ST. LOUIS (NEWSnet/AP) — Amid the rush in some states to ban gender-affirming care for minors, some families understood they they lived in areas where those already receiving puberty blockers or hormone therapy could continue those services.

But in some states, including Missouri and North Dakota, such care for transgender youth has abruptly halted because medical providers are wary of liability provisions in local laws.

This is one of the reasons that advocates say gender-affirming hormone therapy and puberty blockers for transgender minors has become harder to access, even in states where it technically remains legal.

“It was a completely crushing blow,” said Becky Hormuth, whose 16-year-old son was receiving treatment from the Washington University Gender Center at St. Louis Children’s Hospital until it stopped the care for minors this month.

“There was some anger there, not towards the doctors, not toward Wash U. Our anger is towards the politicians,” she said. “They don’t see our children. They say the health care is harmful. They don’t know how much it helps my child.”

Since last year, conservative lawmakers and governors have prioritized restricting access to transgender care under the name of protecting children. At least 22 states have now enacted laws restricting or banning gender-affirming medical care for transgender minors. Most of the bans face legal challenges and enforcement on some of them has been put on hold by courts.

All the laws ban gender-affirming surgery for minors, although it is rare, with fewer than 3,700 performed in the U.S. on patients ages 12 to 18 from 2016 through 2019, according to a study published last month. It’s not clear how many of those patients were 18 when they received the surgeries.

There’s more variation, though, in how states handle puberty-blockers and hormone treatments under the new bans. Georgia’s law does not ban those for minors. The others do. But some states, including North Carolina and Utah, allow young people taking them already to continue. Others require the treatments to be phased out over time.

These treatments are accepted by major medical groups as evidence-based care that transgender people should be able to access.

In North Dakota, the law allows treatment to continue for minors who were receiving care before the law took effect in April. But it does not allow a doctor to switch the patient to a different gender dysphoria-related medication. And it allows patients to sue over injuries from treatment until they turn 48.

Providers there have simply stopped gender-affirming care, said Brittany Stewart, a lawyer at Gender Justice, which is suing over the ban in the state.

“To protect themselves from criminal liability, they’ve just decided to not even risk it because that vague law doesn’t give them enough detail to understand exactly what they can and cannot do,” Stewart said.

Jasmine Beach-Ferrara, the executive director of the Campaign for Southern Equality, said it’s not just liability clauses that have caused providers to stop treatment.

“It’s hard to overstate the level of kind of chaos and stress and confusion it’s causing on the ground,” she said, “particularly ... for people who live in more rural communities or places where even before a law went into effect, it still took quite a bit of effort to get this care.”

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