The clock is ticking in Missouri as health care providers race to establish care regimens for trans patients

By Alisha Ebrahimji, Kyung Lah and Anna-Maja Rappard, CNN

Kharri has moved from state to state, running from politics and family, to get the medical gender-affirming care he needs to be his most authentic self without anyone’s intervention.

Kharri, 19, is ready to move again, out of Missouri to neighboring Kansas, after Missouri’s attorney general introduced an emergency rule that would limit transgender care for minors and adults.

Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender — the one the person was designated at birth — to their affirmed gender, the gender by which one wants to be known.

The rule is expected to go into effect Thursday and will expire February 6, 2024, a release from Attorney General Andrew Bailey’s office said.

Established patients could continue care once the order goes into effect, but new patients could face a slew of requirements that would widely limit access, the rule says.

Advocacy groups have sued Bailey over the new rule, which claims people often take “life-altering interventions,” like pubertal suppression or gender transition surgery, “without any talk therapy at all,” and that the emergency action is “needed because of a compelling governmental interest and a need to protect the public health, safety, and welfare” of Missourians.

A state judge Wednesday evening blocked the rules from taking effect. St. Louis County Circuit Judge Ellen Ribaudo said she would issue a decision on the plaintiff’s motion for a temporary restraining order by Monday, saying she wanted more time to review briefs that will submitted by Bailey.

The actions in Missouri follow North Dakota Gov. Doug Burgum signing a bill this week banning gender-affirming care for most minors with the possibility of a felony for health care professionals who provide it. Indiana and Idaho enacted their own bans on gender-affirming care for youths this month, and several other states have signed into law restrictions on gender-affirming care for minors in the past few years.

At a pop-up Planned Parenthood clinic in neighboring Kansas, Missourians have been seeing medical professionals to establish care ahead of the impending deadline.

Ashley Miller, a Planned Parenthood nurse practitioner, said she’s tried to answer patients’ questions about their future in their home state where their care may not be legal.

“It’s hard not to feel like your local politician is in the room with you,” she said.

“You want to believe people when they tell you who they are or what they want for their life and you don’t want to say, ‘Well, you know, I believe you that you are transgender, but maybe we should phone your local politician to see if they agree,” Miller added.

Living behind a mask

Like Kharri, Andi, 20, crossed state lines to go to the Planned Parenthood clinic in Kansas to establish gender-affirming care for himself, moving up a May appointment to beat the impending order.

CNN is only using Kharri’s and Andi’s first names to protect their privacy, at their request.

Andi, who was assigned female at birth, said he’s been weighing the decision to transition for six years, and having access to appropriate care means a lot to him.

“I just feel like it’ll (the transition) be a lot more self love and confidence and happiness in my life,” he said.

Right now, Andi said, “It’s a constant disconnect from my own body, my own being, I look in the mirror, I feel like an impostor, a stranger.”

With no support from family, and now given the state’s actions, Andi said he relies on his self confidence and friends who have become family to help him achieve his goal.

“I feel like I’m living behind a mask all the time, but just under my whole skin feels that way,” he said.

Kharri understands that all too well. The teenager, who was assigned female at birth, said he’s felt that way since he was 14.

For Kharri, Kansas is the last affordable state where he can live and receive the medical care he needs to transition, he said. Having uprooted his life once already from Tennessee to Missouri, he said he feels like a nomad without a true home and like a refugee in his own country.

“We are terrified,” he said. “This world is terrifying. … Talk with us. Like just sit there and talk, listen to what, what we’re saying. We’re not trying to indoctrinate anyone.”

Angela Huntington, a patient navigator for Planned Parenthood, said she hears that panic Kharri described on the other side of the phone often, as she has hustled to get patients appointments at Planned Parenthood’s pop-up clinic.

“It’s heartbreaking to hear their stories,” she said. “Some people are just ready…they’re ready to make the change. Some people are being forced to make this decision maybe a little sooner than they wanted to because the threat is looming.”

“I just want people to live their best lives, live the lives and the bodies that they feel that are their own, they should be making their own decisions about their own bodies and there should be nobody else involved but them and their, their medical professional,” she said.

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