A Missouri judge has upheld a 2023 state law that bars transgender minors from receiving cross-sex hormones, surgeries and other gender-affirming care treatments.
Lambda Legal, the ACLU of Missouri and St. Louis-based law firm Bryan Cave Leighton Paisner last year sued the state, arguing the law discriminates against transgender minors and violates the rights of parents to decide what treatment is best for their children.
Attorneys filed the suit in Cole County on behalf of transgender minors and their families, medical providers and advocacy groups.
In a decision released Monday, Wright County Circuit Judge Craig Carter ruled the law did not violate the state’s constitution, noting that there is lack of consensus on whether gender-affirming care for minors is appropriate and safe.
When scientific and medical consensus is uncertain, laws are allowed to be broad, Carter wrote in his decision.
The decision comes around two months after the end of a nine-day bench trial that included testimony from transgender people, their families, medical providers and ethicists.
“The Court finds an almost total lack of consensus as to the medical ethics of adolescent gender dysphoria treatment,” Carter wrote in his decision. “The evidence at trial showed severe disagreement as to whether adolescent gender dysphoria drug and surgical treatment was ethical at all and if so, what amount ... was ethically allowable.”
The law, known as the SAFE Act, also bars the state’s Medicaid program from paying for gender-affirming treatment for people of all ages.
Representatives from Lambda Legal criticized the judge’s decision and said they planned to appeal.
“The court’s findings signal a troubling acceptance of discrimination [and] ignore an extensive trial record and the voices of transgender Missourians and those who care for them,” Lambda representatives wrote in a statement. “The state has prioritized politics over the well-being of its people.”
The American Academy of Pediatrics and other established medical groups have supported age-appropriate gender-affirming care for minors. In addition to medical procedures, such care can include therapy, changing one’s name or wearing different clothes.
Advocates for transgender minors have emphasized hormone replacement therapy and gender-affirming surgeries are rarely performed on patients younger than their mid-teens.
Carter "took the ability for families to decide what medical decision is right for them and gave it to politicians with agendas and no medical credentials,” said Shira Berkowitz, public policy and advocacy director at PROMO, the MIssouri LGBTQ advocacy organization.
Missouri’s gender-affirming care ban allowed patients who had already begun gender-affirming medical care to continue treatment. However, after the law went into effect in August 2023, some medical providers stopped performing treatments for all minor patients, citing legal risk.
