Rulings in Texas, Missouri jumble again where US transgender youth can receive treatment

A judge on Friday ruled against Texas’ ban on gender-affirming health care for minors while a separate judge in Missouri let a similar ban take effect, jumbling again where in the U.S. transgender youth can receive treatment.

The conflicting decisions, handed down hours apart in two Republican-led states, added to the legal unpredictability that is unfolding nationwide over a historic wave of new laws this year that target LGBTQ+ rights.

Underscoring the fast-changing landscape, Texas swiftly appealed to keep its new restrictions on track to take effect Sept. 1, when it would become the largest state in the U.S. to enforce a ban on gender-affirming care for minors.

“Across the country, countless transgender youth are having their well-being threatened and their lives uprooted by dangerous and unconstitutional bans,” said Elizabeth Gill, an attorney for the ACLU, which represented families and doctors challenging the Texas ban.

More than 20 states have adopted laws to ban some gender-affirming care for minors, although some are not yet in effect or have been put on hold by courts. Many of them prevent transgender minors from accessing hormone therapies, puberty blockers and transition surgeries, even though medical experts say such surgical procedures are rarely performed on children.

In Texas, state District Judge Maria Cantu Hexsel sided with a group of families who argued it would violate parents’ rights and have devastating consequences for transgender children and teenagers who would be denied treatment recommended by their physicians.

Cantu Hexsel, an elected judge who ran as a Democrat, also ruled the state’s ban would discriminate against transgender children and violate doctors’ ability to follow “well-established, evidence-based” medical guidelines under threat of losing their license.

Almost immediately, the state filed an appeal to the Texas Supreme Court, putting the lower ruling on hold for now. In a statement, the Texas attorney general’s office said it would “continue to enforce the laws duly enacted by the Texas Legislature and uphold the values of the people of Texas.”

In Missouri, the ruling by St. Louis Circuit Judge Steven Ohmer means that beginning on Monday, healthcare providers are prohibited from providing gender-affirming surgeries to children. Minors who began puberty blockers or hormones before Monday will be allowed to continue on those medications, but other minors won’t have access to those drugs.

Some adults will also lose access to gender-affirming care. Medicaid no longer will cover treatments for adults, and the state will not provide those surgeries to prisoners.

Physicians who violate the law face having their licenses revoked and being sued by patients. The law makes it easier for former patients to sue, giving them 15 years to go to court and promising at least $500,000 in damages if they succeed.

The ACLU of Missouri, Lambda Legal, and Bryan Cave Leighton Paisner last month sued to overturn the Missouri law on behalf of doctors, LGBTQ+ organizations, and three families of transgender minors, arguing that it is discriminatory. They asked that the law be temporarily blocked as the court challenge against it plays out. The next hearing in the case is scheduled for Sept. 22.

But Ohmer wrote that the plaintiffs’ arguments were “unpersuasive and not likely to succeed.”

“The science and medical evidence is conflicting and unclear. Accordingly, the evidence raises more questions than answers,” Ohmer wrote in his ruling. “As a result, it has not clearly been shown with sufficient possibility of success on the merits to justify the grant of a preliminary injunction.”

“We are enraged — not only has our government and elected officials failed us, but now our justice system has failed to do its job in protecting the most vulnerable of our population,” said Aro Royston, board secretary of the Missouri LGBTQ+ advocacy group PROMO, in a statement.

One plaintiff, a 10-year-old transgender boy, has not yet started puberty and consequently has not yet started taking puberty blockers. His family is worried he will begin puberty after the law takes effect, meaning he will not be grandfathered in and will not have access to puberty blockers for the next four years until the law sunsets.

The law expires in August 2027.

Proponents of the law argued that gender-affirming medical treatments are unsafe and untested.

Republican Missouri Attorney General Andrew Bailey’s office wrote in a court brief that blocking the law “would open the gate to interventions that a growing international consensus has said may be extraordinarily damaging.”

The office cited restrictions on gender-affirming treatments for minors in countries including England and Norway, although those nations have not enacted outright bans.

“Missouri is the first state in the nation to successfully defend at the trial court level a law barring child mutilation,” Bailey said in a statement after Friday’s ruling. “I’ve said from day one as Attorney General that I will fight to ensure that Missouri is the safest state in the nation for children.”

Every major medical organization in the U.S., including the American Medical Association, has opposed bans on gender-affirming care for minors and supported the medical care for youth when administered appropriately. Lawsuits have been filed in several states where bans have been enacted this year.

The Food and Drug Administration approved puberty blockers 30 years ago to treat children with precocious puberty — a condition that causes sexual development to begin much earlier than usual. Sex hormones — synthetic forms of estrogen and testosterone — were approved decades ago to treat hormone disorders and for birth control.

The FDA has not approved the medications specifically to treat gender-questioning youth. But they have been used for many years for that purpose “off label,” a common and accepted practice for many medical conditions. Doctors who treat trans patients say those decades of use are proof the treatments are not experimental.