Trans Adults Officially Being Detransitioned In Missouri: "I'm Scared And Don't Know What To Do"

Transgender adults are officially being pulled off of their medication in Missouri and forced to detransition. A new ban targeting trans care statewide is one of the cruelest in the country.

On April 13th, Missouri Attorney General Andrew Bailey signed a decree that banned most gender affirming care for transgender adults in the state. This set of guidelines, reminiscent of targeted restrictions on abortion providers also known as TRAP laws, makes most care in the state impossible to administer. As a result, doctors that provide gender affirming care statewide have had to pull their trans patients off of their medication, forcing them to medically detransition. The Missouri order is one of the cruelest in the country, and is part of a new wave of laws that target adult care.

The Missouri ban outlines numerous stipulations for clinics offering care, effectively making it illegal or too legally precarious to provide such services. One particularly troublesome requirement mandates that transgender individuals must have depression and anxiety resolved prior to receiving gender-affirming care. Coupled with another condition stating that dysphoria must be "intense," clinics that successfully address depression and anxiety to comply with the first stipulation may then be informed that their patients' dysphoria was not "intense" enough. This creates a clear Catch-22, particularly since gender-affirming care often alleviates depression and anxiety on its own.

See the regulations:

Regulations from Missouri AG order

For transgender adults already receiving care, a questionable "grandfather" clause purportedly allows them to continue treatment. However, in practice, this is not the case. Clinics must still retroactively adhere to all other regulations, even for transgender adults who have been grandfathered into their care. Compliance with some of these regulations is unattainable, such as evaluating "transgender social contagion," an unproven pseudoscientific concept that clinics have no means to assess.

Additionally, the mandate requires clinics to maintain 15-year follow-up records, distribute misleading informational pamphlets, ensure that patients are evaluated by a psychologist for unspecified developmental psychology concerns, and maintain extensive paperwork detailing compliance with these regulations. Ultimately, the directive imposes sudden and strict infrastructure requirements, similar to Targeted Regulation of Abortion Providers (TRAP) laws used to close abortion clinics. As a result, transgender individuals' access to medication is effectively restricted or eliminated at all levels.

As weeks have gone by, stories have come out of Missouri describing the effect this is having on local transgender care. A video posted to TikTok went viral where an adult transgender individual named Milo emotionally detailed the devastating effects of the Missouri General’s actions:

“I’m scared and I don’t know what to do. Testosterone has been lifesaving for me. Taking me off of testosterone right now is taking away my happiness. It’s taking away my healthcare. I’m a legal adult, I can make my own decisions. I don’t know for sure, because I haven’t been able to get in contact with my provider, but it looks like I will have to detransition for the time being… and I don’t know what to do, I don’t know what to think. I’m going to college in Missouri so I can’t even get out.”

See the video:

Milo's story is tragic, but it is not the only account emerging from Missouri of transgender individuals losing their healthcare. The day after the directive, numerous transgender patients received a letter from a clinic stating that compliance with the new Missouri regulation in time to distribute medication was unattainable. Consequently, the clinic, like several others, had to examine the rules, guard against opportunistic inquiries by the Attorney General, and assess their ability to ever comply with the regulation. This led to the cancellation of appointments for transgender patients.

Harvard Clinical Instructor Alejandra Caraballo stated of the regulations, “This policy effectively bans all gender affirming care by creating a kafkaesque set of regulations no one can meet.”

See the letter:

Gender affirming care saves lives. Many studies have found the positive impact of this care on transgender people obtaining it, such as a study that showed a 73% reduction in suicidality or another that showed a 40% reduction in recent suicide attempts. Over 50 studies have showed the benefits of gender affirming care, and these studies have been compiled by the Cornell University Center for the Study of Inequality. Policies like this not only deny the care, it traumatizes transgender people by pulling them off of the care.

These laws that are targeting gender affirming care providers in Missouri are similar to TRAP laws used to target abortion providers. Trap laws are defined by Planned Parenthood as costly, severe, and medically unnecessary requirements imposed on abortion providers to shut down clinics and make access more difficult. TRAP laws that are commonly seen involve reporting requirements, overly burdensome compliance standards, counseling requirements, and mandatory disinformation documents. All of these are being recycled and used in the Missouri ban.

The Attorney General’s regulations officially go into effect on April 27th. Pop-up clinics have emerged across the state to try to get transgender people access to the medication before the hard cut-off time. If the policies take effect, they will have a devastating impact on the trans community in Missouri. Lambda Legal is currently recruiting people affected in order to challenge the policy in court.