Missouri’s ‘terrifying’ rule on gender-affirming care will force ‘mass medical detransitioning’

trans rights

Missouri is set to make access to gender-affirming healthcare nearly impossible, in a move which has been described as “terrifying” and will result in “mass medical detransitioning” for trans citizens. 

On 13 April, the state’s Republican attorney general Andrew Bailey issued an emergency rule to all trans people in Missouri, which will come into force on Thursday (27 April) and will stay in effect until February 2024. 

The lengthy new rule stipulates trans people of all ages will have to suffer through three years of medically documented “long-lasting, persistent and intense” gender dysphoria and undergo 15 hours of therapy over 18 months before they can receive gender-affirming care – and then be tracked for at least 15 years to observe the “adverse effects” of trans healthcare. 

Alongside this, under the rule, symptoms of depression and anxiety must be “treated and resolved” before the patient receives gender-affirming care and people must go through a “comprehensive screening to determine whether the patient has autism”.

In essence, having depression and anxiety – mental health conditions which have been shown to be exacerbated by gender dysphoria – would disqualify a person from the very treatment which could reduce the prevalence of the conditions in their day-to-day lives. 

Being autistic would also prevent someone from getting gender-affirming care, something MSNBC columnist Eric Garcia said conservatives are “weaponising”, meaning autistic trans people have to “choose between their identities”. 

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The restrictions tabled in Missouri are seen by activists as some of the most extreme in the United States as they will make access to trans healthcare nearly impossible, while those who are eligible will have years-long wait for care. 

The Attorney General of Missouri has introduced a rule that will see ban most trans adults from a accessing gender affirming care.
The Attorney General of Missouri has introduced a rule that will see ban most trans adults from a accessing gender affirming care. (Photo by Loredana Sangiuliano/SOPA Images/LightRocket via Getty Images)

PROMO, Missouri’s LGBTQ+ public policy and advocacy organisation, said by issuing the emergency rule Bailey “fanned the flames of hate” and put trans people at the centre of his “culture war”. 

“Let’s be clear – gender-affirming care is based on decades of clinical experience and research and is not considered experimental,” the group said in a statement, “The attorney general’s claims are maliciously cherry-picked and come from unverified sources that allow him to promulgate disgusting, obstructive, and misleading information into an emergency rule. 

“It should be clear to anyone paying attention that the real threat to Missourians is the attorney general himself.”

In the statement, a spokesperson for PROMO went on to state that lawmakers are “intentionally silencing trans voices” and “normalising hate and fueling fear”, adding: “We are living through an all out attack on transgender Missourian’s lives and very ability to exist.”

In response to Bailey’s emergency rule, LGBTQ+ groups came together to “condemn” the impact the move will have on trans Missourians. 

Lambda Legal, the American Civil Liberties Union (ACLU), the National Center for Lesbian Rights (NCLR), GLBTQ Legal Advocates & Defenders (GLAD), and Human Rights Campaign (HRC) said in a joint statement: “This is a dangerous and unprecedented escalation in the assault on evidence-based health care for transgender people. 

“Cutting off treatment for those who need it will create predictable, unnecessary, and serious harm. It is also a blatant attempt to strip transgender people of equal protection under the law and to subject them to intrusive government surveillance and control.”

Lambda Legal and the ACLU of Missouri are working to take legal action against the order, saying they will “defend the rights of transgender people” against “anti-science and discriminatory fearmongering”. 

As the rule is set to come into force, trans people in the state are taking to social media to share that their doctors are already beginning to roll back their gender-affirming care. 

One Twitter user shared a copy of an email from their doctor, which showed they were unable to fulfil her hormone therapy prescription as they do not have the resources to defend their licence – if investigated by the state under the emergency rule. 

Independent journalist Erin Reed, who tracks anti-trans legislation, said what she has been “terrified of for the last three years” has “officially begun”. 

“Trans adults are being pulled from gender-affirming care in Missouri. There will be mass medical detransitioning if this rule takes effect,” she wrote on Twitter, urging people to protect their care immediately.  

GOP AG Bailey has come under fire in recent weeks for Missouri’s growing anti-trans stance and crackdown on trans healthcare, with the government under his leadership going as far as to encourage people to report medical professionals providing gender-affirming care to patients

Earlier in April, the Missouri government launched the The Transgender Center Concerns Form – subsequently titled a “snitch form” by the trans community – which called on residents to “submit a complaint or concern about gender transition intervention you have experienced or observed in Missouri”. 

The controversial form received widespread attention and LGBTQ+ activists and allies, both in Missouri and the wider US, spammed the form with fan fiction, bumbling anecdotes and even the full script for DreamWorks cult favourite, Bee Movie

The form has since been deleted from the Missouri government website.

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