Missouri Lawmakers OK Limits On Transgender Health Care And Athletics

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SPRINGFIELD, Mo. — Republicans in the Missouri Senate endorsed a pair of bills early Tuesday that would ban gender-affirming care for minors and restrict them from participating in sports, a move that follows the state attorney general’s emergency rule limiting the treatment.

Approval of the bills, which came after a 13-hour Democratic filibuster and closed-door negotiations, means the measures need one final vote in the Senate before being sent to the House. It marks a significant hurdle overcome by Republicans, who previously have been unable to come to an agreement on an issue that has risen to the top of their agenda this year.

It is likely to move steadily once it gets across the building to the Republican-controlled House.

Senate Bill 49 permanently bans “gender transition surgery” for minors, which medical experts have said is rare, and outlaws prescribing puberty-blocking drugs and cross-sex hormone therapies to minors until 2027. It makes exceptions for minors who have been prescribed those medications prior to the bill’s effective date of Aug. 28, allowing them to continue receiving treatment that opponents of the bill have described as critical health care.

Attorney General Andrew Bailey issued the emergency regulations on Monday to halt “experimental gender transition interventions” for minors. He outlined a series of required “guardrails” for any treatment for minors, including informed consent and an 18-month waiting period to receive the care.

The emergency rule must be approved by the Secretary of State’s office before being published in the Missouri register and going into effect.

“I am dedicated to using every legal tool at my disposal to stand in the gap and protect children from being subject to inhumane science experiments,” Bailey said in a statement.

As an emergency rule, the timeline for approval from the secretary of state and publication in the Missouri Review is “truncated,” according to Missouri Secretary of State Jay Ashcroft. If approved, Ashcroft said the rules would go into effect in “about 10 days,” and would be in place for 180 days.

Bailey’s rule and the two Senate bills come amid a national anti-LGBTQ push in largely red states as lawmakers debate restrictions on transgender health care, drag shows, bathroom access, and how LGBTQ topics are discussed in schools.

PROMO, an LGBTQ+ policy and advocacy organization, called the move a “gross and reprehensible action that puts the health, wellness, and very lives of transgender and gender-expansive youth at risk.”

“The Missouri Attorney General does not have the right to politicize health care nor use transgender bodies as political pawns,” PROMO said in a statement.

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Emergency ruling limits gender-affirming care for minors

The Endocrine Society, which is cited in Bailey’s release, maintains the position that “medical intervention for transgender youth and adults (including puberty suppression, hormone therapy and medically indicated surgery) is effective, relatively safe (when appropriately monitored), and has been established as the standard of care.”

Bailey’s regulation would prevent providers from offering gender-affirming procedures if they do not:

Perform a full psychological/psychiatric assessment, including at least 15 hourly sessions over the span of at least 18 months, to identify whether the patient has any other mental health comorbidities;
Treat and resolve existing mental health comorbidities;
Track all adverse effects from any course of covered gender-affirming procedures for at least 15 years from the start of the intervention;
Obtain and keep on file informed written consent;
Ensure that the patient has a comprehensive screening to determine whether or not they have autism;
Ensure at least annually that the patient’s gender identity is not the result of a “social contagion.”

Missouri appears to be the first state to issue such a rule on gender-affirming care.

At least seven states have already enacted restrictions or bans on such care: Alabama, Arkansas, Arizona, Mississippi, Tennessee, Utah, and South Dakota. And more than 20 states are considering bills this year to restrict or ban gender-affirming care.

In 2022, the Texas Attorney General released an opinion that called gender-affirming care child abuse and Gov. Greg Abbott issued a first-of-its-kind order, instructing child welfare officials to investigate reports of gender-confirming care for children.

And last year, Florida medical officials with the support of Gov. Ron DeSantis, banned transgender children from receiving hormones or undergoing surgeries to treat gender dysphoria.

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Limiting transgender athlete participation in school sports

Senate Bill 39, sponsored by Missouri state Sen. Holly Thompson Rehder, restricts the ability of transgender student-athletes to play on sports teams matching their gender identity post-transition. Those limits extend to K-12 public schools, private schools, and colleges and universities; the bill allows for female students to compete with male students if no corresponding female league is offered or available.

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