The Missouri Supreme Court on Tuesday unanimously upheld a ban on gender transition surgeries, cross-sex hormones and other gender-affirming care for minors.
Writing for the court, Judge Kelly Broniec said prohibiting the surgeries doesn't violate the rights of transgender children. Plaintiffs sued to overturn the ban, arguing it violates the equal protection and due process clauses of the Missouri Constitution.
"Although parents have a right 'to make decisions concerning the care, custody, and control of their children[,]' ... there is no fundamental 'right of a parent to obtain for his or her child a medical treatment that, although the child desires it and a doctor approves, the state legislature deems inappropriate for minors,'" Broniec wrote.
Missouri's General Assembly enacted the ban, also known as the SAFE Act, in 2023, and the law took effect later that year. The ban expires in 2027, though lawmakers have said they want to make the prohibitions permanent. A ballot initiative planned for November also seeks to ban such care indefinitely.
In the lawsuit, providers, organizations and families argued on behalf of minors that the ban interfered with parents' rights to decide appropriate medical care for their children and that it was discriminatory based on transgender status and sex.
The state's highest court disagreed, saying in its opinion that the ban "classifies only on age and medical use … the SAFE Act prohibits the performance of gender transition surgery on, and prescription or administration of cross-sex hormones or puberty-blocking drugs for "any individual under eighteen years of age."
Representatives from the ACLU, one of the organizations that sued on behalf of patients, emphasized certain treatments, such as cross-sex hormones or puberty blockers, are used by cisgender minors and aren't subject to the same restrictions.
"Today's decision allows the state to continue to enforce a harmful ban that singles out transgender Missourians and denies them compassion and equal access to medically necessary health care," said ACLU of Missouri Litigation Director Gillian Wilcox in a statement. "The decision not only allows the state to target transgender Missourians access to health care but also leaves everyone's health care options at the whims of politicians, should certain care ever fall into the political arena."
The court also upheld Missouri's ban on using state Medicaid funds for gender transition surgeries and hormones, stating the treatments are an "area fraught with medical and scientific uncertainties" and demonstrate a lack of accepted standards of practice.
Attorney General Catherine Hanaway celebrated the court's decision and its confirmation of the legislature's authority,
"This win sends a clear message: Missouri will always protect children from dangerous, untested, and experimental procedures," she said in a statement. "The Attorney General's Office will continue to stand shoulder-to-shoulder with parents, lawmakers, and communities to defend Missouri's laws and preserve the future of our youth."
Several medical associations have supported appropriate and considered gender-affirming procedures for children.
American Academy of Pediatrics President Susan J. Kressly last year called restrictions "a baseless intrusion into the patient-physician relationship" after the Centers for Medicare and Medicaid Services proposed rules prohibiting Medicaid payments for gender-affirming care to minors.
"The government's actions today make that task harder, if not impossible, for families of gender-diverse and transgender youth," Kressly said.
The decision comes on the heels of the 2025 U.S. Supreme Court ruling that upheld Tennessee's ban on gender-affirming care for those under 18, which the Missouri judge quoted throughout Tuesday's decision.
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