Recent legislative actions in states like Georgia and Missouri have raised serious concerns about access to gender-affirming care for transgender individuals, particularly those with autism diagnoses. These regulations, framed under the guise of protecting youth, are increasingly demonstrating a broader intent to restrict the rights of all transgender people, regardless of age, and are disproportionately impacting vulnerable populations.
In Georgia, Governor Kemp signed Senate Bill 140 (SB140) into law in March 2023. This law bans various forms of gender-affirming care for minors within the state. Following closely, Missouri’s Attorney General unveiled an “emergency regulation” in April 2023, initially presented as concerning youth under 18, but shockingly extends restrictions to individuals of all ages seeking gender-affirming care. This unprecedented move signals a disturbing trend: the escalating legislative efforts are not merely about protecting children, but about fundamentally limiting transgender rights across the board.
A particularly discriminatory aspect of the Missouri regulation is its direct targeting of individuals with disabilities. It mandates that healthcare providers must not offer gender-affirming care until patients undergo a “comprehensive screening to determine whether the patient has autism.” While not an outright ban on care for autistic transgender individuals, this requirement creates significant and often insurmountable barriers.
The ambiguity surrounding the “comprehensive screening” is a major point of concern. It is unclear what this screening entails, but it will undoubtedly add substantial costs, logistical difficulties, and delays to an already complex process. Accessing adult autism assessments is notoriously challenging. These assessments are not widely available, often expensive, and rarely covered by health insurance plans. Furthermore, some assessments require information from childhood caregivers, posing a significant hurdle for individuals estranged from unsupportive families. This screening mandate serves to increase the burden on all transgender individuals seeking care and may deter healthcare providers from prescribing necessary gender-affirming treatments.
Even for autistic transgender individuals who manage to navigate and fulfill this screening requirement, the Missouri regulation presents further obstacles. It compels providers to maintain detailed records on a wide range of criteria, including the autism screening. This mandatory record-keeping can create a chilling effect, making providers apprehensive about offering care to autistic patients. The fear of potential legal repercussions or increased scrutiny may lead some providers to find reasons to deny care or healthcare systems to implement policies that discriminate against autistic individuals seeking gender-affirming care. This situation could result in higher standards of informed consent for autistic patients or an outright avoidance of treating this population.
This regulation not only obstructs access to crucial healthcare but also reinforces harmful stereotypes about autism. It perpetuates the discriminatory myth that autistic people are incapable of understanding their own gender identities, effectively deeming them “too disabled” to make informed decisions about their bodies and healthcare. The regulation is clearly intended to impede autistic transgender individuals from accessing gender-affirming care, and it is poised to achieve precisely that outcome.
Furthermore, the Missouri regulation extends its discriminatory reach to individuals with mental health disabilities. It stipulates that “existing mental health comorbidities” must be “resolved” before gender-affirming care can commence. This requirement is blatantly discriminatory, as it excludes individuals with active mental health conditions from accessing care, regardless of their capacity to provide informed consent. The regulation places providers in a precarious position, requiring them to certify the “resolved” status of a patient’s mental health, creating fear of liability even if a patient experiences a recurrence of symptoms in the future.
This provision may inadvertently discourage transgender individuals from seeking mental health support, fearing it could jeopardize their future access to gender-affirming care. This is particularly alarming given the well-documented link between gender dysphoria, transphobia, and mental health conditions like depression, anxiety, and PTSD. Transgender individuals are placed in an untenable situation: they may need mental health care to address issues exacerbated by dysphoria and lack of affirming care, yet accessing mental health services could be used as a barrier to receiving the very gender-affirming care needed. Similar to the autism screening requirement, the mandated record-keeping on mental health history will further discourage healthcare professionals from providing care to transgender individuals with any mental health history, exacerbating stigma against this already marginalized population.
The Missouri “emergency regulation” sets a dangerous precedent, paving the way for similar restrictive laws in other states. While several states have already banned or restricted gender-affirming care for transgender youth, Missouri’s regulation is the first to extend such extreme limitations to all transgender people. Any legal restriction on gender-affirming care is unacceptable, but the Missouri regulation starkly reveals the ultimate goal: to eliminate access to gender-affirming care for transgender individuals of all ages.
Organizations like the Autistic Self Advocacy Network (ASAN) are actively condemning these discriminatory laws and similar measures that aim to deny gender-affirming healthcare. ASAN and other LGBTQ+ advocacy groups are committed to fighting these restrictions, particularly those that weaponize disability to justify discrimination. These organizations stand in solidarity with the LGBTQ+ community to challenge these harmful policies and advocate for equitable healthcare access for all transgender individuals.
