This blog is originally appeared at LGBTQ Nation.

The nine-day trial featured witnesses with varying levels of credibility.

A Missouri county judge has upheld the state’s ban on gender-affirming care for minors.

In a 74-page ruling issued on Monday, Wright County Circuit Court Judge Craig Carter stated, “If we don’t let a 16-year-old buy a six-pack of beer and a pack of cigarettes, or allow an adult to purchase them for the teen, should we permit the same child and parent to decide to permanently alter the teenager’s sex?”

The restrictions on gender-affirming care, passed by Missouri lawmakers in 2023, prohibit minors from using hormones, puberty blockers, and undergoing gender-affirming surgeries. The law also blocks state funding for gender-affirming care for adults through Medicaid and for incarcerated individuals in state prisons.

The ACLU of Missouri and Lambda Legal have promised to appeal the ruling.

Judge Craig Carter acknowledged the “ethical minefield” of the case, writing that “the medical profession stands in the middle” with “scant evidence to lead it out.”

The nine-day trial featured witnesses of varying credibility, with the state’s Solicitor General Joshua Divine introducing partisan politics into the proceedings. Some experts presented research that had been retracted, which the plaintiffs argued was problematic. Divine maintained that the scientific community had dismissed the research due to “cancel culture.”

Carter’s ruling was partly based on testimony from Jamie Reed, a whistleblower who previously worked at the Washington University Transgender Center at St. Louis Children’s Hospital. Reed’s affidavit helped inspire the gender-affirming care ban. She testified that the hospital treated many patients with mental health issues without comprehensive psychological evaluations. There was disagreement at trial over whether a licensed therapist’s evaluation was sufficient for gender-affirming care, or if a psychologist or psychiatrist was required.

The judge found Reed’s testimony credible, noting, “Her testimony does not arise from any ideological or other bias.” He also pointed out that Reed is married to a transgender individual.

Reed is now the executive director of the LGBT Courage Coalition, an advocacy group that opposes gender-affirming care for minors. The day before she testified, her partner announced he was discontinuing testosterone treatments and “detransitioning.”

While Carter accepted Reed’s credibility, he was less convinced by some of the plaintiffs’ witnesses. He expressed concerns about deferring to organizations like WPATH, which the plaintiffs relied on. WPATH, the World Professional Association for Transgender Health, is a professional group that sets standards for gender-affirming care, but Carter noted that it self-describes as being “committed to advocacy.”

Ultimately, Carter’s ruling emphasized U.S. Supreme Court precedent that grants lawmakers broad discretion in areas “fraught with medical and scientific uncertainty.” He concluded that there is “an almost total lack of consensus as to the medical ethics of adolescent gender dysphoria treatment,” and therefore, the state legislature has the authority to ban the care.