美国国家公共电台 NPR--Missouri to restrict gender-affirming care for trans adults this week

Missouri to restrict gender¹-affirming care for trans adults this week

Transcript²

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ST. LOUIS, Mo. – Chelsea Freels has spent a good bit of time in 2023 trying to convince Missouri lawmakers to not vote for legislation barring what's known as gender-affirming care for transgender youth like her.

Over and over, the 17-year-old from suburban³ St. Louis has heard GOP lawmakers talking about how they need to pass legislation to protect people like her. And over and over, she says she replies:

"Protect me from what?" Freels says. " 'Oh no! The kid is getting better grades. Oh no! The scary transgender has friends! What are they going to do? Smile?' "

Despite Freels testifying that gender-affirming care has made her feel much happier and has helped her heal from depression and suicidal thoughts, Missouri lawmakers seem poised⁴ to approve legislation that bars puberty blockers, hormone⁵ therapy and gender transition surgery for minors⁶.

Intervention⁷ from Democrats⁸ in the state Senate, though, has made the bill — that's most likely to get approved before the end of session — less restrictive than other GOP states. It now includes provisions that exempt⁹ those like Freels who are already receiving treatment.

A surprise announcement from the state AG

But then, a bombshell: Missouri Attorney General Andrew Bailey put forward emergency rules placing barriers to gender-affirming care for minors and adults. The rules are set to go into effect later this week, although opponents filed a petition Monday evening seeking an order to temporarily block implementation¹⁰.

Bailey says the rules are meant to keep both parents of transgender youth and transgender adults more informed before receiving gender-affirming care, describing them as an "innovative¹¹ approach" for people to "have all the information necessary to make good decisions."

But LGBTQ advocates across Missouri see the rules as a dramatic departure from the rhetoric¹² used to pass a ban for minors — that it's necessary to protect children — and that it's an existential attack on transgender Missourians.

"We are living through an all-out attack on transgender Missourian's lives and the very ability to exist," says Robert Fischer, the communications director for the Missouri-based LGBTQ advocacy group PROMO.

'Unlike anything we've seen before'

Bailey's move is unusual for a number of reasons, aside from the fact that it affects both transgender minors and adults.

For one thing, the guidelines weren't passed by a legislature or signed by a governor, but rather derived¹³ from Bailey's powers to enforce laws around consumer protection. (Officials in Texas and Florida have also used rules to try to limit transgender care.) And the rules are not inconsequential: Providers are barred from giving gender-affirming care if, among other things, someone has not received 15 hourly sessions of therapy over at least 18 months, has not been screened for autism and has not had documented gender dysphoria for three years.

"These are intended to protect all patients and make sure that all patients have access to mental health services," Bailey said in an interview with St. Louis Public Radio.

Despite claims by some Republicans, many health care providers and medical groups, including The American Medical Association, say this kind of care is tested. The AMA calls gender-affirming care, "medically-necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people."

But the new rules in Missouri also state that a provider must "ensure that any psychiatric symptoms from existing mental health comorbidities of the patient have been treated and resolved." When asked to clarify what that means, Bailey responded: "Treating these other mental health problems before we race down the road of administration of experimental drugs."

But many medical professionals, like Brandon Hill, strongly dispute Bailey's characterization of gender-affirming care as experimental.

Hill is with Vivent Health, a Milwaukee-based agency with facilities in Missouri. Vivent Health primarily provides care to LGBTQ people, including gender-affirming care. Hill says what Bailey is doing is "unlike anything we've seen before, particularly in that it does include adult individuals over 18."

And while there are exemptions¹⁴ for people in the rules who already receive care, Hill says the guidelines are so onerous¹⁵ that they could block access for everyone.

"This could lead to the discontinuation of that care if the health care providers are not able to meet all these new requirements that are both antiquated¹⁶ and not based in science," Hill says.

Missouri as part of a GOP state trend

As at least a dozen other GOP states pass restrictions¹⁷ on transgender rights this year, there's been some conjecture¹⁸ in Missouri on why it's become such a big issue in this state's politics and policy.

Some say Missouri Republicans are energized¹⁹ to curtail²⁰ gender-affirming care for minors because of right-leaning media outlets²¹ and social media platforms amplifying²² opposition²³ to transgender rights. And lawmakers, like GOP state Sen. Rusty²⁴ Black, say that's causing their constituents²⁵ to demand action.

"I've got grandparents getting a hold of me over these issues," he says.

Others, like Democratic state Sen. Greg Razer, say it's a consequence of the party running out of ideas on how to restrict abortion²⁶ rights or reduce gun restrictions.

