On Monday a Missouri judge upheld a state law banning transgender child mutilation and chemical castration, as well as prohibiting Medicaid from covering these medical interventions.

In a 74-page ruling, Judge R. Craig Carter ruled that the law, passed in 2023, was constitutional in the face of a challenge from three teenagers who claim to be a gender different from their biological sex, some medical professionals, and gay lobbying groups:

Gender dysphoria is classified as a mental disorder. Generally, western medicine treats mental disorders by actually treating the mental aspect, like prescribing Zoloft to treat depression. However, the gender dysphoria treatment prohibited by Missouri uses drugs and surgeries to either inhibit normal healthy human growth or surgically remove and replace healthy human organs. Such an approach to treatment is well outside normal medicine, and medical ethicists are unable to agree on the propriety thereof.

Furthermore, the credible evidence shows that a vast majority of children who are diagnosed with gender dysphoria outgrow the condition. The Endocrine Society guidelines state that approximately 85% of gender dysphoria-diagnosed prepubertal children did not remain gender incongruent later in life. The Diagnostic and Statistical Manual holds that around 98% of these children do not remain gender incongruent. Essentially, it seems that all of this untested, non-emergency, possibly unethical, possibly unnecessary care would be performed on children and adolescents when the vast majority of minors would simply outgrow the condition by the time they reach adulthood.

Carter also highlighted the experimental nature of the medical interventions, noting the “almost total lack of consensus as to the medical ethics” and a “disagreement as to whether adolescent gender dysphoria and surgical treatment was ethical at all.”

“Any person — including a minor — would be able to obtain anything from meth, to ecstasy, to abortion so long as a single medical professional were willing to recommend it,” the judge added.

The Missouri Save Adolescents From Experimentation (SAFE) Act was signed by Gov. Mike Parson, R-Mo., last year. The act included a ban on puberty blockers and hormones prescribed to children for purposes of pursuing a so-called “gender transition” (though children who had already been put on those drugs are able to continue using them under a grandfather clause).

The measure also penalizes doctors who try to circumvent the law, sets up procedures for potentially removing their medical licenses, and allows patients to sue for damages for up to 15 years after the patient turns 21 or after “the date the treatment of the injury … has ceased.” The law went into effect in August 2023.

“The Court has left Missouri’s law banning child mutilation in place, a resounding victory for our children. We are the first state in the nation to successfully defend such a law at the trial court level,” Missouri Attorney General Andrew Bailey, who defended the law in court, said in a press release. “I’m extremely proud of the thousands of hours my office put in to shine a light on the lack of evidence supporting these irreversible procedures.”

The law sunsets in 2027. Roughly half the country has enacted similar laws, but many remain tied up in litigation.

The Missouri attorney general’s office was joined by Alliance Defending Freedom (ADF) in defending the law.

“Missouri rightly enacted a law that protects the health and welfare of all children — supporting their natural biological development and ensuring that children experiencing gender dysphoria have support and medical care rooted in biology and science,” ADF Senior Counsel Hal Frampton said. “Driven by ideological agendas, activists and the Biden-Harris administration have pushed these dangerous procedures across the country and are attempting to prevent states from exercising their rightful role to regulate the medical profession and protect kids. These procedures have devastated countless lives, which is why countries that were previously leaders in so-called ‘gender affirming’ care are reversing course and curtailing these experimental efforts to alter children’s bodies.”

Bailey’s office has been particularly active in exposing the gender mutilation industry throughout his tenure as attorney general

His office launched an investigation after a 2023 whistleblower report from an employee of a St. Louis “pediatric transgender center” alleged that the organization used experimental drugs on minors and prescribed drugs to them without an “individual assessment.” The whistleblower also alleged that the center manipulated parents into allowing their children to use the drugs, and that some children using the drugs had been driven to attempt suicide.

That center no longer provides such interventions to children, and in the wake of the whistleblower report, Bailey conducted a statewide investigation of transgender mutilation facilities.

Bailey has also expressed interest in regulating the invasive surgeries for adults, as far as legally possible, in an attempt to expose how little the medical industry informs patients — children or adults — about the pathway on which they are about to embark. This regulation would potentially involve using false advertising statutes and consumer protection laws to require informed consent.

Further, in his investigation into the Washington University Transgender Center, Bailey examined the web of influence built around the transgender industry itself, looking into the influence of social workers and therapists in conditioning children to seek transgender mutilation interventions.

Breccan F. Thies is an elections correspondent for The Federalist. He previously covered education and culture issues for the Washington Examiner and Breitbart News. He holds a degree from the University of Virginia and is a 2022 Claremont Institute Publius Fellow. You can follow him on X: @BreccanFThies.