‘Unprecedented and extreme.’ Civil rights groups sue to block MO restrictions on trans care

Logan Casey, a 36-year-old transgender man from St. Louis, is more than a decade into his transition. But, under a new set of restrictions on gender-affirming care, Casey fears he will be denied access to his necessary medication.

Casey, who has ADHD, worries he will have to prove documented gender dysphoria for the last three years to get his testosterone treatments. And he fears that his work as a researcher focused on LGBTQ people will be weaponized against him in order to deny him care.

Casey’s fears were documented in a lawsuit filed Monday by the American Civil Liberties Union of Missouri and LGBTQ civil rights group Lambda Legal against Missouri Attorney General Andrew Bailey seeking to block an emergency rule that restricts gender-affirming care for people of all ages. The two groups in a statement called Bailey’s restrictions “unprecedented and extreme.”

The lawsuit was filed on behalf of Casey, Southampton Community Healthcare, which provides gender-affirming care in St. Louis, Kelly Storck, a St. Louis-based social worker, and the families of two minor transgender girls.

Bailey’s “emergency order is a baseless and discriminatory attempt to limit the healthcare options for transgender individuals, who already face several barriers accessing necessary and life-saving medical care,” Samuel Tochtrop, a doctor at Southampton Healthcare, said in a statement on Monday.

The lawsuit states that Bailey’s restrictions violate the state constitution by legislating “behind closed doors through Missouri’s limited emergency rulemaking procedures…without any input from the Missourians the rule will affect most.”

Bailey, a Republican, earlier this month ramped up the debate over transgender health care and filed a set of restrictions that would make Missouri the first state to restrict gender-affirming care for both adults and children. The rules, which include requiring 15 separate hourly therapy sessions over 18 months before a person can start care, are set to take effect on Thursday.

When asked how his office would respond to a legal challenge prior to the lawsuit, Bailey touted the restrictions as protecting patients.

“Our regulation enacts basic safeguards for interventions that an international medical consensus has determined to be experimental,” Bailey said in a statement provided by his office. “Rather than ensure that patients are protected by common sense safeguards, these organizations are racing to court in an effort to continue their ideologically-based procedures masquerading as medicine.”

Bailey’s restrictions have roiled the state’s transgender community as well as doctors, LGBTQ advocates and civil rights groups. The rules have created an atmosphere of alarm among transgender Missourians as some contemplate whether to rush to stock up on treatments before the rules take effect.

The restrictions, which rely on the state’s consumer protection laws, include a provision that bans doctors from providing puberty blockers or hormone therapy unless a patient has shown three consecutive years of “medically documented, long-lasting, persistent and intense” gender dysphoria.

They also ban treatment until all of a patient’s underlying mental health issues have been resolved, which a Kansas City-based doctor previously told The Star was unrealistic.

The lawsuit states that if Bailey’s rule were to take effect, it would restrict and, “in many respects, completely prohibit” Southampton Healthcare’s ability to provide gender-affirming care. St. Louis-based law firm Bryan Cave Leighton Paisner was also involved in the filing the suit.

The legal filing includes stories from the families of two minor transgender girls. One, identified in the lawsuit as R.S., is in 8th grade in Boone County who was in the process of receiving gender-affirming care. Her family fears that Bailey’s rule will restrict her from getting the care she needs because she has anxiety and ADHD.

The other transgender girl, identified as A.F. in the lawsuit, is 13 and was set to undergo hormone treatment this summer. However, the restrictions would prevent this because she has not met Bailey’s strict requirements for care.

“A.F.’s parents view the Emergency Rule as the greatest threat to her mental health,” the lawsuit said. “When asked how that makes her feel, she stated she ‘would not want to be on this planet anymore.’”

The restrictions come as Republican state lawmakers consider legislation that would ban doctors from providing gender-affirming care to anyone under 18.

Bailey’s office earlier this year launched an investigation into Washington University Transgender Center at St. Louis Children’s Hospital, which provides gender-affirming care for minors. Bailey began the inquiry after a former employee at the center alleged that the center harmed children, rushing mentally ill children into hormone therapy without properly treating their underlying mental health issues.

However, the university released an internal review last week that called the allegations “unsubstantiated.”