FIRST ON THE DAILY SIGNAL—Missouri Attorney General Andrew Bailey issued an emergency regulation Thursday restricting the use of experimental transgender interventions on minors.
An organization of doctors, nurses, and health care professionals supported Bailey’s order, despite pro-transgender activist groups condemning it as based on “debunked claims” that ignore “medical evidence” and threatening a lawsuit to block it.
“We absolutely support the efforts of Attorney General Bailey and his efforts to restrict transgender medical interventions,” Dr. Stanley Goldfarb, chairman of Do No Harm, told The Daily Signal in a statement Friday. “At least four European countries have evaluated their approach to so-called gender affirming care and have decided that it isn’t clear whether it does more harm than good.”
“In this country, there is a need for society to protect children from harmful therapies that are not based in sound medical evidence. Attorney General Bailey’s efforts are striking a blow for science and for child safety,” added Goldfarb, a kidney specialist. “Unfortunately, a number of national medical societies have come under the control of activists who are promoting an ideology that is not based in careful medical science.”
Bailey, who has launched an investigation into a St. Louis pediatric transgender center following a whistleblower complaint, declared that state law already prohibits experimental transgender medical interventions under consumer protection laws. His regulation requires extensive informed-consent disclosures and psychiatric requirements for medical interventions, including 15 hourlong therapy sessions and three years of documented gender dysphoria.
Lambda Legal and the American Civil Liberties Union of Missouri threatened a lawsuit to block the regulation, claiming that Bailey ignored scientific evidence in promulgating it.
“The Attorney General’s so-called emergency rule is based on distorted, misleading, and debunked claims and ignores the overwhelming body of scientific and medical evidence supporting this care, as well as the medical experts and doctors who work with transgender people every day,” the organizations wrote in a Thursday statement. “This rule is a shocking attempt to exploit Missouri’s consumer protection laws in order to play politics with lifesaving medical care.”
Lambda Legal and the Missouri ACLU claimed that the rule will “have a drastically negative impact on transgender youth.” The organizations promised to “defend the rights of transgender people through any necessary legal action, just as we have done in other states engaging in this anti-science and discriminatory fearmongering.”
“We look forward to defending our regulation in court if we need to,” Madeline Sieren, press secretary for Bailey, told The Daily Signal in a Friday statement.
Sieren responded to reports in left-leaning media outlets such as Axios, which cite the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, and the World Health Organization as supporters of “gender-affirming care,” without noting the many medical organizations and doctors speaking out against experimental interventions.
“I would point these leftist reporters who are ignoring the science to our six pages of endnotes citing scholarly studies and medical journals supporting that these transition intervention procedures are purely experimental,” Sieren said.
The emergency regulation cites many organizations, including the pro-transgender advocacy group the World Professional Association for Transgender Health, which promulgates standards of care that the American Medical Association and others have adopted. The regulation notes that WPATH has faced harsh criticism that it is too quick to endorse medical interventions. Even so, WPATH still recommends talk therapy for gender dysphoria, as “this therapy often involves exploring the many influences on a person’s gender identity, including ‘peer and other social relationships,’ and ensuring that gender dysphoria is not secondary to, or better accounted for, by other diagnoses.’” Bailey’s regulation cites this recommendation as support.
The regulation also cites WPATH’s acknowledgement that “there are no studies of the long-term outcomes of gender-related medical treatment for youth who have not undergone a comprehensive assessment.”
It also cites the U.S. Agency for Healthcare Research and Quality, which determined that there is “a lack of current evidence-based guidance for the care of children and adolescents who identify as transgender, particularly regarding the benefits and harms of pubertal suppression, medical affirmation with hormone therapy, and surgical affirmation.”
Psychiatrists, endocrinologists, neurologists, and other doctors recently testified in support of a Florida health agency’s rule preventing Medicaid from funding “puberty-blockers,” cross-sex hormones, and transgender surgeries.
Dr. Stephen B. Levine, a psychiatrist and former leader of the organization that became WPATH, warned that hormonal interventions “are experimental procedures that have not been proven safe.” He condemned WPATH’s standards of care as “not an impartial or evidence-based document.”
Dr. Paul Hruz, a hormone specialist, noted that “there are no long-term, peer-reviewed published, reliable and valid research studies” documenting the percentage of patients helped or harmed by transgender medical interventions. He also notes that attempts to block puberty followed by cross-sex hormones not only impact fertility, but also pose risks such as low bone density, “disfiguring acne, high blood pressure, weight gain, abnormal glucose tolerance, breast cancer, liver disease, thrombosis, and cardiovascular disease.”
Dr. Sophie Scott, a neuroscientist from the United Kingdom, explained that the effects of certain chemicals on the human brain aren’t well-known, and that current science does not support “puberty blockers” for adolescents.
For these and other reasons, the Missouri regulation declares it an “unfair, deceptive, fraudulent, or otherwise unlawful practice” to provide or refer a patient for gender transition interventions if the doctor or health organization fails to obtain informed consent by notifying the patient of certain facts, such as: that the Food and Drug Administration has not approved “puberty blockers” or cross-sex hormones for gender dysphoria; that medical authorities in Europe have restricted these practices; that studies show nearly all children prescribed with puberty blockers have later been put on cross-sex hormones; that studies have not shown a decrease in suicidal tendencies from the use of such interventions; and more.
The regulation also requires a medically documented pattern of gender dysphoria for three years before any intervention, 15 separate hourlong therapy sessions beforehand, an evaluation proving the patient has recovered from any mental health comorbidities beforehand, and the maintenance of data about adverse effects “in a form that can be accessed readily for systematic study,” among other requirements.
Goldfarb, the kidney specialist who leads the medical group Do No Harm, noted that young women with gender dysphoria face “significant psychological disturbances” and require psychological evaluation, as Bailey’s order directs.
“Young women with gender dysphoria require careful, psychological evaluation and often therapy, because a very high percentage of them are suffering from significant psychological disturbances,” he told The Daily Signal. “The idea that one will pursue dangerous puberty blockers, sex characteristic-altering hormones, and even surgeries without careful psychological evaluation and parental involvement is unfathomable. A vast majority of these children are depressed, autistic, and have additional psychological problems that should be addressed before resorting to surgery.”
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