A county judge in Missouri has upheld the state’s ban on gender-affirming care for minors.

In a 74-page ruling issued Monday, Wright County Circuit Court Judge Craig Carter wrote, “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?”

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The restrictions on gender-affirming care, passed by state lawmakers in 2023, bar minors from using hormones and puberty blockers and from undergoing gender-affirming surgeries. They also block state funding of gender-affirming care for adults through Medicaid and for prisoners incarcerated by the state.

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The ACLU of Missouri and Lambda Legal promised an appeal of the ruling.

Carter acknowledged the “ethical minefield” the case presented, writing “the medical profession stands in the middle” of it, “with scant evidence to lead it out.”  

The nine-day trial presented witnesses of varying credibility, with the state’s Solicitor General Joshua Divine dragging partisan politics into the proceedings. Some of his experts introduced research that had been retracted, the plaintiffs argued. He maintained the scientific community had dismissed them because of “cancel culture.”

Carter’s ruling relies in part on testimony from Jamie Reed, a whistleblower who worked at the Washington University Transgender Center at St. Louis Children’s Hospital. A sworn affidavit from Reed helped inspire the gender-affirming care ban.

Reed maintained the hospital treated many patients with mental health problems without comprehensive psychological evaluations; at trial, there was disagreement over whether a licensed therapist’s evaluation was enough to warrant gender-affirming care or if a psychologist or psychiatrist should be a requirement.

The judge found Reed credible.

“Her testimony does not arise from any ideological or other bias,” Carter wrote. “In fact, she is married to a transgender individual.”

Reed is now the executive director of a small advocacy group called the LGBT Courage Coalition, which opposes gender-affirming care for minors. The day before she testified, her partner announced he was stopping testosterone treatments and “detransitioning”.

While Carter found Reed credible despite her advocacy, he didn’t extend the same courtesy to some of the plaintiffs’ witnesses.

He wrote he “has concerns with deferring to the organizations relied on by plaintiffs, such as WPATH, which self-describes itself as an organization ‘committed to advocacy.’” The World Professional Association for Transgender Health is a professional organization that sets standards for gender-affirming care.

Carter’s ruling ultimately focused on U.S. Supreme Court precedent that allows lawmakers broad discretion in areas “fraught with medical and scientific uncertainty.”

He judged there is “an almost total lack of consensus as to the medical ethics of adolescent gender dysphoria treatment,” thereby agreeing the state legislature has the authority to ban the care.

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