First they came for trans kids. Now, in Missouri, they’re coming after trans adults

OPINION: Missouri’s targeting of gender-affirming care is part of the goal to eradicate trans people entirely

Well, here we are. The thing that every person who was “just asking questions” about trans kids said they never had any intention of touching is finally, officially here. In Missouri last week, state attorney general Andrew Bailey essentially ordered all medical providers of gender-affirming care not to provide that care until a set of ridiculous new hurdles are cleared. The arbitrary and capricious rules will apply to adults and youth alike, meaning lawmakers have finally moved on to banning adult transition care. This is an outcome that nearly every trans person I know has been predicting would come to pass.

Bailey’s order introduces broad exclusions and overwrought restrictions, which outright ban care for anyone with depression, autism or other comorbid mental health issues. It also requires three years of consistent, doctor-documented gender dysphoria before a trans adult can access gender-affirming care. It sidesteps the state’s legislature to outright ban care for all minors as well. It is unclear whether adults who are already receiving care will be forced to pause that treatment.

Current professional guidelines for accessing gender-affirming care in the U.S. have been refined over time. It used to be that doctors and therapists had absolute control over the lives of all trans people—with final say over whether, how and when a person could transition. Trans people were heavily institutionalized in service of endless “research” and, coincidentally, medical profit, as the extended evaluations and arbitrary hoops trans people were forced to jump through to access care cost money. A local psychiatrist, for example, could milk thousands of dollars from trans patients by just never approving their transition care and forcing them to continue therapy appointments.

But over recent years, the vice grip the medical and mental health professions had over trans lives has loosened. Some practitioners are now using an “informed consent” model, in which patients can receive hormones so long as they can demonstrate that they understand the risks and effects of treatment. These days, trans people over the age of 18 are mostly treated as adults capable of making their own decisions. Cross-sex hormones can, from some providers, be accessed through informed consent, while other insurance companies and medical providers will sometimes ask for a doctor or therapist note. Genital surgeries, according to the World Professional Association for Transgender Health (WPATH), require a patient to have socially transitioned for at least a year as verified by a therapist, before accessing the procedure. The guidelines also require a second therapist to affirm the patient’s decision to seek gender-reassignment surgery.

“These restrictions seek to make care more difficult to access without outright banning it.”

Bailey’s new rules override the consensus medical protocol with his own personal opinion. He’s not a doctor, but a lawyer by trade, and a politician who is likely trying to build a name for himself in order to win his first statewide election in order to keep his job past 2024. The restrictions he put in place are essentially copycats of the ridiculous Targeted Regulation of Abortion Providers (TRAP) laws conservative politicians have imposed on patients seeking abortion care and their providers over the years.


These restrictions seek to make care more difficult to access without outright banning it. I toured an abortion provider’s facilities in Pennsylvania a few years ago, for example, and during that after-hours tour, staff told myself and a handful of other reporters that the state’s conservative legislature had required them to put in an unneeded, and especially expensive, ventilation system. The changes were requested, the clinic believed, in the hopes that they would jack up the provider’s operating costs and drive them closer to shutting their doors. 

Politicians have similarly imposed cruel requirements on patients seeking abortion care, requiring invasive vaginal probe ultrasounds, and state-required delays windows before an abortion can be obtained.

It’s a well-worn tactic in the abortion arena. Pro-choice activists rightly understand that delay tactics and required doctor-led humiliations of patients are designed to discourage people from accessing abortion care. Bailey’s new trans rules should be considered in the same way.

Trans adults who transitioned 10 years ago are already receiving notes from their doctors saying they can no longer fill their prescriptions. What are they supposed to do now? Moving across state lines or travelling long distances just to access a prescription is at the very least a waste of time and a cruel way to force people to live. Not to mention that thousands of trans people who can’t move or travel out of state to see doctors will be forcibly detransitioned by the state of Missouri. It’s government imposition and overreach in its rawest, most personal form.

For all the talk and bluster from a lot of anti-trans activists who have said that “adults can do what they want,” it’s clear the movement they’ve built has long had only one logical goal: the eventual eradication of trans people writ large through denial of legal acknowledgement and medical care.

We’re finally at that step. Queen of the TERFs J.K. Rowling herself has said in the past that if the rights of trans people were being threatened, she’d march alongside us. Yet her Twitter feed this week is full of her usual transphobic bile and petty-grievance farming.

I’m calling on all of you who promised me over the years that adult transition care was not their concern—and that they merely had “valid concerns” about children—to please take a step back and look at what your movement has built in your name. I suspect most of you knew you were playing a deflection game all along, knowing where this was headed. But I’m willing to bet a few of you still are redeemable.

It’s well past time for the good people of this country to wake up, look around and say enough is enough. Your trans neighbours, friends and family members are utterly terrified of their own governments. We’re at the point where stuff only imagined in our dark dystopian dreams are happening around us and we’re too small of a population to meaningfully force change.

Please help us.

Katelyn Burns is a freelance journalist and columnist for Xtra and MSNBC. She was the first openly trans Capitol Hill reporter in U.S. history.

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