"There's nothing else you can pass, so you have to find a new social wedge issue," says Razer, the only openly gay member of the Missouri Senate. "I think they thought it was going to be critical race theory. That dart²⁷ didn't stick. They're trying to make it stick to trans kids. If that doesn't do it, they'll go after another one."

And there's some evidence that what Bailey is doing may be too far for some Republicans.

Missouri Secretary of State Jay Ashcroft, a leading GOP candidate for governor in 2024, said that he strongly supports banning gender-affirming care for minors but that he doesn't think the state should be creating barriers for adults.

"I don't think people should do it. But there's a difference between what I think and where I think the government should be involved," Ashcroft said in an interview with St. Louis Public Radio. "If you're an adult and you want to spend your own money, I disagree with you, but it's not my place to tell you that you can't."

Ashcroft told the St. Louis Post-Dispatch he doesn't expect the rules to survive a lawsuit²⁸. Bailey dismissed Ashcroft's criticisms.

"I am standing²⁹ up to make sure that patients have the information they need to make informed health care decisions," Bailey said. "I'm not sure that the secretary of state fully³⁰ understood the rule when he offered that opinion."

James Thurow and Danielle Meert are the former St. Louis chapter leaders of TransParent³¹ — a support group for families with transgender children. They've been testifying against gender-affirming care bans for transgender minors, like their son, for years. They say it's critical for the rules to be challenged in court.

Both Thurow and Meert note that gender-affirming care is already expensive, especially if someone doesn't have insurance that can cover some of the cost. Adding requirements for therapy and autism screenings could place the treatments out of reach for low-income families, they say.

Thurow says he's hoping a successful legal outcome could dissuade³² other states from following Missouri's lead.

"Having litigation is incredibly important," Thurow says. "And the more it can get codified³³ on a federal level, the better. Because it's going to happen in every possible red state where they can jam this through."

"We will fight this," Meert adds. "We will win. We are on the right side of history, and we are following all of the leading authorities of medicine."

Political boon³⁴ or bust³⁵?

There's little doubt that the struggle over transgender rights will loom³⁶ large over next year's elections in Missouri. Before Bailey's rules were proposed, the issue was prominent in a number of speeches at the Missouri Republican Party Lincoln Days events — including from U.S. Sen. Josh Hawley.

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"We ought to send a clear message, which is a message rooted in the truth of the Bible and all of our history," Hawley, who is running for a second term next year, said. "Which is: 'Guess what? God made you as you are, and there's nothing wrong with that.'"

Some opponents of barring gender-affirming care for adults and minors hope that the issue will backfire on Republicans, especially as younger voters who support LGBTQ rights turn 18 and go to the polls.

Shira Berkowitz, senior director for policy and advocacy for the group PROMO, says they see the GOP push against transgender rights as "a real misunderstanding of who is transgender and what makes somebody transgender."

"From the kids that we see that testify constantly at the Missouri legislature, we've heard them say things like, 'I'm supported in my family. I'm supported in my school. My teachers use the right pronouns for me. My classmates see me as who I am. The only people that don't are our elected leaders in our state,' " Berkowtiz says.

Chelsea Freels says her generation can help turn back policy that could affect people like her.

"Make no mistake, we will probably lose this battle, but we will win the war," Freels says. "The problem is how many casualties and how many bodies laid dead before we got there?"

But Freels won't be in Missouri much longer to see if that backlash comes to pass.

"I do not want to be here anymore. I'm going to college soon," she says. "And you can take a look at all the red states. And I've got a red state hole puncher and the map of the U.S. And those are places that are not on my list anymore. And Missouri is unfortunately one of them."

1 gender   

n.（生理上的）性，（名词、代词等的）性

参考例句：

• French differs from English in having gender for all nouns.法语不同于英语，所有的名词都有性。
• Women are sometimes denied opportunities solely because of their gender.妇女有时仅仅因为性别而无法获得种种机会。

2 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

3 suburban   

adj.城郊的，在郊区的

参考例句：

• Suburban shopping centers were springing up all over America. 效区的商业中心在美国如雨后春笋般地兴起。
• There's a lot of good things about suburban living.郊区生活是有许多优点。

4 poised   

a.摆好姿势不动的

参考例句：

• The hawk poised in mid-air ready to swoop. 老鹰在半空中盘旋，准备俯冲。
• Tina was tense, her hand poised over the telephone. 蒂娜心情紧张，手悬在电话机上。

