It’s not just trans kids: Republicans are coming after trans adults like me, too | Alex Myers

On Thursday 13 April, Missouri's attorney general issued an emergency ruling that restricts access to gender-affirming care for both minors and adults, under the guise that hormone therapy is an "experimental use" rather than an FDA-approved treatment. For the past year, transgender youth have been a football for conservative politicians, with their access to gender-affirming care restricted or outlawed in 14 states. But this move by Missouri's attorney general is the first attack on gender-affirming care for transgender adults; assuredly, it won't be the last.

The first time I tried to get access to gender-affirming care was in 2003. I was 24 years old and lived in Rhode Island. I'd been out as transgender for eight years by then, eight years spent looking (on a good day) like a 14-year-old boy, until finally the me I saw in the mirror and the me I saw in my head didn't match any more. Only testosterone would make me feel like myself.

I told my doctor, who was kind and sympathetic and said she had no idea about the protocols for administration of testosterone to a transgender person. She did find me a list of all the practitioners in Rhode Island who offered such care. There were three names on the list. True, Rhode Island is not a large state, but still: three names. I called them all. Only one would see me, and only after I had gone to therapy and had a psychologist certify that I was ready to transition.

That was the standard back then - and that's what the Missouri attorney general wants to require of adult transgender individuals now, only more extensive. In 2003 in Rhode Island, I needed to see a therapist for at least three visits. The Missouri AG wants documentation of least three years of "medically documented, long-lasting, persistent and intense pattern of gender dysphoria" before an adult can be approved to get hormones. Three years of therapy is lengthy, time-consuming and expensive; three years is a very long time to suffer before being allowed to get medical attention.

Moreover, back in 2003, "gender identity disorder" was in the Diagnostics and Statistics Manual (DSM) as a mental disorder. Doctors required transgender individuals to visit a psychologist so that there was a "legitimate" diagnosis to accompany the prescription of hormones - even though, back then and still today, the use of hormones for gender reassignment is an "off-label" use. But that diagnosis was removed from the DSM in 2013, replaced with "gender dysphoria".

That's the term Missouri's AG uses in his emergency ruling and, in doing so, trying to return to the idea that being transgender is synonymous with being mentally ill, a narrative that the right has used at several historical moments to marginalize LGBTQ+ individuals. The narrative here isn't really about a diagnosis or medical legitimacy - it certainly isn't about the health of the transgender person. The subtext clearly is that transgender people are mentally ill and delusional, and they need a medical authority to help them figure out who they are.

The therapist that I saw in 2003 was a gay man who had a lot of compassion for the situation I was in. He knew it was a hoop I had to jump through, and he also knew he had to do his job. He asked me questions, took notes, and eventually wrote a letter certifying that I fit the diagnosis of "gender identity disorder" and that hormone therapy would help treat this disorder.