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Opinion: Missouri AG’s Emergency Order Threatens Vulnerable Trans Youth

Missouri Attorney General’s emergency regulation released April 13th has imposed substantial limitations on who is eligible for gender-affirming care. The new “guardrails” imposed by the Attorney General’s office include a mandate on providing medically-inaccurate information about gender-affirming care and prohibits care without at least 15 separate therapy sessions across 18 months. There are additional restrictions on receiving gender-affirming care for minors with “social media addiction,” “maintain data about adverse effects,” and any person with depression, autism, or any “mental health comorbidities.”

These restrictions neglect the overwhelming body of evidence that supports gender-affirming care for trans people. In the United States, every major medical organization from the American Academy of Pediatrics to the American Medical Association endorses gender-affirming care for minors. Consider AAP’s policy statement on gender-affirming care, which reads in part: “The AAP recommends that youth who identify as transgender and gender diverse have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space.” For transgender and gender-expansive youth, this means access to medical treatments including hormones, puberty blockers, and other medical interventions for gender alignment.

The Attorney General’s statement presumes multiple ideas that are not scientifically sound. For example, stipulations prohibiting care on young people who use social media and the requirement to monitor for “social contagion” presumes that more people are coming out as transgender because of the influence of social media or celebrities. This assertion that being transgender is not a natural part of who we are ignores a long, extensive, and global history of cultures and peoples who recognize more than two genders and transgender identities.

It is true that more people come out today as transgender than four decades ago, but this is primarily driven by social change that has fostered greater acceptance of transgender people. In this same period, there are also more young people who have come out as bisexual – not because there is something causing an increase in bisexuality, but rather because greater social acceptance of people who are not heterosexual. As society has grown increasingly accepting of people who are not straight and cisgender, we have made it more comfortable for people to come out of the closet. Another case study is with left-handedness, which began to steadily increase through the mid 20th century until it plateaued in the 1970s. Researchers who studied this attributed the rise to “a decline in enforcing right-handedness.” When we reject rigid notions of gender and sexuality that trap us into narrow and restrictive boxes, we can all become more free and connected to our identities.

Another inaccurate generalization made is about the safety of gender-affirming care. The Attorney General’s statement argued that gender-affirming care is only “experimental,” and thus should not be used by children suffering gender dysphoria. These claims neglect how gender-affirming care and interventions, including hormones and puberty blockers, have been used for decades and are safe. The World Professional Association for Transgender Health, whose writings were cherry-picked by the Attorney General to support his emergency order, has openly condemned his emergency order. As they write: “Gender-affirming interventions are based on decades of clinical experience and research and are not considered experimental. Gender affirming hormone therapy (GAHT) is a component of widely accepted medically necessary care for TGD people.”

The Attorney General’s letter also misses out on a glaring omission – about how gender-affirming care saves lives for young people who are trans and gender-expansive. As Columbia University’s Department of Psychiatry writes, while a disproportionately high number of transgender and gender-expansive youth experience depression or suicidal ideation, “numerous research studies have found that gender-affirming care leads to improved mental health among TGNB youth.” A recent study from the University of Washington quantified the impact, finding that transgender and gender-expansive youth were 60% less likely to experience depression and 73% less likely to experience suicidality after receiving gender-affirming care.

Attorney General Bailey’s unwanted intervention in the medical decisions of transgender and gender-expansive people neglects the overwhelming scientific evidence which opposes onerous restrictions as he proposed. Such an emergency order deprives the freedom of patients and doctors to make the medical decisions that are right for them. Young people need healthcare, not paternalism. The Attorney General’s decision is dangerous and hurts the very kids he claims to want to help.