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Missouri activists celebrate, worry after Bailey pulls rule limiting gender-affirming care

Demonstrators took to the streets of downtown St. Louis to protest statewide policies and rhetoric targeting transgender people on April 16, 2023, outside of City Hall.
Danny Wicentowski
St. Louis Public Radio
Demonstrators protest policy and rhetoric concerning transgender people in April outside City Hall in downtown St. Louis. Advocates for transgender people say they worry Missouri officials will make further attempts to restrict gender-affirming care.

Health care providers and transgender patients in Missouri say they’re relieved that Attorney General Andrew Bailey this week pulled an emergency rule to limit gender-affirming care. But they’re preparing for more challenges to patient access to surgery, hormones and other treatments.

The rule Bailey filed in April would have expired in February. It required both adults and minors to submit to hours of therapy and resolve any mental health issues before obtaining gender-affirming care.

It also required patients to undergo screening for autism, display at least three concurrent years of gender dysphoria and sign informed consent forms that included claims about the health risks of certain procedures before receiving care. Advocates for transgender care said those claims were not based in science or mischaracterized studies about the risks of gender-affirming treatments.

The American Academy of Pediatrics, the American Medical Association and other major medical associations support gender-affirming care and say children who receive such care are healthier.

The rule created hurdles that would have drastically reduced who would have been able to get treatment, said Dr. Sam Tochtrop, who treats transgender patients at Southampton Healthcare in St. Louis.

He was overwhelmed when he learned of Bailey’s decision to pull the rule.

“I needed to take a minute to lean against a pole,” said Tochtrop, who is a plaintiff in a lawsuit that sought to overturn the rule.

“In a way, it does feel like a victory. [But] in the total landscape of things, it feels like a relatively small one,” he said. “It does make an enormous difference in the lives of many of our patients.”

A spokeswoman for Bailey said the attorney general pulled the rule because the state legislature this month passed a bill that bans gender-affirming care for people under 18. Gov. Mike Parson is expected to sign the bill and another one that requires student-athletes to compete under the gender they were assigned at birth.

Bailey frequently has said Missouri should protect children from gender-affirming procedures, but the emergency rule applied to transgender people of all ages.

Transgender activists said they can’t completely celebrate the rule’s termination given that Parson likely will sign the ban on care for minors into law.

“It feels like I just jumped off the train that was about to run off the rails, but there’s still another train coming,” said June Choate, an events coordinator and support group facilitator for the Metro Trans Umbrella Group. “There’s still that tension … just living in this state, especially with what we’re seeing down in Florida, you can’t help but feel that sense of paranoia.”

This week, Florida Gov. Ron DeSantis signed a law banning gender-affirming care for minors and placing limits on treatment for adults.

Choate said although Missouri this session focused on care for minors, she fears lawmakers could target adult care in the future.

Tochtrop said providers need to stay vigilant and realize more restrictions could come.

“Just because this emergency rule didn’t end up going through and now that it is withdrawn doesn't mean there isn’t going to be another something like this that is going to pop up in coming weeks or months,” he said. “We need to … try to fight for the rights of our patients, fight for the rights of trans folks, even if there’s not an immediate threat right there in front of us.”

Advocates for transgender people are encouraging the public to urge Parson to veto the two bills aimed at trans minors.

“This win is huge for our community, and we encourage you all to breathe a little easier today that our most immediate threat is over,” leaders of PROMO Missouri, an LGBTQ advocacy group, said in a statement. “However, we still need you in this fight as we face the anti-trans legislation headed to the governor's desk.”

Sarah Fentem is the health reporter at St. Louis Public Radio.