Ellie Bridgman spent her Thursday night shift at a local gas station in Union, Missouri, planning for the day she will lose access to the gender-affirming treatments that the 23-year-old transgender and non-binary credits with making her “ life is worth living.”
A first-of-its-kind emergency rule introduced this week by Missouri Republican Attorney General Andrew Bailey will place numerous restrictions on both adults and children before they can receive puberty-blocking drugs, hormones or surgeries “with the purpose of making the gender transition.
Transgender rights advocates have vowed to challenge the rule in court before it takes effect on April 27. But promises of swift legal action have done little to ease the concerns of Transmitters like Bridgman, who say it may be time to flee the state.
Before doctors can provide gender-affirming medical treatments, the regulation requires that people have experienced a documented “intense pattern” of gender dysphoria for three years and have received at least 15 sessions per hour with a therapist for at least least 18 months. Patients would also first need to be screened for autism and “social media addiction,” and any psychiatric symptoms of mental health issues would need to be treated and resolved.
Some people will be allowed to keep their prescriptions while they immediately receive the required evaluations.
Bridgman, who uses she/they pronouns, is autistic and has depression. She said she sees only two options: move across the country, away from all her friends and family, to a state that protects access to gender-affirming care, or accept the serious health risks that purchasing could entail. illegal hormone online.
He went to a pharmacy on Friday afternoon to pay out of pocket for all the remaining refills.
“Putting restrictions on transition for people with depression is just one way they completely prevent us from transitioning,” Bridgman said. “For many trans people, dysphoria is the cause of depression. You can’t treat depression without treating the underlying dysphoria.”
Before Bridgman began hormone replacement therapy last summer, she said “life seemed meaningless” and thoughts of suicide were racing through her head. The gender-affirming care was his “last chance at life,” he said.
The regulation comes as Republican lawmakers across the country, including Missouri, have advanced hundreds of measures aimed at nearly every facet of transgender existence, with a particular emphasis on health care.
At least 13 states have enacted laws restricting or prohibiting gender-affirming care for minors. The bills await action by governors in Montana, North Dakota and neighboring Kansas, and nearly two dozen other states are considering legislation to restrict or ban care.
National LGBTQ+ rights groups argue that the Missouri regulation, based on a state law against deceptive and unfair trade practices, goes further than most restrictions enacted elsewhere.
Three states have placed restrictions on gender-affirming care through regulations or administrative orders, but Missouri’s regulation is the only one that also limits treatments for adults.
Cathy Renna, a spokeswoman for the National LGBTQ Task Force, said the rule demonstrates how Republicans are now successfully expanding the scope of gender-affirming care restrictions beyond minors, which advocates have been warning about for months.
“When they see something working in one state, they try to replicate it in another,” Renna said.
Bailey’s restriction comes after a former employee of a clinic for transgender youth in St. Louis alleged that doctors at the Washington University Transgender Center were rushing into treatment without proper patient evaluation.
Bailey said he’s looking into the clinic, but hasn’t issued a report yet. The mistreatment claims have been disputed by others, including another former employee and patients. Neither Bailey nor the university responded to phone and email messages seeking comment.
Dr. Meredith McNamara, an assistant professor of pediatrics specializing in adolescent medicine at Yale School of Medicine, said the evidence broadly supports maintaining access to hormone therapy and other gender-affirming care.
As part of a consent process, Bailey’s rule requires patients to be shown materials containing nearly two dozen specific statements raising concerns about gender-affirming treatments, a practice that doctors like McNamara have denounced as a form of conversion therapy.
“There is no evidence to show that psychotherapy alone is effective,” he said.
Stacy Cay, an autistic trans woman from Kansas City, has been stockpiling vials of injectable estrogen in anticipation of restrictions. The 30-year-old comedian and model realized that she only needed a small dose and had built up enough estrogen to last her for about a year. When she runs out, she will have to travel across state lines to fill prescriptions or consider moving elsewhere.
Cay said her persistent depression will impede her access to hormones under regulation and her autism diagnosis could complicate her path to future care. While the regulation does not specify whether autism disqualifies a person for gender-affirming care, it does require an evaluation.
A 2020 study in the natural science journal Nature Communications estimated that transgender and gender diverse people, or those whose gender expressions do not conform to gender norms, are 3 to 6 times more likely to be autistic compared to with cisgender people. They were also more likely to have other psychiatric and developmental conditions, including depression.
“They know that many of us are autistic, and it’s part of their strategy to paint us as unstable, that we can’t be trusted to make our own medical decisions,” Cay said.
Lawyers for Lambda Legal and the American Civil Liberties Union say they plan to challenge the new rule in court.
Missouri falls under the US Court of Appeals for the 8th Circuit, the same court that upheld a preliminary injunction last year preventing Arkansas from enforcing the nation’s first ban on transgender children receiving gender-affirming treatments. gender. Federal judges also blocked the application of a similar law in Alabama.
Republican lawmakers leading Missouri’s effort to ban gender-affirming treatments for minors said Friday they have no plans to expand their legislation to include adults.
Separate bills passed by the Missouri House and Senate would ban treatments for children under 18, but would place no restrictions on adults who are covered by private insurance or willing to pay for their own health care.
“I think it’s bad for a person’s body, probably even their psyche, to undergo treatments like that,” said state Sen. Mike Moon, a lead sponsor of the Senate legislation. “Adults have the opportunity to make decisions like these.”
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Schoenbaum reported from Raleigh, North Carolina, and Lieb reported from Jefferson City. Associated Press editor Jeff McMillan contributed from Scranton, Pennsylvania.
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