Missouri AG issues order limiting gender-affirming care

Andrew Bailey, Missouri's attorney general, in Washington, DC, on Feb. 28. Photo: Valerie Plesch/Bloomberg via Getty Images

Missouri Attorney General Andrew Bailey issued new regulations Thursday severely limiting gender-affirming care for both adults and youth.

Driving the news: ACLU and Lambada Legal announced they'll take legal action to challenge the order, which states that it's "unfair, deceptive, fraudulent, or otherwise unlawful" to provide a gender affirming care to patients without informed consent and lengthy evaluations.

Reality check: Health experts say most anti-trans state bills are based on scientifically inaccurate information.

• Gender-affirming care is endorsed by medical groups, including the American Medical Association, the American Academy of Pediatrics, the Endocrine Society and the World Health Organization.

Between the lines: The measure is one of several ways gender-affirming care for adults is being targeted without a total ban.

Details: The order institutes a three-year waiting period for medical intervention and requires psychological or psychiatric assessment.

• The assessments must consist of at least 15 sessions over 18 months, at least 10 of which must be with the same therapist, to "explore the developmental influences on the patient’s current gender identity and to determine, among other things, whether the person has any mental health comorbidities."
• Those who transition would be a required to get medical follow-ups for 15 years.

Of note: There are no such waiting periods for other types of care.

Meanwhile, the new rules state that the patient must ensure they've "received a comprehensive screening to determine whether the patient has autism."

• It does not specify whether this means that people with autism would be banned from treatment. Representatives for the attorney general did not immediately respond to Axios' request for comment to clarify this.

What he's saying: Bailey said that he put the emergency regulation into place to clarify that "[b]ecause gender transition interventions are experimental and have significant side effects, state law already prohibits performing those procedures in the absence of substantial guardrails that ensure informed consent and adequate access to mental health care."

What they're saying: "The Attorney General’s so-called emergency rule is based on distorted, misleading, and debunked claims and ignores the overwhelming body of scientific and medical evidence supporting this care as well as the medical experts and doctors who work with transgender people every day," the ACLU of Missouri and Lambada Legal said in a joint statement.

• "We will defend the rights of transgender people through any necessary legal action, just as we have done in other states engaging in this anti-science and discriminatory fearmongering."

Zoom out: State efforts to restrict gender-affirming care nationwide are moving beyond trans youth and increasingly toward adults.

• Gender-affirming care advocates say the efforts are proof anti-trans lawmakers want to block all access to those services, not just restrict care to minors, Axios' Oriana González reports.

Flashback: Last month, Bailey issued another regulation attempting to bar trans youth from gender affirming care.

Editor's note: This article has been updated with comment from ACLU of Missouri and Lambada Legal.

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