Missouri judge pauses enforcement of limits on gender-affirming care for trans youth and adults for 15 days

By Devan Cole, CNN

Missouri’s limits on gender-affirming care for minors and adults in the state will be paused for two weeks, a state judge ruled Monday.

St. Louis County Circuit Judge Ellen Ribaudo’s order means that, for now, some of the nation’s widest-reaching limits on gender-affirming care will be paused as she considers whether to block them for a longer period as a legal challenge plays out.

The judge set a hearing for May 11 on the request for a preliminary injunction brought by trans Missourians and health care providers against the restrictions issued last month by Republican Attorney General Andrew Bailey.

The restrictions were set to go into effect last week, but Ribaudo previously temporarily blocked enforcement of them to give herself more time to consider the issue before making a ruling Monday.

A number of GOP-led states have in recent years enacted bans on such care for minors, but Missouri’s rules represented the first time a state has attempted to impose such restrictions on trans adults.

The limits were issued by Bailey in the form of an “emergency rule” that claimed that people often take “life-altering interventions,” like pubertal suppression or gender transition surgery, “without any talk therapy at all,” and that the emergency action is “needed because of a compelling governmental interest and a need to protect the public health, safety, and welfare” of Missourians.

Gillian Wilcox, an attorney with the American Civil Liberties Union of Missouri, which is providing representation to the plaintiffs in the case, welcomed Monday’s order.

“As was clear from the beginning, the attorney general’s claim of an emergency was proven an untruthful and dangerous attempt to get involved in individual and family medical decisions, showing that he will attack the very people he supposed to serve and protect,” Wilcox said.

“We remain confident in our position because the Court even acknowledged that it deferred its consideration of the science until a later date,” said Madeline Sieren, a spokesperson for Bailey’s office, in a statement. “We will continue to fight for all patients to have access to adequate health care.”

Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender — the one the person was designated at birth — to their affirmed gender, the gender by which one wants to be known. Major medical associations agree gender-affirming care is clinically appropriate for children and adults with gender dysphoria, according to the American Psychiatric Association.

Among other stipulations, the attorney general’s rule says it’s “unlawful” for individuals or health care providers to provide gender-affirming care without confirming that a patient has “for at least the 3 most recent consecutive years … exhibited a medically documented, long-lasting, persistent and intense pattern of gender dysphoria.”

If allowed to go into effect, the rule would expire February 6, 2024, according to a release from Bailey’s office.

The lawsuit was brought last Monday by a transgender adult in the state, two trans youth there, a St. Louis center that providers treatment for gender dysphoria and a social worker in the city who “provides individual therapy and assistance with gender care needs,” according to court documents.

Their lawyers argued in their complaint that Bailey, who relied on a state consumer protection law to issue his emergency rule, exceeded his authority in doing so and did not properly follow the state’s rulemaking process.

Urging the judge to reject the request, Bailey said in court papers that he was justified in issuing the rule and argued the plaintiffs are “attempting to short-circuit the standard litigation process” by seeking the emergency relief.

“In short, the bogeyman caricature of this regulation as a ‘horrifying’ ‘ban’ on care is grossly inaccurate. This regulation simply ‘promote(s) psychotherapy and reserve(s) puberty-blockers and cross-sex hormones for a system in which patients’ have received a comprehensive assessment and commonsense protections,” they wrote.

In pushing such restrictions for minors, lawmakers have long argued that young people should wait until adulthood to make decisions around such care. But LGBTQ advocates have stressed that the long-term goal for conservatives has been to prohibit the care for everyone, regardless of age, and several bills seeking to restrict the care for adults were introduced in statehouses around the country earlier this year, underscoring that point.

This story has been updated with additional details Monday.

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CNN’s Kyung Lah contributed to this report.