Court upholds Missouri ban on gender-affirming care for minors

A Missouri court on Monday upheld a state law banning gender-affirming health care for minors and prohibiting Medicaid from covering transition-related care, allowing the controversial law to remain in place following a nine-day trial in September.

Wright County Circuit Judge Craig Carter wrote in a 74-page ruling Monday that Missouri’s 2023 law is constitutional, rejecting a legal challenge brought against it by three transgender teenagers, medical providers and two LGBTQ advocacy organizations.

Carter added he believes there is “an almost total lack of consensus as to the medical ethics of adolescent gender dysphoria treatment.”

“Regarding the ethics of adolescent gender-affirming treatment, it would seem that the medical profession stands in the middle of an ethical minefield, with scant evidence to lead it out,” he wrote.

Missouri’s Republican Attorney General Andrew Bailey, whose office launched an investigation into a pediatric transgender clinic last year and briefly restricted gender-affirming care for minors and some adults under an emergency rule it terminated after one month, called Monday’s decision “a resounding victory for our children.”

“I’m extremely proud of the thousands of hours my office put in to shine a light on the lack of evidence supporting these irreversible procedures,” Bailey said in a statement that also referred to gender-affirming medical care for youth as “child mutilation.”

In a social media post, Bailey said, “The national mood on this issue has moved significantly since we launched our investigation.”

Laws passed in 24 states similarly ban gender-affirming care for transgender minors, half of which took effect after Bailey’s office began its investigation into the Washington University Transgender Center at St. Louis Children’s Hospital over a former employee’s allegations of medical malpractice.

Legal challenges to laws that ban gender-affirming care have been met with mixed results, and federal appeals courts have split over whether such measures are constitutional. The Supreme Court is set to hear arguments early next month in a challenge to Tennessee’s ban, setting the stage for a blockbuster showdown over transgender rights.

Missouri’s law, which is set to expire in 2027, prohibits health care providers from administering puberty blockers or hormones to minors who had not begun treatment before August 2023. It also bans surgeries for transgender children and teenagers under 18 and bars the state’s Medicaid program from covering gender-affirming health care for individuals of any age.

Every major medical organization, including the American Medical Association, has backed gender-affirming health care for transgender adults and minors as medically necessary and opposed efforts to restrict care.

“We are extremely disappointed in this decision, but this is not the end of the fight and we will appeal,” Lambda Legal and the American Civil Liberties Union of Missouri, which are representing the plaintiffs who sued to overturn the law, said in a joint statement. “However, the court’s findings signal a troubling acceptance of discrimination, ignore an extensive trial record and the voices of transgender Missourians and those who care for them, and deny transgender adolescents and Medicaid beneficiaries from their right to access to evidence-based, effective, and often life-saving medical care.”

“Despite heartfelt testimony from parents of transgender youth, transgender adults who’ve benefited from this care at various stages of life, a transgender minor, and some of Missouri’s most dedicated health care providers, the state has prioritized politics over the well-being of its people,” the organizations added. “This ruling sends a chilling message that, for some, compassion and equal access to health care are still out of reach.”