Many states are also trying to restrict gender-related treatments for adults.

Missouri has imposed sweeping rules to limit health care to trans adults. Other states have banned Medicaid coverage or introduced bills banning young adult care.

Missouri this month became the first state in the countries to severely restrict gender-related treatment for people of all ages. , following a series of quieter movements across the country that reduced transgender adults' access to medical care.

Last year, the Florida joined six other states in banning Medicaid from covering some form of gender care for transgender people of all ages. These bans affect about 38,000 beneficiaries of the public insurance program, according to the Williams Institute, a research center at U.C.L.A. School of Law

And in at At least five states, Republican lawmakers have proposed bills that would abolish gender care for minors as well as young adults. Some are trying to ban it for those under 21 and others for those under 26.

Missouri's radical new policy has taken a different approach. Citing consumer protection laws meant to regulate fraud, state Attorney General Andrew Bailey issued an emergency rule barring doctors from providing gender-based treatments to patients — of any age — unless they fail to meet a series of significant restrictions, including 18 months of psychological evaluation. . The rule also stated that patients should not receive gender-related treatment until mental health issues were "resolved".

The onerous restrictions equivalent to a "de facto ban," Gillian said. Branstetter, communications strategist at the American Civil Liberties Union, whose Missouri chapter has announced plans to file a legal challenge to the rule.

"The political situation regarding trans health care was always directed here,” Ms. Branstetter said. themselves and their doctors “quickly” comply with psychological assessments and other restrictions.

Aro Royston, a 35-year-old transgender man in St. shocked by the new policy. He said he had been taking testosterone for eight years, with monthly refills prescribed by his doctor. If he could no longer access treatments, he would be "devastated", he said. he stated, and would travel out of state for treatment.

"I think what bothers me the most is that I'm a functioning member of this company,” said Mr. Royston, program manager at a U.S. defense contractor. "I worked on defense programs to protect my nation. And my nation can't protect me?"

Missouri's new policy goes into effect 27 April and expires in February 2024, when the state legislature is back in session. (Two bills that would have banned care for minors — and barred Medicaid from covering it for all ages — did not advance in this year's session.)

ImageMissouri Attorney General Andrew Bailey released emergency rule barring doctors from providing gender-related treatments to patients of any age unless they meet a series of important restrictions.Credit....