City DOH Response to Missouri Attorney General's Emergency Rule on Transgender Healthcare

Last week, Missouri’s Attorney General issued an emergency rule placing extreme restrictions on gender-affirming healthcare in Missouri, and yesterday he confirmed this will affect transgender youth and adults.

Since the introduction of this rule, the City of St. Louis Department of Health and our healthcare partners have been closely evaluating how this affects standards of care across our region. The City of St. Louis remains steadfast in our support for all our transgender neighbors and their families, and in our commitment to break down discriminatory barriers to life-saving and gender-affirming healthcare for all who seek it. Broad, sweeping decisions like this will negatively impact the physical and mental well-being of our trans community members, and we condemn policies that interfere with anyone’s ability to make decisions for our own bodies. Gender-affirming care is still available. 

The Attorney General’s emergency regulations institute extreme restrictions that require: (1) medically documented gender dysphoria for three years; (2) at least 15 consecutive therapy sessions over 18 months; and (3) that all mental health conditions are treated and resolved prior to gaining access to gender-affirming care. These arduous limitations, among many other restrictions in the emergency rules, would impose barriers to care that are nearly impossible for providers, parents, and transgender people to overcome. The regulations would go into effect on April 27, 2023, and expire on February 6, 2024.

There is strong consensus among medical professional organizations, including the American Medical Association, the American Psychological Association, the American Academy of Pediatrics and the Endocrine Society, that individualized gender-affirming care for transgender people is medically necessary and effective. Prohibiting evidence-based clinical care not only directly harms the health of individual patients, but also reinforces discrimination, stigma, and negative mental health outcomes for the wider transgender community. Transgender youth of color are even more vulnerable due to the added negative impacts of systemic racism and marginalization. Providing gender-affirming care, on the other hand, can improve mental health outcomes for transgender and nonbinary individuals. Children and young adults receiving gender-affirming care experience a lower risk of depression and suicidality.

Any person affected by this rule on gender-affirming care is encouraged to contact:

• Legal Help Desk at Lambda Legal or the ACLU of Missouri for more information on their legal rights. 
• Metro Trans Umbrella Group (MTUG) for local services and resources available to transgender folks. MTUG maintains a list of inclusive therapists and medical providers. 
• Trans Lifeline at 877-565-8860 or the St. Louis Queer+ Support Helpline at 314-380-7774 for emotional, identity-affirming support. 

The City of St. Louis Department of Health is working with Mayor Jones’s office and community leaders around policies to support the trans community and its health rights.