Transgender Missourians fear adult gender-affirming care restrictions are coming
Missouri lawmakers recently joined a number of other GOP-dominated states in limiting gender-affirming care for transgender youth, and while some Republican legislators say they’re not interested in adult restrictions, trans community members remain on guard.
When asked if adult restrictions are next up for the Missouri legislature, state Rep. Bill Hardwick, R-Pulaski County, said, “Part of freedom is you make decisions I don’t like.”
Senate President Pro Tem Caleb Rowden, R-Columbia, said he doesn’t think the legislature should do anything relative to trans adults in the 2024 session. And Sen. Nick Schroer, R-St. Charles County, said, “If you’re going to use your money and your body, even though I disagree with it, you still should have the right to do as you please.”
But transgender Missourians like Ben Greene worry that other Republicans will move to restrict care for adults.
“I think that their goal doesn't even have to do with health care. I think that might be the next step,” said Greene, who gives public talks about transgender inclusivity. “I think their end goal, which they have openly stated, is the elimination of transgender people from Missouri and from public life.”
Close observers of the policy push against transgender rights say that a mixture of complacency among the general public and demand from GOP voters will ultimately prompt Republicans legislators to move their focus from transgender children to transgender adults.
They see Republicans escalating their policies — similarly to how they incrementally curtailed abortion rights in Missouri before instituting a ban.
“It's a scary time,” said Robin Boyd, who provides speech and communications services to transgender and gender-nonconforming individuals. “We're kind of bracing for impact, but we're also trying to … take action.”
Bailey’s rules alarm LGBTQ community
Missouri Attorney General Andrew Bailey’s emergency rules provided the clearest evidence for transgender Missourians and their allies that some Republicans want to place restrictions on gender-affirming care for adults.
Before he pulled the rules earlier this month, Bailey wanted transgender youth and adults to have, among other things, at least 15 hours of mental health therapy, a screening for autism and three years of documented gender dysphoria. The rules also required people to treat and resolve their mental health conditions.
Bailey said the rules were a form of informed consent before hormone therapy or gender transition surgery. When Bailey pulled the rules on May 16, Greene said he felt immense relief.
“I was pretty stressed and knew that it was going to hurt a lot of people,” Greene said. “And when I saw that he withdrew it that was like this huge exhale.”
Bailey told the Washington Examiner last week that his office retains the "authority to promulgate additional rules as we deem necessary as emergency crisis situations develop as they relate to adults."
Although some prominent Republicans, such as Secretary of State Jay Ashcroft and Lt. Gov. Mike Kehoe, said they don’t support restrictions on gender-affirming care for adults, others aren’t ready to shut the door on debating restrictions on adults in the future. That includes Sen. Bill Eigel, a St. Charles County Republican who is likely running against Ashcroft and Kehoe for governor.
“Personally my belief is that all these surgeries are harmful no matter who they are,” Eigel said. “And I think there’s going to be a time and place for discussion about whether or not we need to expand that beyond 18 years old.”
Other Republican officials were hesitant to provide their opinion on whether policies similar to Bailey’s now-scuttled emergency rules should be enacted into law.
During his end-of-session press conference, House Speaker Dean Plocher, R-Des Peres, was asked several times whether he would support restrictions on gender-affirming care for adults. He chose to only discuss the bills the legislature passed this year that largely centered around transgender minors.
“I stand by the product that we produced, which is a good product for Missourians,” Plocher said. “It really protects our kids. What we’re here to do is protect vulnerable people.”
While Senate Minority Leader John Rizzo, D-Independence, said Republicans thought the gender-affirming care ban for minors would be a politically helpful issue, he added that it also placed GOP leaders in a bind.
“I did sit in meetings with them and tell them, ‘If you do this, the next obvious question is going to be why aren't you doing it for adults?’” Rizzo said. “When you throw red meat to rabid people, they don't stop being hungry. And that's what they did. They threw kids on the chopping block with that bill. And the next logical step is for people to take that hate and move it to the next step, which is obviously adults.”
