Missouri AG limits life-saving trans healthcare for people of all ages: ‘Exceptionally cruel’

Pro-trans activists hold up a 'Trans Rights Now' placard.

Missouri’s attorney general has introduced an “exceptionally cruel” anti-trans rule that severely limits gender-affirming care for people of all ages in the state.

Andrew Bailey’s move means gender-affirming care for all trans people has been pretty much banned, with strict requirements – including the need for all trans people to have three years of “long-lasting, persistent and intense pattern of gender dysphoria” – needing to be met in order to obtain care. 

The anti-trans rule also requires all trans people to undergo 18 months of therapy sessions designed to “explore influences on the patient’s gender identity and mental-health comorbidities”.

Before gender-affirming care is permitted, the rule requires “any psychiatric systems from existing mental-health comorbidities”, such as depression and anxiety, to be resolved – and the rule includes a ban on care for trans adults with autism. 

The rule also sets out a requirement to check for “social contagion” and requires 15 years of medical follow-ups for all trans adults. 

Collectively, and taking into account that many trans people suffer with depression or anxiety before gender-affirming care, the requirements would ban the vital care for most adults in Missouri. 

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The World Professional Association for Transgender Health’s (WPATH) standards of care guide warns against prolonged waits for gender-affirming care, stating that this should begin promptly for trans adults unless there is a robust reason to delay. 

The organisation also notes that many trans people may have mental health problems and receiving vital treatment can help. 

“Like their cisgender counterparts, TGD [transgender and gender-diverse] people may have mental health problems. Treatment for mental health problems can and should occur in conjunction with GAMSTs [gender-affirming medical and/or surgical treatments] when medical transition is needed.

“It is vital gender-affirming care is not impeded unless, in some extremely rare cases, there is robust evidence that doing so is necessary to prevent significant decompensation with a risk of harm to self or others.

“In those cases, it is also important to consider the risks delaying GAMSTs poses to a TGD person’s mental and physical health (Byne et  al., 2018).”

In a Twitter post, independent journalist Erin Reed described the provisions as exceptionally cruel.

“Your regulation is going to die the moment it hits court,” she wrote. “You literally advocate for conversion therapy.

“Unfortunately for you, no matter how many laws you pass, you can’t hold back the rising tide of trans acceptance in society, and ultimately, you will lose this fight.” 

Bailey said that “the left” had refused to report all the facts and referred to “the science behind protecting our children from these procedures”.

A US-based study published by the New England Journal of Medicine in January revealed that gender-affirming care improves the mental health of trans teens.

The study, which followed young trans people for two years while they were treated with life-changing hormone therapy, evaluated 315 transgender youths aged between 12 and 20, with the average participant being 16.

It found that participants reported an increase in positive emotions, life satisfaction and improved self-confidence, and also highlighted participants reporting less anxiety and a decrease in depression.