Two more states join the growing list with moves to restrict gender-affirming care for under-18s

Missouri and Louisiana inched closer toward banning transition care for trans youth, building upon a tsunami of state efforts to restrict access to puberty blockers, hormone therapies, and reassignment surgeries.

The majority of state-led initiatives restricting gender-affirming care have applied to minors, with many voices on the right concerned over what they argue is abuse with far more risks than benefits to a child’s mental and physical wellbeing.

But those arguments run counter to messaging from major medical organizations such as the American Academy of Pediatrics and the American Psychiatric Association, which support using treatments like puberty blockers as ‘medically necessary’.

Missouri’s Republican Gov Mike Parson signed a bill into law on Wednesday that prohibits doctors from performing gender transition surgeries or prescribing hormone therapy or other drugs for gender transition to under-18s.

Meanwhile, in Louisiana, the state senate resurrected a once-presumed-dead bill banning hormone treatments, transition surgeries, and puberty blockers for trans minors there.

At least 20 states have taken steps to restrict or fully ban transition healthcare for trans youth

Most youth who have spoken with mental health professionals and caregivers and decide to transition with a start with puberty blockers (shown) medically

Most youth who have spoken with mental health professionals and caregivers and decide to transition with a start with puberty blockers (shown) medically

The fight over transgender healthcare access reached a fever pitch in early 2022 when Texas’ Republican Gov Greg Abbott issued a state-wide order that parents found to be sanctioning transition care for their children could be investigated for child abuse. 

The investigations ordered by Gov Abbott were the first of their kind and jumpstarted a fight over healthcare specifically.

Louisiana Republicans resuscitated the bill after a failed attempt last month to advance it out of committee for a full vote.

The legislation passed in the Senate largely along party lines by a vote of 29 to 10 and will return to the House floor for one final vote, where it is expected to succeed before landing on Gov John Bel Edwards’ desk.

While the House is almost guaranteed to send the legislation to the governor’s office, it is unclear whether Mr Edwards will sign it into law. 

Edwards is a Democrat – a conservative one but a Democrat nonetheless – who once rejected a measure that would have barred transgender girls and women from participating on sports teams that match their gender identity.

Gov Edwards billed it as ‘discrimination’ and a ‘solution in search of a problem that simply does not exist in Louisiana’. More recently, Edwards chose not to block a similar measure from becoming law.

But even if Gov Edwards rejects the bill if and when it is sent to his desk, it might not make a difference. 

The measure passed out of the GOP-controlled legislature by such a wide margin that it could override a veto from Edwards.

In Missouri, meanwhile, healthcare providers will be prohibited from prescribing transition services to minors starting August 28.

Gov Parson said on Wednesday: ‘We support everyone’s right to his or her own pursuit of happiness; however, we must protect children from making life-altering decisions that they could come to regret in adulthood once they have physically and emotionally matured.’

He further characterized transition care as ‘harmful, irreversible treatments and procedures’.

Gov Parson added: ‘These decisions have permanent consequences for life and should not be made by impressionable children who may be in crisis or influenced by the political persuasions of others.’

Trans rights advocates have slammed Missouri’s new law, calling it ‘deceitful’, ‘cruel’, and a ‘shameful abuse of power’.

The American Civil Liberties Union of Missouri said: ‘While the government pushed this deceitful bill behind the guise of protecting children… This law strips patients and parents of their rights. 

It requires that the uninformed opinions of politicians dictate decisions related to medical treatment based on consent informed by medical professionals.’

Transgender healthcare services and access to them have become a leading culture war issue, with those leaning conservative more likely to oppose a minor’s authority to make a life-altering decision such as removing breasts or suppressing testosterone.

Some evidence shows that youth experiencing gender dysphoria came to accept their bodies and biological sex without medical intervention. 

Dr Riittakerttu Kaltiala, a Finnish child and adolescent psychiatrist described as an expert in pediatric transition care, said in February that ‘four out of five’ trans youth grow out of it.

At the same time, Dutch researchers found that the vast majority of people who begin transitioning in their youth continue with the care into adulthood.

Researchers considered data from 720 trans youth ranging in age at the start from 13 to 17 who visited the gender identity clinic of Amsterdam UMC for puberty-blocking drugs. Ninety-eight percent of the trans youth continued on to take hormone therapies to continue their transition.

The Food and Drug Administration approved puberty blockers 30 years ago to treat children with precocious puberty, which causes sexual development to begin much earlier than usual.

Sex hormones — synthetic forms of estrogen and testosterone — were approved decades ago to treat hormone disorders or as birth control pills.

The FDA has not approved the medications specifically to treat gender-questioning youth, but they have been used for many years for ‘off-label,’ a common and accepted practice for many medical conditions.