Bills already affect some adults
Legislation that bars transgender athletes from participating in sports that align with their gender identity also affects colleges and universities. And the gender-affirming care ban includes language barring the state from paying for hormone therapy or gender transition surgery for people in prison or on Medicaid.
“It also takes away rights of adults who are 18 and older,” said Rep. Chris Sander of Lone Jack, one of two openly gay Republicans in the Missouri House.
Some Republicans have said that the restrictions on taxpayer funding for gender-affirming care are defensible, since it aligns with their beliefs that adults can pursue hormone therapy or gender transition surgery if they use their own money.
“It’s just a matter of the state deciding where it's going to spend its money,” said Rowden. “We don't think it's in the best interest of the state and the taxpayer to spend money on those things.”
But that may not be possible for people like Asher Hackworth, a Springfield resident and a Medicaid recipient.
Hackworth said that with Medicaid, his prescription for testosterone was already costing about $75 a month. And that, he said, is a lot of money for people who only make around $500 monthly.
Hackworth also said he worries about what will happen if people don’t have access to treatments that help them transition properly.
“The proven treatment for gender dysphoria is to transition and to have your gender align with your experiences and your body,” Hackworth said. “Whatever as a trans person you feel dysphoric about, the goal is to make you feel euphoric. And not transitioning is literally the most dangerous thing for transgender people.”
Others are worried that legislators will turn their attention to adults who support transgender Missourians.
Robin Boyd, a speech and language pathologist, said that even though the legislation that just passed doesn’t specifically single out her type of gender-affirming care, there’s no guarantee that won’t happen in the future.
“I’m also part of the community. I’m an intersex queer person,” Boyd said. “As these laws are looming, there are these heavy feelings and concerns regarding my own health care — but also my friends and my patients."
Daniel Bogard, the father of a transgender child who has sought to retain access to gender-affirming care for minors, said he worries that the next step could be to enact criminal penalties on parents.
“They have to keep escalating in order to keep the fire burning,” Bogard said. “And as a parent of a trans kid, this is what terrifies me. Because we look at places like Florida and Texas, and we see the model for what is to come next in Missouri. Look, we are up at night, worried that our government is going to send [Department of Family Services] to take our kid away for following the best instructions and advice of his doctors and his therapists and our family and our faith.”
Legal and political pressures could turn the tide
Like other transgender Missourians, Hackworth doubts that Republicans will hold off on pushing for legislation that affects transgender adults. He notes that there’s been an uptick in disparaging rhetoric on social media against transgender people and that, along with negative coverage of gender-affirming care from conservative media outlets, is pressuring GOP politicians to act.
“They're calling us groomers, they are just talking about how it's like a mental illness,” Hackworth said. “I'm a very active person on social media. And I see the things that these people are saying about us — they call us slurs regularly. And these are just everyday people within the community.”
Not everyone believes that more restrictions against transgender adults are inevitable.
Nora Huppert of Lambda Legal, a New York-based group that helped challenge Bailey’s emergency rules, said any effort to restrict gender-affirming care for adults will run into legal problems, adding that curbs for minors are already facing litigation in a number of states.
“I think that any policy that goes after gender-affirming care for trans adults will clearly be an act of discrimination against transgender people. And when those policies are enacted by state officials, as it was [in Missouri] and not through the democratic process, they may also be vulnerable under state administrative law,” Huppert said. “They're completely arbitrary. And they are very capricious, because they attempt to enact sweeping restrictions on personal and bodily autonomy without really any sound medical support.”
Others are hoping that the public sours on the GOP push to restrict transgender rights. Greene said Bailey’s emergency rules “put a huge spotlight on this issue.”
“A lot of people in Missouri, who have not previously been politically active, said: ‘Oh, wow we thought it was about protecting kids or about sports fairness” Greene said. “And there are so many people, more than I have ever seen, who are saying: ‘I'm ready to be an ally.’”
Jamie Cayley, who is pursuing a master’s degree in social work at Washington University, said altering the tide could have less to do with political or legal action than with people becoming more knowledgeable and comfortable about those who are transgender.
“Most people don't know what a trans person looks like. They don't know that they know trans people,” Cayley said. “A lot of it is, ‘Hey, this is us. This is what we look like. We're not scary.’”