The Missouri Supreme Court has unanimously upheld a ban on gender transition surgeries, cross-sex hormones and other gender-affirming care for minors.
Writing for the court, Judge Kelly Broniec said the prohibited surgeries don’t violate the rights of transgender children. Plaintiffs sued to overturn the ban, arguing it violates the equal protection and due process clauses of the Missouri Constitution.
“Although parents have a right ‘to make decisions concerning the care, custody, and control of their children[,]’....there is no fundamental ‘right of a parent to obtain for his or her child a medical treatment that, although the child desires it and a doctor approves, the state legislature deems inappropriate for minors,’ Broniec wrote.
Missouri’s General Assembly enacted the ban, also known as the SAFE Act, in 2023, and the law took effect later that year. The ban expires in 2027, although lawmakers have said they want to make the prohibitions permanent. A ballot initiative planned for November also seeks to ban such care indefinitely.
In the lawsuit, plaintiff E.N. argued on behalf of her minor child that the ban interfered with parents’ rights to decide appropriate medical care for their children and that it was discriminatory based on transgender status and sex.
In its opinion, the state’s highest court disagreed, saying the ban “classifies only on age and medical use…the SAFE Act prohibits the performance of gender transition surgery on, and prescription or administration of cross-sex hormones or puberty-blocking drugs for “any individual under eighteen years of age.”
The court also upheld Missouri’s ban on using state Medicaid funds for gender transition surgeries and hormones, stating the treatments are an “area fraught with medical and scientific uncertainties” and demonstrates a lack of accepted standards of practice.
However, several medical associations have supported appropriate and considered gender-affirming procedures for children.
American Academy of Pediatrics President Susan J. Kressly last year called restrictions “a baseless intrusion into the patient-physician relationship” after the federal Centers for Medicare and Medicaid Services proposed rules prohibiting Medicaid payments for gender-affirming care to minors.
“The government’s actions today make that task harder, if not impossible, for families of gender-diverse and transgender youth,” Kressly said.
The decision comes on the heels of the 2025 United States Supreme Court decision that upheld Tennessee’s ban on gender-affirming care for those under 18.
