Missouri AG imposes 'guardrails' on gender transition interventions for minors

A hand holds up a small transgender pride flag. The blue and pink stripes represent the colors for a boy and girl, while the white stripe represents self-declared gender identities, such as transitioning, intersex, neutral and undefined gender.
A hand holds up a small transgender pride flag. The blue and pink stripes represent the colors for a boy and girl, while the white stripe represents self-declared gender identities, such as transitioning, intersex, neutral and undefined gender. | Getty Images

Missouri Attorney General Andrew Bailey has implemented an emergency regulation imposing what his office calls "guardrails" on gender transition interventions for minors as the push to ban the controversial practices continues on a state-by-state basis.

In a statement Monday, Bailey said he is "issuing an emergency regulation clarifying that, because gender transition interventions are experimental, they are covered by existing Missouri law governing unfair, deceptive, and unconscionable business practices, including in administering healthcare services."

"As Attorney General, I will protect children and enforce the laws as written, which includes upholding state law on experimental gender transition interventions," Bailey said. "Even Europe recognizes that mutilating children for the sake of a woke, leftist agenda has irreversible consequences, and countries like Sweden, Norway, and the United Kingdom have all sharply curtailed these procedures. I am dedicated to using every legal tool at my disposal to stand in the gap and protect children from being subject to inhumane science experiments."

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The new regulation "clarifies that state law already prohibits performing experimental procedures in the absence of specific guardrails." The guardrails require medical professionals to inform patients that "the use of puberty blocker drugs or cross-sex hormones to treat gender identity disorder or gender dysphoria is experimental and is not approved by the Food and Drug Administration (FDA)" and that "the FDA has issued a warning that puberty blockers can lead to brain swelling and blindness."

The Attorney General's office characterized the move as "necessary due to the skyrocketing number of gender transition interventions despite rising concerns in the medical community that these procedures are experimental and lack clinical evidence of safety or success."

The emergency regulation will hold the force of law for either 30 legislative days or 180 days, "whichever is longer."

Additional mandatory disclosures outline how Sweden's National Board of Health and Welfare determined in a February 2022 report that the risks associated with puberty blockers and cross-sex hormones "outweigh the possible benefits."

The regulation also urges providers to cite the Endocrine Society's finding that "the large majority (about 85%) of prepubertal children with a childhood diagnosis did not remain GD/gender incongruent in adolescence."

"One scientific study notes that an individual whose friend identifies as transgender is 'more than 70 times' as likely to similarly identify as transgender, suggesting that many individuals' incorrectly believe themselves to be transgender and in need of transition' because of social factors," the release from the attorney general's office states. 

The regulation also bans gender transition interventions if the patient has not "received a full psychological or psychiatric assessment" consisting of at least 15 hour-long therapy sessions over a period of 18 months "to determine, among other things, whether the person has any mental health comorbidities."

An additional requirement imposed on providers seeking to perform gender transition interventions on minors seeks to ensure that "any existing mental health comorbidities of the patient have been treated and resolved."

The regulation also stipulates that doctors must "adopt and follow a procedure to track all adverse effects that arise from any course of covered gender transition intervention for all patients beginning the first day of intervention and continuing for a period of not fewer than 15 years." Doctors seeking to provide such interventions must also screen patients for autism and examine whether or not their gender dysphoria results from "social contagion" on an annual basis.

The regulation comes after the attorney general announced an investigation into the Washington University Transgender Center at St. Louis Children's Hospital after a former employee submitted a sworn affidavit stating that the clinic has sterilized hundreds of children and even lied to parents. The clinic has denied Bailey's request for a moratorium on prescribing puberty blockers or cross-sex hormones as his office investigates the claims. 

The new regulation is opposed by LGBT advocacy groups, including Planned Parenthood. Dr. Colleen P. McNicholas, the chief medical officer for Planned Parenthood of the St. Louis Region and Southwest Missouri, called the claims made in the announcement "medically false and harmful."

"Scientific evidence shows — and the medical community agrees — that gender-affirming care is safe, effective, and life-saving," McNicholas said in a statement shared on Twitter. "We denounce this government interference in the practice of medicine, and we demand politicians leave health care between providers and their patients. Shame on any politician who uses trans youth for political theatrics."

More than a half dozen states have implemented bans on some or all gender transition interventions for minors, specifically Alabama, Arizona, Arkansas, Florida, Mississippi, South Dakota, Tennessee and Utah.

In the absence of action by the state legislature, Texas Attorney General Ken Paxton and Texas Commissioner of Family and Protective Services Jaime Masters have issued formal opinions characterizing gender transition services as a form of child abuse. The moves by state legislatures and executive officials related to gender transition interventions for minors come in response to concerns about the long-term impacts of puberty blockers, cross-sex hormones and gender transition surgeries.

The American College of Pediatricians has identified the potential side effects of puberty blockers as "osteoporosis, mood disorders, seizures, cognitive impairment" as well as sterility. The organization has listed "an increased risk of heart attacks, stroke, diabetes, blood clots and cancers across their lifespan" as some of the potential long-term impacts of cross-sex hormones. 

As for gender transition surgeries to remove and/or create synthetic body parts in order to align a person's sexual organs with their stated gender identity, graphic images posted on social media last week by Florida Gov. Ron DeSantis' office reveal scars left behind from double mastectomies that remove healthy breasts from trans-identified females as well as scarred forearm tissue used to create synthetic penises in trans-identified females. 

Last year, the U.K's National Health Service proposed new guidelines warning doctors not to so easily encourage minors to socially transition by changing their names and pronouns because many children dealing with gender dysphoria may be going through a "transient phase."  

The proposed guidelines followed an independent review led by Dr. Hillary Cass, the former president of the Royal College of Paediatrics and Child Health, which found that "social transitioning" is not a "neutral act" and could have "significant effects" in terms of "psychological functioning." 

"The clinical management approach should be open to exploring all developmentally appropriate options for children and young people who are experiencing gender incongruence, being mindful that this may be a transient phase, particularly for prepubertal children, and that there will be a range of pathways to support these children and young people and a range of outcomes," the guidelines state. 

Detransitioner Chloe Cole has emerged as a prominent voice for a community of young adults who formerly identified with the opposite sex but saw their gender dysphoria subside as they got older.

Cole is suing doctors, attributing the suicidal thoughts and deteriorating state of mental health she experienced as a teenager to the life-altering double mastectomy she received at the age of 15.

While Cole was "advised that the distress she experienced because of her gender dysphoria would resolve as she transitioned," she discovered that her "distress always came back worse" following the "initial relief" that occurred after "each phase of transition."

Ryan Foley is a reporter for The Christian Post. He can be reached at:

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