5 hormone   

n.荷尔蒙，激素，内分泌

参考例句：

• Hormone implants are used as growth boosters.激素植入物被用作生长辅助剂。
• This hormone interacts closely with other hormones in the body.这种荷尔蒙与体內其他荷尔蒙紧密地相互作用。

6 minors   

n.未成年人( minor的名词复数 )；副修科目；小公司；[逻辑学]小前提v.[主美国英语]副修，选修，兼修( minor的第三人称单数 )

参考例句：

• The law forbids shops to sell alcohol to minors. 法律禁止商店向未成年者出售含酒精的饮料。 来自《简明英汉词典》
• He had three minors this semester. 这学期他有三门副修科目。 来自《简明英汉词典》

7 intervention   

n.介入，干涉，干预

参考例句：

• The government's intervention in this dispute will not help.政府对这场争论的干预不会起作用。
• Many people felt he would be hostile to the idea of foreign intervention.许多人觉得他会反对外来干预。

8 democrats   

n.民主主义者，民主人士( democrat的名词复数 )

参考例句：

• The Democrats held a pep rally on Capitol Hill yesterday. 民主党昨天在国会山召开了竞选誓师大会。
• The democrats organize a filibuster in the senate. 民主党党员组织了阻挠议事。 来自《简明英汉词典》

9 exempt   

adj.免除的；v.使免除；n.免税者，被免除义务者

参考例句：

• These goods are exempt from customs duties.这些货物免征关税。
• He is exempt from punishment about this thing.关于此事对他已免于处分。

10 implementation   

n.实施，贯彻

参考例句：

• Implementation of the program is now well underway.这一项目的实施现在行情看好。

11 innovative   

adj.革新的，新颖的，富有革新精神的

参考例句：

• Discover an innovative way of marketing.发现一个创新的营销方式。
• He was one of the most creative and innovative engineers of his generation.他是他那代人当中最富创造性与革新精神的工程师之一。

12 rhetoric   

n.修辞学，浮夸之言语

参考例句：

• Do you know something about rhetoric?你懂点修辞学吗？
• Behind all the rhetoric,his relations with the army are dangerously poised.在冠冕堂皇的言辞背后，他和军队的关系岌岌可危。

13 derived   

vi.起源；由来；衍生；导出v.得到( derive的过去式和过去分词 )；（从…中）得到获得；源于；（从…中）提取

参考例句：

• Many English words are derived from Latin and Greek. 英语很多词源出于拉丁文和希腊文。 来自《简明英汉词典》
• He derived his enthusiasm for literature from his father. 他对文学的爱好是受他父亲的影响。 来自《简明英汉词典》

14 exemptions   

n.（义务等的）免除( exemption的名词复数 )；免（税）；（收入中的）免税额

参考例句：

• The exemptions for interpretive rules, policy statements, and procedural rules have just been discussed. 有关解释性规则、政策说明和程序规则的免责我们刚刚讨论过。 来自英汉非文学 - 行政法
• A: The regulation outlines specific exemptions for some WPM. 答：该规定概述了某些木质包装材料的特定的例外情形。 来自互联网

15 onerous   

adj.繁重的

参考例句：

• My household duties were not particularly onerous.我的家务活并不繁重。
• This obligation sometimes proves onerous.这一义务有时被证明是艰巨的。

16 antiquated   

adj.陈旧的，过时的

参考例句：

• Many factories are so antiquated they are not worth saving.很多工厂过于陈旧落后，已不值得挽救。
• A train of antiquated coaches was waiting for us at the siding.一列陈旧的火车在侧线上等着我们。

17 restrictions   

约束( restriction的名词复数 )； 管制； 制约因素； 带限制性的条件（或规则）

参考例句：

• I found the restrictions irksome. 我对那些限制感到很烦。
• a snaggle of restrictions 杂乱无章的种种限制

18 conjecture   

n./v.推测，猜测

参考例句：

• She felt it no use to conjecture his motives.她觉得猜想他的动机是没有用的。
• This conjecture is not supported by any real evidence.这种推测未被任何确切的证据所证实。

19 energized   

v.给予…精力，能量( energize的过去式和过去分词 )；使通电

参考例句：

• We are energized by love if we put our energy into loving. 如果我们付出能量去表现爱意，爱就会使我们充满活力。 来自辞典例句
• I am completely energized and feeling terrific. 我充满了活力，感觉非常好。 来自辞典例句

20 curtail   

vt.截短，缩短；削减

参考例句：

• The government hopes to curtail public spending.政府希望缩减公共事业开支。
• The minister had to curtail his visit.部长不得不缩短访问日期。

