Missouri Enacts Restrictions on Youth Gender Transition Care
JEFFERSON CITY, MO – Missouri Governor Mike Parson signed Senate Bill 49 (SB 49), known as the 'Missouri Save Adolescents from Experimentation (SAFE) Act', into law in June 2023. Effective August 28, 2023, the law prohibits healthcare providers from administering certain medical and surgical gender transition treatments to individuals under 18. Proponents describe the measure as necessary for safeguarding children, while opponents argue it restricts essential healthcare.
Key Provisions of SB 49

The law specifically bars physicians from performing surgeries or prescribing puberty-blocking drugs and cross-sex hormones to minors *for the purpose of gender transition*. Violating providers risk losing their professional licenses and may face civil lawsuits. The ban on surgeries for minors is permanent under the law, while the restrictions on puberty blockers and hormone therapies are set to expire in August 2027 unless reauthorized by the legislature. The law does not prevent treatments for minors diagnosed with medically verifiable disorders of sex development (DSDs).
Supporters Cite Child Protection Concerns
Proponents of SB 49 argue that minors lack the maturity to consent to potentially irreversible medical procedures related to gender transition. They emphasize concerns about long-term health risks and the possibility of future regret. Supporters state the law protects children from what they term 'experimental' medical interventions, ensuring decisions with lifelong consequences are deferred until adulthood.
Opponents Raise Concerns Over Discrimination and Access to Care
Critics, including major medical associations and LGBTQ+ advocacy groups, argue the law discriminates against transgender youth and denies them medically necessary, often life-saving care recommended by established medical guidelines. They contend that withholding treatment for gender dysphoria can lead to severe mental health issues, including increased rates of depression and suicide. Opponents view the law as legislative interference in private medical decisions between patients, their families, and healthcare providers.
Enforcement and Legal Challenges

The law took effect on August 28, 2023. As anticipated, it faced immediate legal challenges. Organizations like the ACLU of Missouri filed lawsuits arguing the ban is discriminatory, violates equal protection guarantees, and infringes on parental rights. Courts have issued temporary orders and rulings in this and similar cases in other states, with the legal landscape continuously evolving.
National Implications and Broader Debate

Missouri's SB 49 is part of a larger trend of state-level legislation across the U.S. addressing medical care for transgender minors. While numerous states have enacted restrictions, others have passed laws protecting access to gender-affirming care. This divergence highlights the intense national debate over parental rights, bodily autonomy, the role of government in healthcare, and the appropriate medical care for transgender youth.