Are transgender treatments consumer fraud?

Missouri may soon be the first state to restrict transgender treatments to both adults and youth, and it’s taking an unorthodox way to get there.

State attorney general Andrew Bailey has attempted to regulate transgender interventions by invoking the state’s Merchandising Practices Act, a law that protects consumers from unfair or deceptive businesses. Under Bailey’s order, anyone offering hormone therapy and sex reassignment surgery in the state would be guilty of consumer fraud unless they abide by the attorney general’s long list of requirements. A state judge temporarily blocked the order while a lawsuit against it is under consideration in court.

The Merchandising Practices Act, part of Missouri’s consumer protection law, is commonly associated with shady car dealers and scam artists. Bailey says healthcare providers are no different when they encourage patients to undergo procedures “not supported by solid evidence.” But consumer advocacy groups say it’s a peculiar move.

If the order eventually gets the green light, Missouri would impose a list of requirements on anyone seeking to offer gender transition surgery or other medical interventions. A patient would need to show proof of experiencing gender dysphoria for at least three years and attend at least 15 therapy sessions over 18 months. Medical providers would be required to assess the patient to rule out autism or mental health issues as causes for their gender dysphoria. If the patient is a minor, providers would also be required to assess them for a social media addiction.

Consumer advocacy groups I spoke with said they had never heard of anyone filing a consumer complaint about transgender therapy. Typically consumers are the ones complaining first, not state governments, noted Ira Rheingold, executive director of the National Association of Consumer Advocates.

Rheingold said that if Bailey hasn’t received any consumer complaints, it seems more like a “solution in search of a problem.”

A month before Bailey issued the order, his office announced a tip line allowing people to file reports of “questionable gender transition interventions.” But pranksters and online trolls inundated the tip line with fake reports and explicit language. Within a month, the attorney general’s office took it down. A spokesperson estimated receiving thousands of tips, but it’s unclear how many were legitimate.

Dr. André Van Mol, a family physician in California and co-chair of the American College of Pediatricians’ Committee on Adolescent Sexuality, told me that “such procedures have neither been proven safe, nor effective, nor do they reduce suicides.”

Some people who have undergone the treatments disagree, saying the Missouri law will deprive people of a potentially life-saving intervention. A Missouri resident who identifies as transgender told the Associated Press last month that hormone therapy is essential for resolving suicidal thoughts and depression.

But dissatisfied patients who feel they were manipulated by doctors into getting these treatments applaud the Missouri order, saying it will protect vulnerable patients and force doctors to do more comprehensive assessments.

Walt Heyer underwent sex reassignment surgery in Colorado 40 years ago. When Heyer was a child, his grandmother dressed him up in homemade purple dresses and complimented him as a girl. His teenage uncle later sexually abused him. Heyer’s pent-up gender distress led him to a gender specialist, who discounted his traumatic childhood and prescribed female hormones for his gender identity disorder. At age 42, Heyer had sex change surgery so he could stop identifying as “Walt” and start identifying as “Laura.”

Heyer said his decision to get gender reassignment surgery wrecked his marriage, complicated his relationship with his children, and ended his career. After eight years as “Laura,” he detransitioned and now blames doctors for recommending hormones and surgery in the first place.

Today, as founder of the detransition support group Sex Change Regret, he said he hears from thousands of unsatisfied patients who wish they had not gone through with these procedures. Many come to this conclusion years after they’ve transitioned, but by then, it’s too late. Heyer said that in most cases, patients have to report any harm within two years to qualify for a medical malpractice lawsuit.

Heyer called Missouri’s order a “comprehensive, intelligent, and accurate approach” that should be implemented across the country to protect people like himself.

“This is the best thing I’ve ever seen. I’m all for it,” he said. “I think somebody is trying to find a good way to save some people’s lives.”