A judge in Missouri has upheld the state’s ban on gender-affirming care for transminors and on restrictions for the treatment for adults.

Judge Robert S. Carter of the Cole County, Mo., Circuit Court ruled Monday that the law did not violate the Missouri constitution and wrote that there is “an almost total lack of consensus as to the medical ethics of adolescent gender dysphoria treatment.” This comes even though every major medical organization supports such care.

The bans are contained in Senate Bill 49, which Republican Gov. Mike Parson signed into law in June 2023. The law took effect in August of that year after another judge refused to block enforcement of it while the lawsuit against it proceeds.

The suit was brought in July 2023 by the families of three transgender people, Southampton Community Healthcare and two of its medical providers, and two organizations, PFLAG and GLMA: Health Professionals Advancing LGBTQ+ Equality. They are represented by Lambda Legal, the American Civil Liberties Union of Missouri, and Bryan Cave Leighton Paisner LLP. Gov. Parson is named as defendant. The suit is known as Noe v. Parson, Noe being one of the anonymous plaintiffs.

The law indefinitely bans gender-affirming surgeries for trans minors (genital surgery, however, is almost never performed on minors) and temporarily bans the administration of puberty blockers and cross-sex hormones. The latter ban is set to expire in August 2027, and young people who were already on the treatment when the law was enacted are allowed to stay on it. Gender-affirming treatment is still legal for cisgender youth for conditions such as early-onset puberty or a disorder of sex development. The law also bans Medicaid funding for gender-affirming treatment for the purpose of transition, even for adults, and gender-affirming surgeries for incarcerated people.

The statute violates the Missouri constitution’s guarantee of equal protection of the law, similar to that provided in the U.S. Constitution, according to the lawsuit, and interferes with parents’ right to manage their children’s health care. Trans minors in Missouri will suffer irreparable harm under the law, the suit states.

Missouri Attorney General Andrew Bailey, a Republican, issued a press releasepraising Carter’s ruling and calling gender-affirming care “child mutilation.”

“The Court has left Missouri’s law banning child mutilation in place, a resounding victory for our children. We are the first state in the nation to successfully defend such a law at the trial court level,” Bailey said in the release. “I’m extremely proud of the thousands of hours my office put in to shine a light on the lack of evidence supporting these irreversible procedures. We will never stop fighting to ensure Missouri is the safest state in the nation for children.”

Before the legislature acted, Bailey had issued an emergency rule to severely restrict gender-affirming care. He withdrew it when lawmakers passed SB 49 and sent it to Parson, saying it was a stopgap measure until the legislature acted. But his rule had been blocked by a St. Louis County judge while a lawsuit against it proceeded.

Bailey has been in a legal battle with a medical center in St. Louis, as he has sought release of unredacted records on gender-affirming care. The center has refused, and a judge has sided with it. He has won release of documents from three other health care providers.

Lambda Legal and the ACLU of Missouri said they will appeal Carter’s ruling. His decision is “largely copying a brief submitted by the State and ignoring thousands of pages of a transcript not yet provided to the parties that reflects nine days of testimony in the case,” which was heard in September and October, says a press release from the groups.

“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 the release. 

“Despite heartfelt testimony from parents of transgender youth, transgender adults who’ve benefited from this care at various stages of life, a transgender minor, and some of Missouri’s most dedicated health care providers, the state has prioritized politics over the well-being of its people,” the organizations added. “This ruling sends a chilling message that, for some, compassion and equal access to health care are still out of reach.”