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Missouri Attorney General Andrew Bailey Promulgates Emergency Regulation Targeting Gender Transition Procedures for Minors

Home 9 Press Release 9 Missouri Attorney General Andrew Bailey Promulgates Emergency Regulation Targeting Gender Transition Procedures for Minors

JEFFERSON CITY, Mo. – In an effort to protect children, Missouri Attorney General Andrew Bailey promulgated an emergency regulation clarifying that, because gender transition interventions are experimental and have significant side effects, state law already prohibits performing those procedures in the absence of substantial guardrails that ensure informed consent and adequate access to mental health care. The emergency regulation follows the launch of an investigation by Attorney General Bailey into a St. Louis pediatric transgender center that has been accused by a whistleblower of using experimental drugs on children, distributing puberty blockers and cross-sex hormones without individualized assessment, and even giving children these life-altering drugs without parental consent. The regulation is necessary due to the skyrocketing number of gender transition interventions, despite rising concerns in the medical community that these interventions lack clinical evidence of safety or success.

Medical organizations in both the United States and across Europe have recently emphasized the experimental nature of these interventions. The U.S. Agency for Healthcare Research and Quality recently determined that “[t]here is a lack of current evidence-based guidance for the care of children and adolescents who identify as transgender, particularly regarding the benefits and harms of pubertal suppression, medical affirmation with hormone therapy, and surgical affirmation.” And Sweden’s National Board of Health and Welfare recently declared that there is a “lack of reliable scientific evidence concerning the efficacy and the safety” of pubertal suppression and cross-sex hormone therapy and that “the risks” of these interventions “currently outweigh the possible benefits.”

“As Attorney General, I will always fight to protect children because gender transition interventions are experimental,” said Attorney General Bailey. “My office has uncovered a clandestine network of clinics across the state who are harming children by ignoring the science. When even progressive countries like Sweden, Norway, Finland, and the United Kingdom have all sharply curtailed these procedures, it’s time for the United States to course correct. My office is stepping up to protect children throughout the state while we investigate the allegations and how they are harming children.”

The emergency regulation is based on dozens of scientific studies and reports, which are cited in endnotes. The regulation outlines that in order for gender transition interventions to comply with state law, the following guardrails must be in place:

  • Specific informed-consent disclosures informing patients that, among other things,
    • 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)
    • The FDA has issued a warning that puberty blockers can lead to brain swelling and blindness
    • A study spanning 5 decades of almost 5,000 transgender people who had received cross-sex hormones, regardless of treatment type, nevertheless showed a “two-fold increased mortality risk,” which “did not decrease over time”
    • A follow-up study recently determined, “Youths with a history of mental health issues were especially likely to have taken steps to socially and medically transition”
    • A study of 1,655 parental reports found that “parents tended to rate their children as worse off after transition” and “that parents believed gender clinicians and clinics pressured the families toward transition”
    • A summary of available evidence written by medical societies “from around the globe” found that “there are no proven methods to preserve fertility in early pubertal transgender adolescents”
    • Sweden’s National Board of Health and Welfare (“NBHW”) recently declared that, at least for minors, “the risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits”
    • 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 Endocrine Society found that “the large majority (about 85%) of prepubertal children with a childhood diagnosis did not remain GD/gender incongruent in adolescence”
    • Puberty suppression presents a risk of stunted growth and failure to attain normal peak bone density
    • Puberty is associated with profound developmental maturation of the brain, and researchers have expressed concern that interruption of normally timed puberty may therefore be harmful to the brain
    • The World Professional Association for Transgender Health (“WPATH”) has acknowledged, “In most children, gender dysphoria will disappear before, or early in, puberty”
  • Prohibiting gender transition interventions when the provider fails to,
    • ensure that the patient has received a full psychological or psychiatric assessment, consisting of not fewer than 15 separate, hourly sessions (at least 10 of which must be with the same therapist) over the course of not fewer than 18 months to explore the developmental influences on the patient’s current gender identity and to determine, among other things, whether the person has any mental health comorbidities
    • ensure that any existing mental health comorbidities of the patient have been treated and resolved
    • ensure that, for at least the 3 most recent consecutive years, the patient has exhibited a medically documented, long-lasting, persistent and intense pattern of gender dysphoria
    • with respect to a patient who is a minor, ensure that the patient has received a comprehensive screening (at least annually) for social media addiction or compulsion and has not, for at least the six months prior to beginning any intervention, suffered from social media addiction or compulsion
    • maintain data about adverse effects in a form that can be accessed readily for systematic study
    • 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
    • obtain and keep on file informed written consent
    • ensure that the patient has received a comprehensive screening to determine whether the patient has autism
    • ensure (at least annually) that the patient is not experiencing social contagion with respect to the patient’s gender identity

Attorney General Bailey’s emergency regulation becomes effective April 27, 2023, and expires February 6, 2024.

The emergency regulation can be read here

A one-pager on the emergency regulation can be found here