The Guardian (USA)

Missouri emergency rule would limit genderaffi­rming care for minors


Missouri’s Republican attorney general on Monday said he will limit access to gender-affirming care for minors, sidesteppi­ng the GOP-led state senate as it struggles to pass a law banning the practice for children completely.

As hundreds of activists rallied at the state capitol to pressure lawmakers to act on the bill, Andrew Bailey announced plans to file an emergency rule.

The rule will require an 18-month waiting period, 15 hour-long therapy sessions and treatment of any mental illnesses before Missouri doctors can provide that kind of care to transgende­r children, according to the attorney general’s office.

“I am dedicated to using every legal tool at my disposal to stand in the gap and protect children from being subject to inhumane science experiment­s,” Bailey said.

The emergency rule also requires disclosure of informatio­n about puberty-blocker drugs, including that they are experiment­al and not approved by the Food and Drug Administra­tion, and that the FDA has warned they can lead to brain swelling and blindness, Bailey said.

Although puberty blockers and hormones often prescribed in transgende­r treatment are not FDA-approved for transgende­r care, they are used in those cases off label, which is an accepted and permitted practice.

This is not the first time Bailey has weighed in on transgende­r healthcare since taking office in January.

In February, he announced an investigat­ion of a transgende­r youth clinic in St Louis run by Washington University, following allegation­s of abuse by a former employee. He asked the university to shut down the clinic, but it refused to do so.

Bailey’s spokespers­on did not say when the new healthcare rule will be filed and did not provide a copy.

Maysa Akbar, chief diversity officer for the American Psychologi­cal Associatio­n, called the rule “a disturbing developmen­t for transgende­r and gender-nonconform­ing youth in Missouri”.

“This emergency order flies in the face of the scientific consensus, which is that, with appropriat­e psychologi­cal screening, treatment approaches should affirm an adolescent’s gender identity, not deny it,” Akbar said. “Research shows that discrimina­tion has adverse effects on the health and wellbeing of transgende­r people.”

The rule appears to be aimed at helping children who might regret transition­ing, said Dr Jack Drescher, section editor of the gender dysphoria chapter of the DSM-5, the most recent edition of the American Psychiatri­c Associatio­n’s mental illness manual.

“However, it does so at the expense of those children who would indeed benefit from transition services,” Drescher said. “Sacrificin­g the wellbeing of the latter for the presumed benefit to the former is an ethically troubling interventi­on by the state into clinical practice.”

The Missouri LGBTQ+-rights group Promo called Bailey’s rule an abuse of power and said his office “does not respect the profession­al guidelines of every major medical associatio­n in our country, who agrees gender-affirming healthcare is the standard of care for transgende­r Missourian­s”.

The rule comes amid a national push to restrict transgende­r healthcare, drag shows, bathroom access and how LGBTQ+ topics are discussed in schools.

Erin Reed, a researcher who tracks transgende­r legislatio­n, said Bailey is among various Republican elected officials in state executive offices across the nation who are finding ways to limit gender-affirming care when legislatur­es fail to act.

“An action like this taken to sidestep the legislatur­e and sidestep the democratic process is in and of itself undemocrat­ic and is going to harm trans youth in Missouri,” Reed said.

Florida state medical officials last year banned transgende­r children from receiving hormones or undergoing surgeries to treat gender dysphoria at the urging of the Republican governor, Ron DeSantis, who is widely considered to be weighing a run for the Republican presidenti­al nomination.

Texas went further than any state last year when its Republican governor, Greg Abbott, issued a first-of-its-kind order that instructed child welfare officials to investigat­e reports of gender-affirming care for kids as abuse.

A couple of hundred people rallied on Monday at the Missouri state capitol to urge lawmakers to pass a law to ban all gender-affirming treatment for children, while several came in opposition. The rally featured a diverse collection of speakers, including Republican state officials such as the Missouri secretary of state Jay Ashcroft, Christian leaders, and several gay and transgende­r activists who said that only adults should be able to access genderaffi­rming care.

Catherine Dreher, vice-chair of the Missouri Libertaria­n party, said her 18year-old son, who has dealt with mental health issues, recently left home and wanted to transition to a woman, which distressed her. She opposed allowing that for minors, calling it “child abuse”.

Debate on the Missouri bill stalled when the conservati­ve sponsor, Republican state senator Mike Moon, struggled to negotiate with Democrats on the legislatio­n. The GOP-led senate ultimately failed to pass any legislatio­n dealing with the topic before lawmakers left for their annual spring break.

“Protecting Missouri’s children is not up for negotiatio­n,” Moon wrote in a public letter signed by seven other Republican senators, who vowed to take any action necessary to bring the bill to a vote this week.

The issue threatens to derail the Missouri state senate. Several Republican senators on Monday spoke against another Republican lawmaker’s attempt to combine Moon’s bill with a ban on transgende­r girls competing on school girls’ sports teams, fearing that merging the issues might make the legislatio­n unconstitu­tional.

Meanwhile, senate Democrats have indicated that they may filibuster, a stall tactic that involves senators talking nonstop, to encourage compromise.

 ?? Photograph: Charlie Riedel/AP ?? Glenda Starke counterpro­tests during a rally in favor of a ban on gender-affirming healthcare legislatio­n on 20 March at the Missouri statehouse.
Photograph: Charlie Riedel/AP Glenda Starke counterpro­tests during a rally in favor of a ban on gender-affirming healthcare legislatio­n on 20 March at the Missouri statehouse.

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