COLUMBIA, Missouri — A judge recently ruled against Texas’ ban on gender-affirming health care for minors, while a separate Missouri judge let a similar ban take effect, confusing yet again where American transgender youths could receive medical treatment.
The contradictory decisions were handed down just hours apart last Friday, in two Republican-led states. They added to the unfolding legal unpredictability nationwide of a historic wave of new laws this year targeting LGBTQ+ rights.
Underscoring the fast-changing legal landscape, Texas swiftly appealed to keep its new restrictions on track to take effect Sept. 1, when it would become the largest state in the U.S. to enforce a ban on gender-affirming care for youths and certain adults.
“Across the country, countless transgender youth are having their well-being threatened and their lives uprooted by dangerous and unconstitutional bans,” said ACLU attorney Elizabeth Gill, who represented families and doctors challenging the Texas ban in court.
More than twenty other states have adopted laws banning some gender-affirming care for minors; some have not yet gone into effect or may have been put on hold by legal action in the courts.
The essence of the controversy surrounding these new law is that the may prevent transgender minors from accessing hormone therapies, puberty blockers and transition surgeries. This despite the fact that medical experts say such surgical procedures are rarely performed on minors.
Texas State District Judge Maria Cantu Hexsel (D) agreed with a group of families who argued the ban would violate parents’ rights, and have devastating consequences for transgender children and teenagers who would be denied prospective treatments recommended by their physicians.
Judge Cantu Hexsel also ruled Texas’ ban would discriminate against transgender children and would violate doctors’ ability to follow “well-established, evidence-based” medical guidelines under threat of losing their rights of choice.
Texas officials immediately filed an appeal with the state’s Supreme Court, putting the lower ruling on hold for now. In a prepared statement, the Texas attorney general’s office said it would “continue to enforce the laws duly enacted by the Texas Legislature and uphold the values of the people of Texas.”
In Missouri, St. Louis Circuit Judge Steven Ohmer’s ruling means that beginning on Monday, health care providers are prohibited from providing gender-affirming surgeries to children; minors who began puberty blockers or hormones before Monday will be allowed to continue on those medications, but other minors won’t have access to those drugs.
Some adults will also lose access to gender-affirming care. Medicaid will no longer will cover treatments for adults, and the state will not provide those surgeries to prisoners.
Physicians violating the law will face having their medical licenses revoked and will risk being sued by patients. The law makes it easier for former patients to sue, giving them 15 years to go to court and promising at least $500,000 in damages if they succeed.
The ACLU of Missouri, Lambda Legal, and Bryan Cave Leighton Paisner last month sued to overturn the Missouri law on behalf of doctors, LGBTQ+ organizations, and three families of transgender minors, arguing that it is discriminatory. They asked that the law be temporarily blocked as the court challenge against it plays out.
The next hearing in the case is scheduled for Sept. 22. But Judge Ohmer wrote that the plaintiffs’ arguments were “unpersuasive and not likely to succeed.”
“The science and medical evidence is conflicting and unclear. Accordingly, the evidence raises more questions than answers,” Ohmer wrote in his ruling. “As a result, it has not clearly been shown with sufficient possibility of success on the merits to justify the grant of a preliminary injunction.”
Aro Royston, board secretary of the Missouri LGBTQ+ advocacy group PROMO, released a statement saying, “We are enraged — not only has our government and elected officials failed us, but now our justice system has failed to do its job in protecting the most vulnerable of our population”.
One plaintiff, a 10-year-old transgender boy, has not yet started puberty and consequently has not yet started taking puberty blockers. His family is worried he will begin puberty after the law takes effect, meaning he will not be grandfathered in and will not have access to puberty blockers for the next four years until the law sunsets.
The law expires in August of 2027.
Every major medical organization in the U.S., including the American Medical Association, has opposed bans on gender-affirming care for minors and supported the medical care for youth when administered appropriately. Lawsuits have been filed in several states where bans were enacted this year.
The Food and Drug Administration approved puberty blockers 30 years ago to treat children with precocious puberty — a condition that 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 and for birth control.
The FDA has not approved the medications specifically to treat gender-questioning youth. But they have been used for many years for that purpose “off label,” a common and accepted practice for many medical conditions. Doctors who treat trans patients say those decades of use are proof the treatments are not experimental.
Associated Press Correspondents Summer Ballentine and Jim Vertuno filed the original version of this report. Vertuno reported from Austin, Texas.