Missouri judge blocks rule limiting gender-affirming health care

The legal fight over the ruling is not over, and some trans Missourians tell Scripps News they are making active plans to flee to the state.
Posted at 8:59 PM, Apr 26, 2023

Clark Roman has called St. Louis home for exactly ten years. It's here that the 32-year-old got his MBA, built a successful career and community of friends, and bought his first house for himself and his three pets. 

"I just really love it here," said Roman. 

But today, the transgender man says he's ready to pack his things and go because Missouri "feels a lot less friendly and a lot scarier than it used to" for the trans community. 

Roman started transitioning five years ago when he started "having these moments of what we call gender euphoria." 

He describes how it felt to discover himself: 

"I got my hair cut really short, like that was gender euphoria. It was like the first time I was like, 'Oh, I look in the mirror and I see something that looks right.'" 

A few months after coming out, with guidance from a local doctor, Roman started taking testosterone in the form of weekly at-home injections. 

He credits his masculinizing hormone therapy, a type of gender-affirming care, with saving his life. 

"I spent a lot of my early teens and twenties being pretty suicidal or at least passively suicidal. And now I'm not and I haven't really been since I started having gender-affirming care." 

On Wednesday evening, a Missouri state judge temporarily blocked state rules that would have restricted gender-affirming health care for children and adults, but Roman says the temporary reprieve is not enough to change his mind. 

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"Even this being blocked doesn't make a difference for me moving forward. I think at this point I've realized enough that I have to be somewhere that has active safety protections in place." 

"I think the floodgates have been so far opened on anti-trans legislation that even if we get a temporary reprieve or a temporary blockage of this ruling, that doesn't protect me for the next wave of legislative attacks. There's going to be these legislative actions taken." 

Missouri's Attorney General Andrew Bailey, who unilaterally put forward the now-blocked emergency order, tells Scripps News that the regulation "enacts basic safeguards for procedures masquerading as medicine." Under the rule, providers would be barred from offering gender-affirming care to new patients unless those patients, among other things, have received 15 hourly sessions of therapy over at least 18 months, have been screened for autism, have three years of documented gender dysphoria and have "resolved" any symptoms from mental health issues. 

"My community is scared," said local pastor Lazarus Jameson, who is trans and uses they/them pronouns. As the chaplain of Lot's Wife Trans & Queer Chaplaincy, Jameson offers emotional and spiritual care to other trans adults. 

"A lot of our opponents use anti-trans language and claim Christianity as their vehicle for legitimacy but they have Christianity entirely wrong," they said. 

Jameson says they love supporting people during their transitions and celebrating milestones that come with taking hormones like testosterone, also know as "T". 

"I love getting pictures of like, you know, my guys who start T[estosterone]. You know, you get a picture. They want to tell someone that they got a chest hair, right? You know, and that's such a big deal," they said. 

The pastor, who is thinking of relocating across the Mississippi River to Illinois to stay close to the people they serve, say the temporary injunction order is "a net positive but it's not enough to make us safe." 

Jameson stresses that not every trans Missourian is able to move. 

"I serve a lot of folks with disabilities who can't leave. We've got people with custody agreements. They can't leave," they said.

Some providers tell Scripps News that if the rule kicks in, they would have no choice but to stop offering gender-affirming care to new patients in Missouri. "Currently we don't see that as feasible," said Brandon Hill, the interim president and CEO of Vivent Health, an organization with health centers in St. Louis and Kansas City, Mo. Hill says that calling gender-affirming treatments  experimental is a "complete misnomer."

As for Roman, he hopes to relocate to Chicago or Minneapolis as soon as he finds a new job. 

In the meantime, by using half doses, he has stockpiled enough testosterone to last him for the next 15 to 30 weeks.