‘People are scared.’ Trans Missourians fear AG’s rules will restrict care for adults, minors

When Kris Humphreys, a primary care physician who provides gender-affirming care for adults in the Kansas City region, learned about new rules restricting transgender health care in Missouri, it was a gut punch.

“My phone has rung off the hook today with terrified patients,” said Humphreys, who is licensed in both Kansas and Missouri but sees patients in Kansas. “People are scared, they’re sad, they’re angry. They’re terrified.”

For Humphreys, who is transgender and uses they/them pronouns, it’s hard to put into words how devastating the restrictions will be for Missourians seeking gender-affirming care.

While Missouri lawmakers target procedures that assist minors in transitioning genders, Missouri Attorney General Andrew Bailey, a Republican, ramped up the debate last week and went after gender-affirming care for people of all ages, including adults.

Bailey filed a set of restrictions, including requiring 15 separate hourly therapy sessions over 18 months before a person can receive care. The restrictions aimed at limiting all transgender health care, including adults, are believed to be the first of their kind in the country.

Humphreys said the new restrictions on transgender health care will effectively end gender-affirming care for adolescents in Missouri. And, they said, the rules could do the same for adults.

“It is an intentional withholding of care,” they said. “It’s going to cost lives. It’s certainly going to cost mental health. And I just find it unethical and unconscionable.”

When Bailey’s office announced the restrictions, it said the restrictions were aimed at stopping gender-affirming care for minors. But the wording of the restrictions makes no distinction between minors and adults.

“We have serious concerns about how children are being treated throughout the state, but we believe everyone is entitled to evidence-based medicine and adequate mental health care,” Madeline Sieren, Bailey’s spokesperson, told The Star in an email when specifically asked if the rules extended to adults.

The Republican attorney general’s emergency rules, which will take effect April 27 and expire in 2024, have roiled the state’s transgender community as well as doctors, LGBTQ advocates and civil rights groups. The restrictions have created an atmosphere of alarm among transgender Missourians as some contemplate whether to rush to stock up on treatments before the rules take effect.

Many worry the rules will severely limit doctors’ abilities to provide care for patients seeking life-saving treatment. Advocacy groups have also threatened to sue over the move to limit care for adults.

Kendall Martinez-Wright, a 29-year-old Afro–Puerto Rican transgender woman from the rural city of Palmyra in northeastern Missouri, said that people of color in the transgender community already have to deal with high rates of violence and families that do not welcome them.

“This emergency rule is playing with our very lives,” she said, saying that the restrictions were “beyond disturbing and diabolical.”

But some Missouri Republicans who are pushing for limits to transgender care celebrated the new restrictions.

“As we know very little about the long-term effects of these experimental procedures, these surgeries and hormone treatments should not be permitted and should never be performed on children,” state Sen. Denny Hoskins, a Warrensburg Republican, told The Star.

The rules come as Republican lawmakers debate bills aimed at prohibiting doctors from providing transgender health care to people under 18. Bailey issued his rules on the same day the Missouri House passed a bill that would gender-affirming care for minors. The Senate has already passed a less strict version of the legislation.

Kansas City Mayor Quinton Lucas, who is an attorney, urged doctors to ignore the rules in a tweet Friday.

“No healthcare organization in Missouri should follow this unlawful order,” he tweeted. Bailey’s “shameful actions, however, will have an effect. His rhetoric shows no regard for children and families affected by his hate and the lives that will be lost as he tries to erase members of our community.”

Some doctors who provide gender-affirming care in Missouri were unwilling to talk with The Star about Bailey’s new rules, fearing that added attention would hurt their ability to care for patients.

The restrictions, which rely on the state’s consumer protection laws, include a provision that bans doctors from providing puberty blockers or hormone therapy unless a patient has shown three consecutive years of “medically documented, long-lasting, persistent and intense” gender dysphoria.

They also ban treatment until all of a patient’s underlying mental health issues have been resolved, which a Kansas City-based doctor previously told The Star was unrealistic. Doctors who violate the restrictions could face lawsuits from Bailey’s office for fraud.

However, the restrictions state that they wouldn’t apply to “continuing prescription or provision of a specific intervention that has already begun,” leading some in the transgender community to believe that they may be grandfathered in and would still be allowed to receive treatment.

“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 Star on Friday. “It’s cruel and the cruelty is the point.”

Most troubling to Williams, who said she pored over the rules several times after they were released, is a provision that requires doctors to screen patients for autism before providing gender-affirming care.

“After jumping through all those hoops to get access to gender affirming care…after doing all of that, you have to get tested to see if you might have autism, which is extremely ableist and discriminatory,” she said.

“There will be trans people who will take their own lives because of this” said Daniel Bogard, a St. Louis rabbi and father of a young transgender boy. “The Attorney General has blood on his hands from this.”

Bogard told The Star he spoke with members of the transgender community who were scrambling to figure out how they can get six months worth of medications after the rules were announced.

On top of the restrictions, the rules require doctors to provide patients a lengthy list of potential negative side effects and information designed to curtail treatment. Humphreys, the transgender doctor who provides gender-affirming care, said Bailey’s restrictions rely on outdated studies or mischaracterizations of studies that are supportive of gender-affirming care.

Numerous studies, including by the Journal of the American Medical Association, show that gender-affirming care results in lower chances of depression, anxiety and suicidality, Humphreys said.

One of the disclosures in Bailey’s rules describes puberty blockers or cross-sex hormones to treat gender identity disorder as “experimental and is not approved by the Food and Drug Administration.”

The FDA has approved puberty blockers to treat children with precocious puberty, a condition that causes early sexual development. And sex hormones have been approved to treat hormone disorders.

While the FDA has not approved the medications specifically to treat gender-questioning youth, they have been used for that purpose “off label” — a commonly accepted medical practice.

Across the Kansas City region, few clinics offer gender-affirming care for minors. Gender Pathway Services at Children’s Mercy provides family-centered services for transgender and gender-questioning children, including behavioral health services and hormone therapy, according to its website.

Marlene Bentley, a hospital spokesperson, told The Star in an email Friday that the hospital was “reviewing the emergency regulation and continue to be dedicated to providing the best evidenced-informed care focused on the long-term physical and mental health outcomes for every child we see.”

The rules follow an investigation launched by Bailey’s office into Washington University Transgender Center at St. Louis Children’s Hospital, which provides gender-affirming care for minors. Bailey began the inquiry after a former employee at the center alleged that the center harmed children, rushing mentally ill children into hormone therapy without properly treating their underlying mental health issues.

However, patients and parents of patients who spoke with The Star have cast doubt on the allegations, saying the center’s treatment had been misrepresented.

The American Civil Liberties Union of Missouri and Lambda Legal, an LGBTQ civil rights group, vowed to sue against the new rules in a joint statement Thursday. Bailey’s office is already facing a lawsuit from Planned Parenthood for investigating gender-affirming care that the organization provides.

“This rule is a shocking attempt to exploit Missouri’s consumer protection laws in order to play politics with life-saving medical care,” the statement said in part. “This emergency regulation will have a drastically negative impact on transgender youth, compounding the prejudice, discrimination, violence, and other forms of stigma they continue to face in their daily lives.”