The Missouri Supreme Court on Tuesday declined to block and formally upheld the state’s ban on gender-affirming medical care for transgender minors, allowing the law to remain in effect as legal challenges continue.
In a unanimous ruling, the court refused to issue an injunction against Senate Bill 49, commonly known as the Missouri Save Adolescents from Experimentation Act. The decision affirms earlier lower-court rulings and keeps the restrictions in place while litigation proceeds.
The law, which took effect in August 2023, prohibits physicians from prescribing puberty blockers or hormone therapy and from performing gender-affirming surgeries for individuals under the age of 18. It also bars Missouri Medicaid from covering gender-affirming care for transgender people of any age and allows the state to revoke medical licenses for providers who violate the ban.
Families of transgender youth, medical providers, and advocacy organizations including the ACLU of Missouri and Lambda Legal argued that the law violates the Missouri Constitution by infringing on equal protection rights, parental authority, and the right to seek medically recommended care. They also noted that many of the same medications restricted under the law are commonly prescribed to cisgender patients for other conditions.
In its written opinion, the court rejected those claims, determining that the law regulates medical procedures based on age and treatment type rather than sex or gender identity. The justices applied a rational-basis standard of review, concluding that the legislature acted within its authority when it restricted access to the treatments.
Civil rights organizations strongly criticized the ruling. In a statement, the ACLU of Missouri said the decision allows the state to continue enforcing a policy that denies transgender Missourians access to medically necessary care and interferes with private healthcare decisions. Lambda Legal echoed those concerns, stating that the law places politicians between families, patients, and doctors.
State officials and supporters of the ban praised the decision. Missouri Attorney General Andrew Bailey said the ruling confirms the state’s authority to regulate medical practices involving minors and described the law as a measure intended to protect children.
Missouri’s law is part of a broader wave of state-level restrictions on gender-affirming care for transgender youth. More than two dozen states have enacted similar bans or limitations, many of which are currently being challenged in state and federal courts. Advocacy groups estimate that nearly half of transgender adolescents in the United States now live in states where access to this care is restricted or prohibited.
While Senate Bill 49 includes a sunset provision scheduled to expire in 2027, some Missouri lawmakers have signaled interest in extending or permanently enshrining the restrictions through future legislation or ballot measures.
Advocacy organizations say they are continuing to explore legal options and public policy efforts, while families affected by the ban report ongoing disruptions to medical care. For now, the Missouri Supreme Court’s ruling leaves the state’s restrictions firmly in place.
