Missouri Law Bars Funding for Gender-Affirming Care for Transgender Inmates

Republican Governor Mike Kehoe signed an appropriations bill for the Missouri Department of Corrections that, effective July 2, includes a one-sentence provision prohibiting the use of state funds for “any cross-sex hormones, or gender transition surgery undertaken for the purpose of any gender transition.” The measure does not allow inmates already receiving such care to continue treatment and offers no guidance on tapering hormone therapy.

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Missouri’s shift follows a 2018 federal court ruling that struck down the department’s “freeze-frame” policy, finding that denying medically necessary treatment to transgender inmates violated the Eighth Amendment’s ban on cruel and unusual punishment. The state had then provided gender-affirming care when medically necessary. Missouri becomes the seventh state—and the second this year after Oklahoma—to ban gender-affirming care for incarcerated individuals; similar statutes exist in Florida, Kentucky, and North Carolina, while Idaho and Georgia’s comparable restrictions have been blocked by federal courts.

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Experts warn that abrupt cessation of hormone therapy can trigger serious physical and mental health consequences. Sudden hormone withdrawal may lead to bone-density loss, increased risk of osteoporosis and fractures, cardiovascular complications, cognitive decline, metabolic dysfunction, and mood instability. For those who have undergone gender-affirming surgery, stopping hormones can cause severe hormonal deficiencies because the body no longer produces adequate hormones naturally.

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Britt Walsh, director of transgender healthcare at Whitman-Walker Health, argues that the law’s lack of a “grandfather clause” or tapering protocol could produce “brutal impacts on emotional well-being and mental health stability,” potentially raising distress and suicidality among incarcerated trans people. She emphasizes that hormone therapy is often “lifesaving” and that its abrupt removal may exacerbate dysphoria, leading to self-harm or suicide attempts.

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• “A lot of people with gender dysphoria describe access to gender-affirming hormone therapy as lifesaving,” — Britt Walsh, Director, Whitman-Walker Health

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• “So I think we could expect to see some pretty brutal impacts on emotional well-being and mental health stability.” — Britt Walsh

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