Judge upholds Missouri’s ban on transgender surgeries and drugs for minors

By Jonah McKeown

St. Louis, Mo., Nov 27, 2024 / 17:30 pm

A Missouri circuit judge on Monday upheld the state’s ban on the provision of puberty blockers, cross-sex hormones, and surgeries to minors for purposes of “gender transitions,” a law which took effect last summer and halted the procedures at some of the state’s largest clinics.

The law, the Save Adolescents from Experimentation (SAFE) Act, also prohibits adults who identify as transgender from accessing transgender health care under Medicaid. It further bars “gender-affirming” surgery for prisoners and inmates. It is set to expire on Aug. 28, 2027.

Lambda Legal, a law firm focused on LGBT activism, filed a lawsuit last year against the state challenging the new law on behalf of several medical professionals engaged in “gender-affirming care” as well the parents of several minors who identify as transgender. The trial began in late September. 

In his Nov. 25 opinion, Wright County Circuit Judge R. Craig Carter cited U.S. Supreme Court precedent in cases such as 2007’s Gonzalez v. Carhart in which the high court held that states have broad power to regulate in areas “fraught with medical and scientific uncertainties.”

State governments can prohibit treatments that are shown to be “fundamentally incompatible with the physician’s role as healer,” the high court held.    

The medical ethics of providing transgender interventions to minors are “entirely unsettled,” Carter noted this week, while the potential harms, including irreversible bodily mutilation and infertility, are serious. 

Carter said he was presented with an “almost total lack of consensus as to the medical ethics of adolescent gender dysphoria treatment.” The plaintiffs challenging the ban were able only to present “low” or “very low” quality evidence in favor of transgender treatments for minors, he wrote. 

“None of these interventions corrects any biological or physical abnormality. Rather, the thought process behind these novel procedures is that even though these adolescents are physically healthy, altering their bodies might reduce distress associated with the mismatch between their bodies and how they perceived their identity,” Carter wrote. 

Carter went on to write that “credible evidence” shows that most children with gender dysphoria —  a persistent feeling of identification with another sex and discomfort with one’s biological sex — grow out of the condition. 

In addition, many patients who seek transgender interventions have “serious mental health comorbidities,” many of which remain unaddressed and untreated. 

None of the commonly-used drugs in transgender interventions are FDA-approved to treat gender dysphoria, he noted, but their use, especially for young girls, has markedly increased in recent years. According to evidence cited by the judge, the prevalence of gender dysphoria among 15-year-olds increased by a factor of 20 between 2017 and 2021, to around 340 per 100,000 people. 

Also mentioned was the fact that in addition to “more than half” of U.S. states, other highly developed nations such as Finland, Sweden, and the Netherlands have begun in recent years to restrict the use of puberty blockers for minors, citing insufficient evidence of their efficacy outweighed by evidence of harm. 

Finland and Sweden further reserve transgender surgery for adults.

The judge also pointed to a 400-page study out of the U.K. known as the Cass Review which found “remarkably weak evidence” in favor of transgender interventions for minors as a means of treating the mental health condition of gender dysphoria. 

That study prompted the U.K. National Health Service (NHS) earlier this year to end the practice of prescribing puberty blockers to children to facilitate a gender transition, a decision that was later upheld in U.K. courts. 

The ruling this week goes on to cite the “unrebutted,” “credible” testimony of Jamie Reed, a former employee at a major Missouri transgender center who in a Feb. 2023 sworn statement said she witnessed doctors prescribing puberty-blocking drugs to minors without parental consent and, in her view, “permanently harming the vulnerable patients in our care.”

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In addition, Reed claimed her former clinic “regularly refers minors for gender transition surgery” and performed at least one double mastectomy on a minor at St. Louis Children’s Hospital. 

Missouri Attorney General Andrew Bailey initiated an investigation into the hospital’s practices based on Reed’s allegations. He later led a seven-state-coalition in suing the Biden administration over a rule that would force doctors to provide sex-change procedures and require health insurers to cover them. 

Missouri Sen. Josh Hawley also announced an investigation into the clinic’s practices after the allegations surfaced.

In a two-year period from 2020 to 2022, the clinic “initiated medical transition for more than 600 children. About 74% of these children were assigned female at birth,” Reed, who describes herself as a “queer woman” who is married to a formerly transgender person, wrote in her sworn statement.

Also testifying in the present case and cited as a credible witness by Carter was Chloe Cole, a young woman from California who in 2022 sued the doctors who performed transgender procedures on her, including a double mastectomy, beginning when she was 12 years old. 

Cole testified about the regret she carries for allowing doctors to remove her breasts, saying she wants to have children and will never be able to breastfeed them. 

In the end, Carter ruled that the plaintiffs’ arguments against Missouri’s law “simply [fail]” and noted that the Seventh Circuit Court of Appeals recently upheld a similar law in Indiana. 

Lambda Legal has vowed to appeal the ruling. 

After the law’s Aug. 2023 implementation, Washington University in St. Louis became the second major hospital in Missouri to shut down the practice of gender transition for minors following University of Missouri Health Care, based in Columbia. 

MU Health Care cited “significant legal liability for prescribing or administering cross-sex hormones or puberty-blockings drugs to existing minor patients.”

Jonah McKeown is a staff writer and podcast producer for Catholic News Agency. He holds a Master’s Degree from the University of Missouri School of Journalism and has worked as a writer, as a producer for public radio, and as a videographer. He is based in St. Louis.

CNA – Catholic News Agency