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Sept. 22, 2024 |  By: Annelise Hanshaw - Missouri Independent

Lawsuit seeking to block Missouri ban on gender-affirming care for minors heads to trial

cole county courthouse

By Annelise Hanshaw - Missouri Independent

A lawsuit filed by transgender children and their parents challenging a one year-old Missouri law restricting minors from accessing cross-sex hormones and puberty blockers heads to trial in Cole County Circuit Court beginning Monday. 

Plaintiffs are asking Circuit Court Judge Craig Carter, who typically serves in Wright County, to block the law’s enforcement.

Pretrial briefs filed by plaintiff’s attorneys and the Missouri Attorney General’s office, which is defending the state, have very little in common in the factual background of the case.

The parties have different definitions of gender-affirming care, with Solicitor General Joshua Divine writing that “gender transition interventions are at best experimental and at worst deeply harmful.” 

Gillian Wilcox, an attorney with the ACLU of Missouri, labeled the treatment “medically necessary, evidence-based and potentially lifesaving.”

“Gender-affirming medical care does not harm transgender youth,” she wrote. “To the contrary, it allows them to thrive.”

Both sides agree that transgender Missourians electing to start gender-affirming care have a condition called “gender dysphoria,” which is widely defined as distress arising from an incongruence between one’s gender identity and sex as assigned at birth.

But Divine argues this is purely a “psychiatric, not medical condition” and calls for talk therapy as an alternative to cross-sex hormones or puberty blockers.

“The worst thing that could befall plaintiffs from not receiving an injunction is that individuals seeking treatment for gender dysphoria will receive counseling instead of chemical and surgical interventions. That is no harm at all,” he wrote.

Plaintiffs point to therapy as an unsatisfactory alternative, meaning the law has taken away all avenues for this type of care. Wilcox argues that gender dysphoria was once categorized by the World Health Organization in a chapter on mental and behavioral disorders, under the name “gender identity disorder,” but has since been moved to a section on sexual health.

The sides both mark this 2013 change from “gender identity disorder” to “gender dysphoria,” but Divine writes this in a shallower history that he says begins in 2007 when “clinicians in the United States started to experiment with surgical and chemical interventions.” 

Wilcox says gender-affirming medical care emerged in the 1920s, with the first clinics in the United States treating transgender patients in the ‘60s and ‘70s.

Arguments in the case are scheduled to last approximately two weeks, though both sides have filed motions seeking to exclude the testimony of doctors and other expert witnesses that the opposing party has brought.

Plaintiffs — including families that have changed their child’s care plan because of the law, health care providers and advocacy groups — will argue that the law is unconstitutional. Additionally, they will try to prove that it is subject to higher scrutiny because it discriminates based on sex and “transgender status.”

Defendants — including Attorney General Andrew Bailey and Gov. Mike Parson, among others — argue the state had a compelling governmental interest in enacting and enforcing the law.

The litigation could also determine whether the state can lawfully exclude gender-affirming care coverage from the state’s Medicaid program and covered services in state prisons.