21 outlets   

n.出口( outlet的名词复数 )；经销店；插座；廉价经销店

参考例句：

• The dumping of foreign cotton blocked outlets for locally grown cotton. 外国棉花的倾销阻滞了当地生产的棉花的销路。 来自《简明英汉词典》
• They must find outlets for their products. 他们必须为自己的产品寻找出路。 来自《现代汉英综合大词典》

22 amplifying   

放大，扩大( amplify的现在分词 )； 增强； 详述

参考例句：

• Often they use borrowed funds, amplifying their gains and losses. 他们通常会用借贷的资金交易，从而放大收益或损失。
• An amplifying type (or analog) device, as opposed to digital device. 放大器类（或模拟）器件，相对于数字器件而言的。

23 opposition   

n.反对，敌对

参考例句：

• The party leader is facing opposition in his own backyard.该党领袖在自己的党內遇到了反对。
• The police tried to break down the prisoner's opposition.警察设法制住了那个囚犯的反抗。

24 rusty   

adj.生锈的；锈色的；荒废了的

参考例句：

• The lock on the door is rusty and won't open.门上的锁锈住了。
• I haven't practiced my French for months and it's getting rusty.几个月不用，我的法语又荒疏了。

25 constituents   

n.选民( constituent的名词复数 )；成分；构成部分；要素

参考例句：

• She has the full support of her constituents. 她得到本区选民的全力支持。
• Hydrogen and oxygen are the constituents of water. 氢和氧是水的主要成分。 来自《简明英汉词典》

26 abortion   

n.流产，堕胎

参考例句：

• She had an abortion at the women's health clinic.她在妇女保健医院做了流产手术。
• A number of considerations have led her to have a wilful abortion.多种考虑使她执意堕胎。

27 dart   

v.猛冲，投掷；n.飞镖，猛冲

参考例句：

• The child made a sudden dart across the road.那小孩突然冲过马路。
• Markov died after being struck by a poison dart.马尔科夫身中毒镖而亡。

28 lawsuit   

n.诉讼，控诉

参考例句：

• They threatened him with a lawsuit.他们以诉讼威逼他。
• He was perpetually involving himself in this long lawsuit.他使自己无休止地卷入这场长时间的诉讼。

29 standing   

n.持续，地位；adj.永久的，不动的，直立的，不流动的

参考例句：

• After the earthquake only a few houses were left standing.地震过后只有几幢房屋还立着。
• They're standing out against any change in the law.他们坚决反对对法律做任何修改。

30 fully   

adv.完全地，全部地，彻底地；充分地

参考例句：

• The doctor asked me to breathe in,then to breathe out fully.医生让我先吸气，然后全部呼出。
• They soon became fully integrated into the local community.他们很快就完全融入了当地人的圈子。

31 transparent   

adj.明显的，无疑的；透明的

参考例句：

• The water is so transparent that we can see the fishes swimming.水清澈透明，可以看到鱼儿游来游去。
• The window glass is transparent.窗玻璃是透明的。

32 dissuade   

v.劝阻，阻止

参考例句：

• You'd better dissuade him from doing that.你最好劝阻他别那样干。
• I tried to dissuade her from investing her money in stocks and shares.我曾设法劝她不要投资于股票交易。

33 codified   

v.把（法律）编成法典( codify的过去式和过去分词 )

参考例句：

• In the meantime, however, Kennecott had been codified elsewhere in the Act. 然而，“肯尼考特”一案已被编人法案。 来自英汉非文学 - 环境法 - 环境法
• Congress has since codified this holding. 从那时以来，国会编纂整理了最高法院的这一裁定。 来自英汉非文学 - 行政法

34 boon   

n.恩赐，恩物，恩惠

参考例句：

• A car is a real boon when you live in the country.在郊外居住，有辆汽车确实极为方便。
• These machines have proved a real boon to disabled people.事实证明这些机器让残疾人受益匪浅。

35 bust   

vt.打破；vi.爆裂；n.半身像；胸部

参考例句：

• I dropped my camera on the pavement and bust it. 我把照相机掉在人行道上摔坏了。
• She has worked up a lump of clay into a bust.她把一块黏土精心制作成一个半身像。

36 loom   

n.织布机，织机；v.隐现，(危险、忧虑等)迫近

参考例句：

• The old woman was weaving on her loom.那位老太太正在织布机上织布。
• The shuttle flies back and forth on the loom.织布机上梭子来回飞动。