Missouri is part of a rapid push to limit transgender health care

LITTLE ROCK, Ark. – The push to limit health care for transgender people has expanded beyond children, with Missouri imposing new restrictions on gender-affirming care for both adults and minors.

The restrictions underscore how quickly states’ efforts to address transgender rights have grown this year, despite new obstacles from the courts and the Biden administration.

Here’s what happens:


More than 450 bills have been introduced in state institutions across the country this year targeting transgender people, which LGBTQ+ advocates say is a record number.

These include bans on gender-affirming medical care for minors and restrictions on the types of restrooms transgender people can use. Lawmakers are also promoting measures limiting classroom teaching about sexual orientation and gender identity, as well as bills that would expel transgender students who want teachers to refer to them by the pronouns they use.


The rules announced Thursday by Missouri’s Republican attorney general put several new restrictions on when someone can receive gender-affirming care. These include 18 months of therapy and will require resolution of mental health issues such as depression or anxiety before someone can receive care. It also requires documentation of three years of “persistent and intense” gender dysphoria before treatment can begin.

The rules, which are due to take effect on April 27, are believed to be the first restrictions imposed by a state on the care of gender-affirming adults. LGBTQ+ advocates condemned the move and promised legal action.

Missouri is one of three states that have banned or restricted gender-affirming care through regulations or administrative orders. Two Florida boards have banned foster care for minors. Texas’ governor has ordered child welfare officials to investigate reports of children receiving such care as child abuse, even though a judge has blocked those investigations.

At least 13 states have already passed laws restricting or banning gender-affirming care for minors: Alabama, Arkansas, Arizona, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Tennessee, Utah, South Dakota and West Virginia. The bills await action from the governors of Kansas, Montana and North Dakota. All but three laws were passed this year.

Federal judges have blocked bans in Alabama and Arkansas, and nearly two dozen states are considering bills this year to limit or ban the care. A new law signed last month by Republican Gov. Sarah Huckabee Sanders aims to effectively reinstate Arkansas’ ban by making it easier to sue providers of such care for minors.

Republican states like Oklahoma have also threatened some funding for hospitals that offer gender-affirming care.

In North Dakota, Republican Gov. Doug Burgum this week on Tuesday signed new laws that effectively ban transgender girls and women from joining women’s K-12 and college sports teams. At least 21 states have passed such laws.

This year has also seen a resurgence of bills barring transgender people from using restrooms that match their gender identity, six years after North Carolina repealed its bathroom law. Republican Kansas lawmakers last week sent Democratic Gov. Laura Kelly a bill that would impose some of the broadest bathroom restrictions and appears to have enough votes to override an expected veto.

This week, Sanders signed a bathroom bill that was scaled back after complaints from transgender people and their families. The law makes it a crime for a transgender person to use a restroom that matches their gender identity, but only if a minor of the opposite sex is present and the person is in the bathroom for sexual purposes.

Sanders has already signed a law banning transgender people in public schools from using a bathroom that matches their gender identity.


There have recently been two major court victories protecting the rights of transgender people, although the flow of legislation continues.

Last week, the U.S. Supreme Court allowed a 12-year-old transgender girl in West Virginia to continue competing on girls’ high school sports teams while the state’s ban continues. Also last week, a federal judge ruled that an Indiana school district did not violate the rights of a former music teacher by forcing him to resign after the man refused to use transgender students’ names and gender pronouns.

Lawsuits have also been filed in recent weeks challenging bans on gender confirmation of minors in care in Indiana and Florida.

There may be more action coming soon. A federal judge who blocked Arkansas’ gender-confirmation ban for juvenile care is considering whether to overturn the ban as unconstitutional.


A proposed rule released last week by the Biden administration would prohibit schools and colleges from enacting outright bans on transgender athletes, but still allow teams to create restrictions in certain cases.

The plan drew outrage from conservatives but also drew criticism from some transgender rights activists, who noted that it could still prevent transgender athletes from competing on teams that match their gender identity.

The proposed rule, which still faces a lengthy approval process, finds that blanket bans would violate Title IX, the landmark gender equality legislation passed in 1972.

Schools that receive federal funding can still adopt policies that limit the participation of transgender students, especially in more competitive high school and college sports.

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