Missouri Attorney General Targets Healthcare for Transgender Adults
Relying on fake medical information promoted by anti-trans activists, Missouri AG Andrew Bailey has acted unilaterally to severely restrict adult transitions.
by Evan Urquhart
A propaganda-laden emergency order from Attorney General Andrew Bailey of Missouri is breaking new ground in the far right’s relentless attacks on transgender Americans. The order goes far beyond the recent efforts to ban gender-affirming care for minors, targeting adults for wide-ranging, unprecedented restrictions on necessary medical treatment.
In form, the order closely resembles abortion TRAP laws, which have been used by Republicans to limit legal abortions by arduous, unnecessary restrictions under the guise of protecting the health of individuals seeking the procedures.
The chilling slate of restrictions under the emergency order include requiring a minimum of 15 therapy sessions over 18 months before an adult transgender patient can receive medical interventions such as cross-sex hormones. As a reminder, trans people are disproportionately likely to be poor and unemployed, and insurance companies often limit the number of therapy sessions that they cover. For many poor trans people, a requirement to undergo 18 months of therapy amounts to an outright ban already.
The order would also require “any existing mental health comorbidities of the patient [to] have been treated and resolved.” Practically speaking, this means trans people who experiencing depression or anxiety would be banned from receiving treatment, even though multiple studies have found that treating gender dysphoria is associated with a reduction in depression and anxiety.
The order includes twelve justifications for the restrictions, all of which seem to have been culled from misinformation spread by anti-trans activists. These include items that are technically true, such as the fact that the FDA has not approved the use of cross-sex hormones and puberty blockers to treat gender dysphoria, without the context that off-label prescribing is both legal and common, along with outright falsehoods.
screenshot from the American Medical Association Journal of Ethics
One false claim in the AG’s document cites an absurdly high desistance rate. It claims, “The Endocrine Society found that “the large majority (about 85%) of prepubertal children with a childhood diagnosis did not remain GD/gender incongruent in adolescence.” This is, simply put, untrue. The only figures in that ballpark are based on outdated criteria for gender incongruence, which was treated by conversion therapists in the 1980s. Recent studies of transgender youth have found that very few young people return to living as the gender assigned to them at birth. For example, one recent study found that 94 percent of youth who socially transitioned identified as binary transgender after a 5 year period.
In reality, the Endocrine Society opposes bans on gender-affirming care for youth, much less for adults. Their website states: “Over the last decade, there has been considerable research on and development of evidence-based standards of care that have proven to be both safe and efficacious for the treatment of gender dysphoria/gender incongruence in youth and adults.”
Any one of the Attorney General’s bullet points could be similarly debunked. The medical evidence in favor of gender-affirming care is not remotely weak or speculative, compared to other treatments, and evidence casting doubt on its efficacy relies on a lack of scientific literacy. The ongoing campaign of misinformation aimed at trans people and their necessary, life-saving medical treatments has resulted in a moment trans people have seen coming for quite some time now, a time when evidence-based treatments for adults are being banned on the basis of transphobic lies and religious zealotry.