A Missouri trial court declined Friday to block a law preventing transgender interventions for minors, citing “conflicting and unclear” medical evidence on the effectiveness of so-called puberty blockers and cross-sex hormones.

“The science and medical evidence is conflicting and unclear,” Judge Stephen R. Ohmer ruled. “Accordingly, the evidence raises more questions than answers.”

Three Missouri families who claim their children identify as the gender opposite their biological sex sued the state’s Republican governor, Michael Parson, challenging the constitutionality of a law he signed June 7.

The families had asked the court to issue a preliminary injunction, blocking the law from going into effect during the course of litigation. However, Ohmer ruled that the families “have not clearly shown a sufficient threat of irreparable injury absent injunctive relief,” so he declined to grant the injunction.

“Today is a day that will go down in Missouri history,” Missouri Attorney General Andrew Bailey, who defended the law, told The Daily Signal in a written statement Friday. “We put their ‘evidence’ under a microscope, and it spoke for itself. Missouri’s children won today. I’m beyond proud to have led the fight.”

“Missouri is the first state in the nation to successfully defend at the trial court level a law barring child mutilation,” Bailey also said in a press release. “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. This is a huge step in that direction.”

Judges in Alabama and Tennessee granted injunctions blocking similar laws in those states, before higher courts restored the laws. District courts have blocked such laws temporarily in at least seven states, including Arkansas, Florida, Georgia, Indiana, and Kentucky.

The Missouri law, SB 49, called the Missouri Save Adolescents from Experimentation Act, or SAFE Act, will go into effect Monday. It states: “A health care provider shall not knowingly perform a gender transition surgery on any individual under eighteen years of age,” nor “knowingly prescribe or administer cross-sex hormones or puberty-blocking drugs for the purpose of a gender transition for an individual under eighteen years of age.”

The law defines “biological sex” as “the biological indication of male or female in the context of reproductive potential or capacity, such as sex chromosomes, naturally occurring sex hormones, gonads, and nonambiguous internal and external genitalia present at birth, without regard to an individual’s psychological, chosen, or subjective experience of gender.”

It defines “gender transition” as “the process in which an individual transitions from identifying with and living as a gender that corresponds to his or her biological sex to identifying with and living as a gender different from his or her biological sex, and may involve social, legal, or physical changes.”

The law states that if a physician administers cross-sex hormones or “puberty blockers” to a minor, such an act “shall be considered unprofessional conduct” and the physician “shall have his or her license to practice revoked by the appropriate licensing entity or disciplinary review board.”

It also creates a cause of action, enabling a minor who undergoes such a procedure to sue the physician or health care provider within 15 years.

The ban doesn’t apply to patients suffering from a disorder of sex development. It also bars physicians from performing transgender surgeries on prisoners.

The law sunsets in 2027 as part of a compromise with Democrats in the Missouri Senate.

Transgender interventions, often referred to by the euphemistic term “gender-affirming care,” involve “puberty blockers”—drugs such as Lupron, which the FDA has not approved for gender dysphoria (the persistent condition of painfully identifying with the gender that is the opposite one’s biological sex); or “cross-sex hormones” (testosterone for girls, estrogen for boys) that introduce a hormone imbalance, a condition that endocrinologists otherwise would recognize as a disease. (Endocrinologists treat the endocrine system, which uses hormones to control metabolism, reproduction, growth, and more.)

Psychiatrists, endocrinologists, neurologists, and other doctors testified in support of a Florida health agency’s rule preventing Medicaid from funding various forms of “gender-affirming care,” such as “puberty-blockers,” cross-sex hormones, and transgender surgeries.

“Patients suffering from gender dysphoria or related issues have a right to be protected from experimental, potentially harmful treatments lacking reliable, valid, peer-reviewed, published, long-term scientific evidence of safety and effectiveness,” Dr. Paul Hruz, an endocrinology researcher and clinician at Washington University School of Medicine, wrote in a sworn affidavit.

Hruz 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 wrote that attempts to block puberty followed by cross-sex hormones not only affect 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.”

Hruz and other doctors argue that the medical interventions often described as “gender-affirming care” are experimental and that the organizations that present standards of care supporting them—the World Professional Association for Transgender Health and the Endocrine Society—represent more a political and advocacy effort than an objective analysis supporting these alleged treatments.

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