Missouri due to be first state to restrict adult gender-affirming care Missouri AG Andrew Bailey has issued a rule that severely limits adults and youth from receiving gender-affirming care. The rule, the first of its kind, is scheduled to take effect Thursday.

Missouri to restrict gender-affirming care for trans adults this week

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This week, a new rule in Missouri would severely restrict gender-affirming health care for transgender kids and adults. It's the first of its kind in the country and is expected to trigger a lawsuit. St. Louis Public Radio's Jason Rosenbaum reports.

JASON ROSENBAUM, BYLINE: Chelsea Freels spent part of 2023 testifying in the Missouri legislature against bills barring transgender youth like her from accessing what's known as gender-affirming care.

CHELSEA FREELS: It's an ethical obligation to go.

ROSENBAUM: Over and over and over again, the 17-year-old heard GOP legislators talk about how they had to protect her. And whenever she heard that argument, Freels says she responded like this.

FREELS: Protect me from what? I mean, oh, no, the kid is getting better grades. Oh, no, the scary transgender has friends. What are they going to do, smile?

ROSENBAUM: Missouri has been one of a number of states seeking to prevent minors from accessing puberty blockers, hormone therapy and gender transition surgeries. And despite Freels and others conveying how gender-affirming care has made them profoundly happier, state lawmakers have been poised to pass some sort of ban, though, likely a less restrictive one than other GOP states. But then came a bombshell. Missouri Attorney General Andrew Bailey put forward emergency rules placing barriers to gender-affirming care to minors and adults. And even though the guidelines amounted to a departure from the GOP rhetoric around protecting kids, they came as no surprise to Freels.

FREELS: The goal is to erase trans people and score as much political capital while you can.

ROSENBAUM: Attorney General Bailey says the rules are about making people more informed before they decide to get gender-affirming care. And the stipulations are not minor. Before an adult can get hormone therapy or gender transition surgery, they would need to get hours of talk therapy, have three years of documented gender dysphoria and ensure mental health issues are, quote, "treated and resolved." Here's Bailey talking about his rules.


ANDREW BAILEY: 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.

ROSENBAUM: Health care experts, like Brandon Hill of Milwaukee-based Vivent Health, concur that what Bailey is doing is unprecedented. His agency provides health care, including gender-affirming care, primarily to LGBTQ people. Even though the attorney general's rules exempt people who are already receiving care, Hill says they're onerous enough to keep treatments out of reach for all transgender Missourians.

BRANDON HILL: When we move into the adult space, this is saying that your government gets to decide your existence and in what way you can access readily available medications that have been used for decades.

ROSENBAUM: The rules are slated to go into effect later this week unless there's an injunction. But there are some signs that they may be a bridge too far for some Republicans, including Secretary of State Jay Ashcroft.

JAY ASHCROFT: I don't think it's government's role to tell adults, generally speaking, how they spend their own money.

ROSENBAUM: And some LGBTQ advocates hope that the issue will backfire on Republicans, especially as younger voters turn 18 and go to the polls. And Chelsea Freels says her generation can help turn back efforts that could affect people like her.

FREELS: Make no mistake, we will probably lose this battle. But we will win the war. The problem is how many casualties and how many bodies lay dead before we get there.

ROSENBAUM: But Freels won't be in Missouri much longer to see if that backlash comes to pass. As a soon-to-be-adult, she's heading to college in the near future. And she's crossed off Missouri schools from her list.

For NPR News, I'm Jason Rosenbaum in St. Louis.

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