In 2023 the state of Missouri passed a law banning gender-affirming care for minors. The law restricted the use of puberty blockers and gender-affirming surgeries.

Transgender minors and some adults in Missouri will soon be banned from accessing puberty blockers, hormones and gender-affirming surgeries under a bill signed Wednesday by the state’s Republican governor.

Beginning Aug. 28, Missouri health care providers won’t be able to prescribe those gender-affirming treatments for teens and children. Most adults will still have access to transgender health care under the law, but Medicaid won’t cover it.

Gender-affirming surgeries for inmates and prisoners will be outlawed.

Within weeks the ACLU of Missouri filed a lawsuit on behalf of the families of trans teens seeking to block implementation of the new law.

Plaintiffs in the lawsuit include the families of three transgender minors and Southampton Community Healthcare, which provides gender-affirming care. Other named plaintiffs are two of Southampton’s providers and two national LGBTQ+ organizations.

That lawsuit finally resulted in a trial which was held at the end of September. There was no jury present. The decision was left in the hands of Circuit Court Judge Craig Carter. Today Judge Carter released his decision. He upheld the state ban and ruled against the plaintiffs on all three of their arguments.

Missouri’s restrictions on puberty blockers and hormone treatment for transgender minors are constitutional and may remain in place, Wright County Circuit Court Judge Craig Carter wrote in a 74-page ruling Monday...

His ruling focuses on a U.S. Supreme Court precedent that allows lawmakers broad discretion in areas “fraught with medical and scientific uncertainty.” Carter concluded that there is “an almost total lack of consensus as to the medical ethics of adolescent gender dysphoria treatment,” granting the state legislature authority to ban the care.

“Regarding the ethics of adolescent gender-affirming treatment, it would seem that the medical profession stands in the middle of an ethical minefield, with scant evidence to lead it out.” he wrote.

During the nine-day trial, which took place at the end of September, experts on both sides opined on the availability of scientific research on gender-affirming care. Carter notes that plaintiffs agreed that standards of care were based on scientifically low-quality evidence. Expert witnesses for plaintiffs said during trial they still felt there was enough to justify the area of treatment.

Jamie Reed testified in this trial as a factual witness. It was her whistleblowing testimony which prompted passage of the 2023 law in the first place. The judge found her testimony credible. Ultimately, the judge noted other areas of the law where children were prohibited from getting what they demanded, even if adults agreed.

“If we don’t let a 16-year-old buy a six pack of beer and a pack of smokes, or let an adult buy those items for them, should we allow the same kid/parent team to decide to change a teenager’s sex forever?” Carter wrote in his ruling.

The ACLU expressed disappointment and has already said it will appeal the decision.

“We are extremely disappointed in this decision, but this is not the end of the fight and we will appeal. However, the court’s findings signal a troubling acceptance of discrimination, ignore an extensive trial record and the voices of transgender Missourians and those who care for them, and deny transgender adolescents and Medicaid beneficiaries from their right to access to evidence-based, effective, and often life-saving medical care,” Lambda Legal and the ACLU of Missouri said in a joint statement.

This case is likely going to wind up being decided by the Supreme Court which already agreed to take up a similar case arising in Tennessee. Oral arguments in that case will take place next summer.