Gender-Affirming Care for Adults Is Now Basically Banned in Missouri

The state’s Attorney General Andrew Bailey announced an emergency regulation that erects enormous barriers to care for trans people of all ages.
Supporters of LGBTQA+ rights participate in the March for Queer & Trans Autonomy on Capitol Hill in Washington, DC on March 31, 2023. (ANDREW CABALLERO-REYNOLDS/AFP via Getty Images)

Missouri is the first state to severely restrict gender-affirming care for transgender adults amid a nationwide, GOP-led push to legislate away trans rights.

The state’s Attorney General Andrew Bailey announced an emergency regulation on Thursday that aims to limit access to gender-affirming care for Missourians by setting sweeping new rules for those seeking treatment. He’s since also launched an online government form that people can use “to submit a complaint or concern about gender transition intervention you have experienced or observed in Missouri.” Together, the initiatives mean Bailey has managed to introduce some of the most severe gender-affirming care restrictions yet—without any passed legislation. 


“I will always fight to protect children because gender transition interventions are experimental,” Bailey said in a statement. Science actually supports gender-affirming care, and it’s not experimental. 

“My office is stepping up to protect children throughout the state while we investigate the allegations and how they are harming children,” Bailey added. The medical consensus in the U.S.—including endorsements from the American Medical Association, the American Academy of Pediatrics, and the Endocrine Society—is that gender-affirming care, which includes name changes, puberty blockers, and hormone replacement therapy, is safe, effective, and medically necessary.

The emergency rule makes it impossible for transgender people of all ages to access gender-affirming care unless they have exhibited a medically documented “long-lasting, persistent and intense” pattern of gender dysphoria for three years. They also have to prove they’ve received “a full psychological or psychiatric assessment” and “15 separate, hourly sessions” of therapy, at least 10 of which must be with the same therapist. This follows several anti-trans lobbyists and lawmakers, who’ve attempted to falsely equate transness with “severe mental illness.” 


People seeking such care will have to be screened for autism and other pre-existing issues, such as anxiety and depression, and pre-existing conditions must “have been treated and resolved” before a person can access gender-affirming care. Health care providers also have to check that a minor who is trans has received a comprehensive screening annually and isn’t suffering from “social media addiction.” 

Care is also prohibited if healthcare workers don’t check yearly whether a patient is “experiencing social contagion with respect to the patient’s gender identity.” This is likely based on yet another GOP-spread myth that transness is a trend or craze. 

The proposal will go into effect on April 27 until February 6, 2024.

“This is what elimination of transgender people looks like,” transgender activist and researcher Erin Reed tweeted. 

Other groups have also come out in opposition of the emergency rule. 

“The Attorney General’s so-called emergency rule is based on distorted, misleading, and debunked claims and ignores the overwhelming body of scientific and medical evidence supporting this care as well as the medical experts and doctors who work with transgender people every day,” the ACLU of Missouri and LGBTQ legal organization Lambda Legal said in a joint statement. “Transgender people in Missouri deserve the support and care necessary to give them the same chance to thrive as their peers.”

Numerous medical governing bodies, including the American Medical Association, American Psychological Association, the American Psychiatric Association, and the American Academy of Pediatrics, have endorsed gender-affirming care for minors as medically necessary. Far-right pundits and some Republican politicians falsely equate gender-affirming care to “sterilization” and “castration,” and tout its supposed dangers. But extensive medical evidence shows that gender-affirming care isn’t harmful; it’s life-saving.

Studies show that trans people are more likely to experience mental health struggles, including anxiety, depression, PTSD, and thoughts of suicide, than cisgender people. Nearly half of all LGBTQ youth have seriously considered suicide. But, experts say, some of these issues can be mitigated with gender-affirming care, which includes puberty blockers and other therapies. These interventions are safe and effective, and are correlated with better mental health outcomes for trans people. Teens who are able to access gender-affirming therapy typically also have better mental health outcomes than trans people who have to wait until adulthood to transition.

This story was updated on Tuesday, April 18.