If you’re a transgender resident of Missouri, the next 10 months are set to be horrible. Under an emergency regulation from state Attorney General Andrew Bailey, it will soon become incredibly difficult, if not impossible, for many patients to receive any sort of gender-affirming care.
It’s just the latest red-state attempt to curtail treatment for trans individuals, but what makes these new regulations stand out is their scope. Republicans elsewhere have framed their crusades against trans youth as attempts to save minors from themselves or the predations of “groomers” who are supposedly turning them into sexualized victims. Missouri’s new regulations, on the other hand, affect everyone — including trans adults, according to a spokesperson for Bailey’s office.
Though some observers have tried to pretend otherwise, the push to de-transition America was never going to remain limited to minors.
Beginning on April 27, it will be considered “an unfair, deceptive, fraudulent, or otherwise unlawful practice” for health care providers in Missouri to provide gender-affirming care without forcing their patients to jump through a number of new hoops. To receive treatment, patients will need a medically documented history of gender dysphoria for the last three years. If you’ve only approached a doctor about trans identity in the last year, you’re out of luck, no matter how long you’ve had those feelings.
Among the regulation’s most onerous provisions is one that precludes treatment on trans individuals unless they undergo at least 15 hourly sessions over the course of a year and a half 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.” Unlike other states, Missouri has not moved to exclude gender-affirming treatments from health insurance coverage. But even with private health insurance, the costs associated with the number of therapy sessions required could be higher than some patients are able to afford.
Even if those hurdles are cleared, health care providers can still violate the new rules if they fail to “ensure that any psychiatric symptoms from existing mental health comorbidities of the patient have been treated and resolved” and “that the patient has received a comprehensive screening to determine whether the patient has autism.” Translation: Patients whose depression or anxiety isn’t “resolved” before they seek gender-affirming care cannot legally get the care that might alleviate some of their symptoms of anxiety or depression. And while the emergency regulation doesn’t say autists are prohibited from receiving care, it does place yet another stigma onto the community, as MSNBC columnist Eric Garcia recently noted.
Lastly, providers are also required to read off to patients, or post on their website, a long list of statements that frame gender-affirming care as unproven and dangerous, mirroring the way “pregnancy crisis centers” try to dissuade pregnant women from getting abortions. They must then keep records of “all adverse effects (both expected and unexpected) that arise from any course of covered gender transition intervention for all patients beginning the first day of intervention and continuing for a period of not fewer than 15 years.” Those effects are to be kept “in a form that can be accessed readily for systematic study.” And it requires that providers “document and retain in such patient’s records a detailed description of compliance with the provisions of section.”
The only upside to be found is that the order includes a carveout for “continuing prescription or provision of a specific intervention that has already begun,” as long as the provider “promptly” moves into compliance with the regulation’s required treatments and assessments. But the sprawling reach of Bailey’s order has sparked uncertainty and fear in trans Missourians. “I don’t know how it’ll affect me — I might be able to get my medicine and I might not,” Zora Williams, a 41-year-old transgender woman from St. Louis, told The Kansas City Star.
“It is completely clear that the whole point of this order is to deter providers from Missouri from providing this care,” Shannon Minter, legal director of the National Center for Lesbian Rights, told The 19th. “The point of this order is to make it so burdensome and so contrary to medical ethics and the standard of care that providers give up and no longer treat transgender patients.” And it seems to be working, as some patients have already received word that their treatment will be on pause as clinicians try to limit their legal exposure. “It’s a hell of a thing to wake up to.” @echozaurora just sent me this email from her doctor, who doesn’t have the resources to defend her license from the Missouri AG going after trans people. She’s in her 30s and has been on hormones for over a decade. pic.twitter.com/MDNQBPUnDi Only the most credulous can be surprised at this turn of events. Though some observers have tried to pretend otherwise, the push to de-transition America was never going to remain limited to minors. Social conservatives have clearly stated that they deliberately chose anti-trans rhetoric as a new rallying cry after the full legalization of same-sex marriage. As it stands, Lambda Legal and the ACLU of Missouri have said that they plan to sue to block Bailey’s orders from coming into effect. It may work, given that the ban relies on a novel reading of Missouri’s consumer protection laws. But even if a court enjoins the regulations, it won’t be enough to stop Republican efforts to place similar restrictions directly on the books. I’m afraid that Missouri is just the first of many places where trans adults will be subject to the same level of persecution and harassment under the law that trans minors are already experiencing across the country.
Hayes Brown is a writer and editor for MS NOW. He focuses on politics and policymaking at the federal level, including Congress and the White House. 
