condition that causes sexual development much earlier than usual. 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 to treat gender-questioning youth. But they have been used for many years for that purpose “off label”, a common and accepted practice. Doctors who treat transgender patients say those decades of use mean the treatments are not experimental.
Critics have raised concerns about children changing their minds. Evidence suggests detransitioning is not as common as opponents of transgender medical treatment for youth contend, though few studies exist.
The Missouri house minority leader, Crystal Quade, said she sent letters to Joe Biden and the Center for Medicare and Medicaid Services, asking for an executive order to extend coverage for Missourians who seek gender-affirming care in other states. She also sent letters to the governors of Kansas and Illinois, asking that their healthcare systems accept Missouri patients for such care.
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