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Attorney General Andrew Bailey’s restrictions on gender-affirming care will affect adults

Andrew Bailey, newly appointed Missouri Attorney General, gives remarks after being sworn in on Tuesday, Jan. 3, 2023, at the Missouri Supreme Court in Jefferson City.
Brian Munoz
St. Louis Public Radio
Missouri Attorney General Andrew Bailey, shown in January, has issued emergency rules limiting transgender health care that go into effect next week.

Missouri Attorney General Andrew Bailey said Thursday that his emergency rules restricting transgender-related health care will affect adults.

There had been questions about whom the rules cover, but in an interview with St. Louis Public Radio, Bailey said they affect children and adults. Some providers of treatment like hormone therapy and gender transition surgery contend the regulations are so onerous that they'll result in gender-affirming care being shut off for everyone.

While part of Bailey’s rule exempts these restrictions for people who are already undergoing gender-affirming care, Brandon Hill, CEO of Vivent Health, said the guidelines are so restrictive that providers would be hesitant to give care to anyone.

“This could lead to the discontinuation of that care if the health care providers are not able to meet all these new requirements that are both antiquated and not based in science at all,” said Hill, whose company provides services largely to LGBTQ people and has clinics in St. Louis and Kansas City. 

Bailey’s rules come during a fierce debate in Missouri and around the country about whether treatments like puberty blockers, hormone therapy and gender-reassignment surgery should be legal for minors. Republicans have said they need to pass such legislation as a way to protect children.

But after Bailey’s rules were released last week, there was no mention that the regulations would only affect minors. Some of the requirements include having three years of documented gender dysphoria, a screening for autism and at least 15 hours of mental health care.

“These are intended to protect all patients and make sure that all patients have access to mental health services, and that all patients understand the experimental nature of the drugs,” Bailey said.

Medical professionals, such as Hill, have said the drugs are not experimental.

“We've never had to navigate a space in which adults seeking care who are informed of the care and informed of all the possible side effects are now being told that the government has decided to say whether they can actually engage in that care,” Hill said.

Asked what the public policy goal is of restricting adults' access to gender-affirming care when much of the discussion in Missouri and elsewhere has revolved around minors, Bailey said he “wanted all patients to have access to the information necessary to make health decisions that can have long-term deleterious health consequences.”

“But at the end of the day that started with protecting children,” Bailey said.

One aspect of the rule stipulates that providers cannot give gender-affirming care if they don’t “ensure that any psychiatric symptoms from existing mental health comorbidities of the patient have been treated and resolved.”

Bailey said that means “treating these other mental health problems before we raced down the road of administration of experimental drugs.”

“Mental health comorbidity is a recognized medical term so that the providers know how to apply those terms,” Bailey said. “And certainly, they've done this before in other contexts. So this is not groundbreaking in the sense that we're quantifying the need to put some safeguards in place to make sure that patients have access to mental health services and information.”

Court fight looms

Several LGBTQ rights groups have promised to sue over the rules, which are set to go into effect on April 27 and last through February 2024.

A consortium of groups including the ACLU, Lambda Legal and the Human Rights Campaign said in a statement: “We wish to make unequivocally clear that we will challenge this and any similar attempt to interfere with the fundamental freedom of transgender people to obtain medically necessary care and to be treated as equal, respected, and participating members of our democracy.”

Bailey said he was confident the rules will hold up in court.

“I'm proud that this is an innovative approach to protecting the health care of patients and making sure that mental health patients have informed consent and have all the information necessary to make good decisions,” Bailey said. “And we're confident in the ultimate success.”

Bailey disagrees with Ashcroft criticism

Secretary of State Jay Ashcroft posted Bailey’s rules online this week as required by state law, which a spokesperson said meant they will go into effect next week.

But Ashcroft is not in favor of restricting gender-affirming care for adults.

“If you’re an adult and you want to spend your own money, I disagree with you,” Ashcroft said on a recent edition of the Politically Speaking podcast. “But it’s not my place to tell you that you can’t. I don’t think people should do it. But there’s a difference between what I think and where I think the government should be involved.”

Bailey disagreed with Ashcroft’s position.

“I am standing up to make sure that patients have the information they need to make informed health care decisions,” Bailey said. “I'm not sure that the secretary of state fully understood the rule when he offered that opinion.”

Jason is the politics correspondent for St. Louis Public Radio.