The new hateful anti-transgender regulations of Missouri show us that it was never about the kids

Jack Molay
4 min readApr 15


New regulations make it practically impossible for transgender people to get gender affirming medical support in Missouri.

Republicans have for a long time covered their transphobia under concern for the kids. In accordance with this a lot of their anti-trans laws and regulations have been there to “protect the kids”.

For sure , the bathroom laws and the attacks on trans participation in sports have proven that their ultimate goal is to exclude trans people from society, but they could always hide behind the idea that trans people would still be allowed to be trans people.

Missouri directive proves that the end goal is the eradication of trans people

The new emergency regulations in Missouri prove beyond doubt that this is no longer the case. Sure, it presents a set of regulations that on paper contain some loopholes that might, theoretically, allow for sanctioned hormone replacement therapy and corrective surgery. Still, there are so many barriers that this is practically impossible.

The underlying logic is the old medical paradigm of gatekeeping (psychiatric therapy, long waiting periods, constant review ensuring that you are living up to the standards of a conservative society). However, they are taking this to a new level.

So, if you are suffering from anxiety and depression (most likely caused by transphobia), that would stop you from getting relevant health care. If they can document that you are affected by “social media addiction” or “social contagion”, that will be used against you. Following Transgender World is probably enough.

So this is really about stopping trans people from showing the world that they are trans. Trans people who have already transitioned can no longer get hormones in Missouri. They will have to detransition or move to a sane state.

Note that the Missouri attorney general issued this new state directive citing a consumer protection law normally used to prosecute fraudulent business practices. These regulations have not even been discussed by lawmakers.

Misleading presentations of science

In the regulations the Republicans have the audacity to cite the World Professional Association for Transgender Health in support of their policy. WPATH is totally against this kind of transphobia. The text is full of biased and selective misrepresentations of relevant research.

The Republicans try to make people believe that transitioning medically is a risky procedure. So keep in mind that the regret rate for trans people who have transitioned using hormones and surgery is less than 1 percent.

The use of puberty blockers is not “experimental”. Drugs in the class have been FDA approved since the 1990s to treat early puberty

Most of the negative findings associated with trans people is caused by lack of proper health care and the rhetoric of Republicans and other transphobes. The Republicans are basically creating the conditions that lead to the suffering they use as an excuse to persecute trans people.

These are the requirements of the transphobic regulations

Any person or health organization that provide a covered gender transition intervention to a patient will have to:

  • Assess (at least annually) whether the patient continues to have gender dysphoria.
  • Disclose conspicuously-on its website, physically in writing, and orally in person by the prescribing provider-to the patient and (if the patient is a minor) to the patient’s parents or legal guardians, [anti-trans propaganda arguments listed in the regulation].
  • 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.
  • 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 psychiatric symptoms from existing mental health comorbidities of the patient have been treated and resolved.
  • Ensure that the patient has received a comprehensive screening to determine whether the patient has autism.
  • 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.
  • Ensure (at least annually) that the patient is not experiencing social contagion with respect to the patient’s gender identity.
  • Track all adverse effects (both expected and unexpected) 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.
  • Maintain data about adverse effects in a form that can be accessed readily for systematic study.
  • Obtain and keep on file informed written consent from the patient and (if the patient is a minor) from all parents or guardians who have authority to consent to medical intervention, as to each requirement [listed in this section of the regulation9. Such written consent shall be obtained for each intervention.

For medical personnel these restrictions are so wide that trying to help trans people will lead to a too high risk for legal persecution. We would guess this means an end of gender affirming medical healthcare in Missouri.

The rules take effect April 27.

Photo: Protester wearing a transgender pride flag at the Missouri State House. From the New York Times, Charlie Riedel, Associated Press

Originally published at on April 15, 2023.



Jack Molay

Writer and news curator looking at everything transgender, nonbinary and queer.