KANSAS CITY, Mo. — A Missouri judge on Monday upheld the state’s ban on gender-affirming care for minors, allowing the state to continue prohibiting treatments such as hormone therapy and puberty blockers for people under 18.

Circuit Court Judge Robert Craig Carter from southern Douglas County wrote in a 74-page order on Monday that the ban was constitutional. The ruling rejects a lawsuit brought on behalf of families of trans youth, medical providers and national LGBTQ advocacy organizations.

In addition to ruling that the ban was constitutional, Carter went a step further, finding that there was “an almost total lack of consensus as to the medical ethics” of treating adolescent gender dysphoria, which is typically defined as the feeling of distress when a person’s gender identity does not match their sex assigned at birth.

“The evidence at trial showed severe disagreement as to whether adolescent gender dysphoria drug and surgical treatment was ethical at all, and if so, what amount of treatment was ethically allowable,” Carter wrote in the order.

Carter’s ruling comes after a nine-day trial that concluded in Jefferson City last month. The trial and lawsuit centered on a law that the Republican-controlled General Assembly passed and Gov. Mike Parson signed into law in 2023.

The law, which took effect in August 2023, bans gender transition surgeries on minors and imposes a three-year moratorium on hormone therapy and puberty blockers unless the patients were already receiving the medications.

The legislation also affects adults, prohibiting Missouri Medicaid dollars from covering gender-affirming care and bans prisons and jails from providing gender-affirming surgeries.

The ban was part of a nationwide push to regulate the lives of transgender people and has sparked fear in Missouri’s transgender community, prompting some to leave the state. The Kansas City-area was at the center of the fight, with transgender residents straddling two states that sought to restrict their rights.

The ACLU of Missouri and the national LGBTQ civil rights law firm Lambda Legal, representing the plaintiffs in the lawsuit, sharply criticized the ruling in a joint statement. The two groups said they planned to appeal.

“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,” the groups said in the statement.

The lawsuit alleged the ban violated the Missouri Constitution by discriminating against trans patients on the basis of sex and their trans status, and deprives parents of a fundamental right to seek medical care for their children. The law also forces medical providers to choose between abandoning their patients or keeping their medical licenses, according to the suit.

Carter disagreed, upholding the law on all counts, according to his order.

Republican Attorney General Andrew Bailey’s office defended the law in court. The ban came after Bailey had previously attempted to severely restrict gender-affirming care by issuing a regulation, leading even some Republicans to question its legality. He eventually abandoned that effort after lawmakers approved the ban.

Bailey and other Republicans have regularly framed restrictions on gender-affirming care as necessary to protect children, an argument Bailey reiterated after Monday’s ruling.

“Mutilation is not healthcare,” Bailey wrote on social media on Monday. “We will never stop fighting to protect your children.”

Bailey’s office put out a release later in the day, saying he was proud of the work his 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,” Bailey said.

Impact on Kansas City

Bailey had pushed for restrictions on gender-affirming care after a former employee at Washington University in St. Louis’ transgender center at St. Louis Children’s Hospital alleged the center was harming patients. The university’s internal report found the allegations to be unfounded.

Despite Bailey’s argument, the ACLU of Missouri and Lambda Legal said Monday that Missouri had “prioritized politics over the well-being of its people.”

“This ruling sends a chilling message that, for some, compassion and equal access to health care are still out of reach,” the groups said. The law firm Bryan Cave Leighton Paisner also represented the plaintiffs in the suit.

After the ruling came down, Celeste Michael, a 23-year-old transgender woman from Kansas City, said that she felt for transgender kids. Trans people, she said, are facing “even more vitriol and more hatred.”

“I think it’s a really scary time to be a trans person,” Michael said. “If they’re going to go for kids, which are our most vulnerable subset of trans people, they’re going for incarcerated people, which are also some of our most vulnerable trans people, who’s to say they’re not going to go for me next?”

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