A Missouri judge just blocked the state’s attempt to restrict gender-affirming care. Here’s what’s next

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ST. LOUIS – A GOP-led attempt in Missouri to restrict access to gender-affirming care for children and adults will not move forward at least until May 15.

This comes after Republican Attorney General Andrew Bailey filed an emergency ruling earlier this month that set first-of-its-kind restrictions on access to transgender health care. The rule, in part, requires that a patient receive 18 months of therapy before they can access gender-affirming care.

St. Louis County Circuit Judge Ellen Ribaudo issued a temporary restraining order on the rule Monday, saying that the trans Missourians represented in a lawsuit against the rule would “be subjected to immediate and irreparable loss, damage or injury if the Attorney General is permitted to enforce the Emergency Rule, and its broad, sweeping provisions were implemented without further fact-finding or evidence.”

Ribaudo temporarily halted Bailey’s rule last week, hours before it was expected to go into effect. Now Bailey’s regulations will remain stalled, at least for another two weeks.

LGBTQ+ rights groups and experts said the emergency rule targets both trans children and adults. Lambda Legal, the ACLU of Missouri, and Bryan Cave Leighton LLP joined together to file a petition for a temporary restraining order on the rule.

“Today’s ruling marks a win for transgender Missourians over an unprecedented attempt by the Attorney General to unilaterally legislate and harm their right to self-expression, bodily autonomy, and access to lifesaving health care,” said Gillian Wilcox, deputy director of litigation for the ACLU of Missouri, in a statement after Monday’s ruling. “As was clear from the beginning, the Attorney General’s claim of an emergency was proven an untruthful and dangerous attempt to get involved in individual and family medical decisions, showing that he will attack the very people he is supposed to serve and protect.”

READ MORE: Judge halts Missouri rule limiting gender-affirming health care

The PBS NewsHour also reached out to the attorney general’s office for comment after the court released its most recent ruling. A spokesperson said the office is ”confident in our position because the Court even acknowledged that it deferred its consideration of the science until a later date. Our six pages of endnotes speak for themselves: these procedures are experimental. We will continue to fight for all patients to have access to adequate health care.”

When Bailey announced the rule on April 13, the state attorney general — who has advanced misleading and debunked claims around gender-affirming health care — said he was doing it to protect children. He added that the emergency regulations are not a ban. But providers in the state, like Planned Parenthood, and trans people who seek gender-affirming care have said that any rule that makes it significantly harder for an individual to get care is considered a ban.

As a record-breaking wave of anti-trans legislation makes its way through state houses across the country, here’s a closer look into how Missouri’s emergency restrictions stand out.

Why does the AG say the rule restricting gender-affirming care is needed?

Missouri Attorney General Andrew Bailey gives his inaugural remarks after being sworn into office on Jan. 3, 2023 at the

Missouri Attorney General Andrew Bailey gives his inaugural remarks after being sworn into office on Jan. 3, 2023 at the Missouri Supreme Court in Jefferson City. Photo by Galen Bacharier/Springfield News-Leader/USA TODAY NETWORK

Trans people often pursue a wide range of social practices and mental and physical services as they transition, from using different pronouns to seeking gender-affirming health care. Some facets of transition, like puberty blockers and hormones, is what Bailey is seeking to regulate.

When Bailey announced the new restrictions more than two weeks ago, he said he was issuing the regulations “in an effort to protect children” and falsely described gender-affirming health care treatments as “experimental,” adding that the care has “significant side effects.”

Every major medical association supports gender-affirming care, and many of those treatments have been standard practice for more than a decade.

The emergency regulations include requirements that patients:

  • Receive a “full psychological or psychiatric assessment,” consisting of 15 separate hourly sessions over the span of 18 months.
  • Have a documented three consecutive years of gender dysphoria.
  • Be screened for social media addiction.
  • Be screened for autism.

Assistant Attorney General Joshua Divine, who is representing Bailey, told the court the AG’s ruling is not a full-on ban.

READ MORE: After removing trans lawmaker, Montana becomes latest state to ban gender-affirming care for minors

But Dr. Colleen McNicholas, chief medical officer at Planned Parenthood of the St. Louis Region and Southwest Missouri, said the language in the ruling as written constitutes a ban.

“Any regulation, any rule, any law, any legislation that makes access so difficult and so burdensome that the end result is that people can’t get the care, don’t seek the care or leave the state to get the care is, in effect, a ban,” she told the NewsHour. “Use whatever words they want but if the end result is that people cannot get the care that they need, then that is and should be considered a ban on care.”

As for Bailey’s claims that gender-affirming health care is “experimental,” McNicholas said it shows he and his team do not understand how science and medicine works.

“All the medications that we use in gender-affirming care are, in fact, FDA-approved medications. We have a ton of data to support the safety and efficacy of these therapies,” she said.

McNicholas also pointed to statements of support for gender-affirming health care, as well as stated concerns about attempt to limit access to it — from the American Medical Association, Endocrinology Associations, the Psychiatric and Psychological Association, the American College of Obstetricians and Gynecologists.

There have been multiple studies that underscore how gender-affirming care can lead to improvements in health and overall well-being. Research from Harvard University’s T.H. Chan School of Public Health, released in 2021 and based on 2015 data, shows gender-affirming health care is associated with longer-term improved health outcomes, including lower rates of smoking, less psychological distress, and a decrease in suicidal ideation.

Advocates say the rule is unnecessary and harmful


Advocates outside the state capitol show support for trans kids in Missouri as the legislature pushes multiple bills targeting access to gender-affirming health care. Photo courtesy of Be Lovely Photography

Katy Erker-Lynch, executive director at PROMO, an organization that advocates for the rights of LGBTQ Missourians, said Missouri has never had an attorney general wield power in this way, other states have tried.

“The best example was Texas and the attorney general and the governor there seeking to criminalize parents for providing access to gender-affirming care or even pathways to access for care for their minor children,” they said.

Erker-Lynch said it’s not just these new regulations that are worrisome but the impact they could have on people’s lives and health, which is something their nonprofit has already began to track as people continue to inquire about what the ruling could mean for them.

READ MORE: Washington, Minnesota become transgender and abortion sanctuaries

“When it [care] is denied, there’s a really serious impact on the mental, social and emotional wellness of individuals and we’re starting to see that get real already in some of the conversations we’re having with people who fear they’re going to lose their care and just the spiraling that some of them are going through,” she said.

The negative repercussions of denying a person care have been studied by nonprofits and federal agencies. Forty-one percent of LGBTQ youth seriously considered attempting suicide in the past year, with higher rates reported among youth who are trans, nonbinary and/or people of color, according to survey data released Monday from the Trevor Project, which also offers crisis counseling for LGBTQ+ youth in need.

A U.S. Department of Health & Human Services report released in March found that “rejection and lack of social and emotional support” affects a person’s health, and that policies that stigmatize and prohibit gender-affirming health care are harmful. The report also noted that 20 years of research underscore the importance of family and community support to the health of LGBTQI+ youth.

“You would not believe the number of phone calls and emails and messages that we’re getting from folks who are asking for resources to leave the states, to leave their homes, to leave their families, cousins, grandparents, schools, communities because they know that when they started receiving gender-affirming care, everything turned around for them,” Erker-Lynch said. “Being denied that, or even the prospect of maybe being denied that, is absolutely terrifying to them.”

The recent efforts to curb care for trans and nonbinary Missourians are not new.

In February, Bailey announced a “multi-agency investigation” after he said a whistleblower made public claims against the Washington University Transgender Center at St. Louis Children’s Hospital. The former employee, in part, allegeding an use of “experimental drugs.”

“My office has uncovered a clandestine network of clinics across the state who are harming children by ignoring the science. When even progressive countries like Sweden, Norway, Finland, and the United Kingdom have all sharply curtailed these procedures, it’s time for the United States to course correct. My office is stepping up to protect children throughout the state while we investigate the allegations and how they are harming children,” he said in a release on the matter.

An advocate at a protest outside the Missouri state capitol holds up a sign that reads, Trans Rights Are Human Rights.

Missourians rally at the state’s capitol after legislators introduced dozens of bills – and the state attorney general issued an emergency rule – that sought to limit transgender people’s access to gender-affirming health care and ban them from participating in sports. Photo courtesy of Be Lovely Photography

The Missouri Social Services Department, Republican Sen. Josh Hawley and Washington University all launched separate investigations.

However, in April, after eight weeks of investigating, Washington University released its findings noting, in part, that the allegations were “unsubstantiated.”

“Washington University physicians and staff at the Center follow appropriate policies and procedures and treat patients according to the currently accepted standard of care, as recommended by the American Academy of Pediatrics and other nationally recognized organizations,” the report reads.

In March, Bailey took it a step further by launching a “tip line” where residents could fill out a form on a state website to “report questionable transition interventions.” The site was live for only a short while before it was removed; the AG’s office later told reporters it was taken down due to a potential “hack” to its system.

As this rule goes through the courts, how is the community responding?

Just days after Bailey announced his emergency regulations, Planned Parenthood held three pop-up gender-affirming health care clinics in Springfield and St. Louis, Missouri, and in Fairview Heights, Illinois, while also expanding services at its nine existing health centers.

McNicholas said it was clear to providers “how scared folks were and how important it was to them to be able to get in.

“We opened an additional 200 slots across our nine health centers before [April] 27, and those appointments filled as well,” she said.

In preparation for any future actions, the provider is assessing what tools it has, including its new mobile clinic, in order to provide care to people no matter what the outcome is.

“Regardless of what happens with this emergency rule, Planned Parenthood will do what it does best, which is continue to show up for people and figure out a way to make sure that folks are continuing to get those lifesaving care,” she said.

WATCH MORE: Battles over reproductive, transgender rights fought in state legislatures

In the meantime, Erker-Lynch said PROMO and other groups are answering questions and ensuring trans young people and adults have the resources they need no matter what the outcome is.

“I want folks to know that, yeah, it’s a really challenging time and it’s the hardest time that we’ve seen for trans Missourians. But also, you know, this is an all out attack across the country that we’re seeing,” they said.

What’s next?

While the temporary restraining order expires on May 15, a preliminary injunction hearing is set for May 11.

There are less than two weeks left in the state’s legislative session. So far this year, the ACLU said it has tracked 48 anti-LGBTQ bills proposed by state legislators in Missouri. Erker-Lynch said there are two that have already made it past the state Senate that advocates across the state are keeping their eyes one.

Senate Bills 39 and 49 are a sports ban and a gender-affirming health care ban, respectively.

Both bills have left the Senate and on their way to the House.

While neither bill has yet to be added to the House’s calendar just last month, Missouri Gov. Mike Parson threatened to call a special session if these two bills aren’t passed.

“If we don’t get it done in session, we’re going to go right into another session in a special session to complete both of those. Those two things are probably a priority in this state,” Parson told reporters last week.

For now, gender-affirming health care remains for Missourians, and advocates say they are prepared to keep it that way.

“We will continue to fight for our clients and for all transgender people in Missouri until this dangerous and unprecedented policy is set fully aside, and we will not be deterred by any attempt to shield this policy from the scrutiny of Missouri’s courts,” said Nora Huppert, a staff attorney at Lambda Legal.