Missouri this month turned the primary state within the nation to severely prohibit gender remedies for individuals of all ages, following a collection of quieter strikes throughout the nation which have been chipping away at transgender adults’ entry to medical care.

Final 12 months, Florida joined six different states in banning Medicaid from overlaying some type of gender take care of transgender individuals of all ages. These bans have an effect on an estimated 38,000 beneficiaries of the general public insurance coverage program, in line with the Williams Institute, a analysis heart at U.C.L.A.’s regulation faculty.

And in not less than 5 states, Republican legislators have proposed payments that may abolish gender take care of minors in addition to younger adults. Some are trying to ban it for anybody beneath 21, and others for these beneath 26.

Missouri’s sweeping new coverage took a distinct strategy. Citing shopper safety legal guidelines meant to manage fraud, the state legal professional normal, Andrew Bailey, issued an emergency rule prohibiting medical doctors from offering gender remedies to sufferers — of any age — until they adhere to a slew of serious restrictions, together with 18 months of psychological evaluation. The rule additionally mentioned that sufferers mustn’t obtain gender remedies till any psychological well being points are “resolved.”

The onerous restrictions quantity to a “de facto ban,” mentioned Gillian Branstetter, a communications strategist on the American Civil Liberties Union, whose Missouri chapter introduced its intent to file a authorized problem to the rule.

“The political state of affairs relating to trans individuals’s well being care was at all times headed right here,” Ms. Branstetter mentioned.

The rule excludes people who find themselves presently receiving remedies, as long as they and their medical doctors “promptly” adjust to the psychological assessments and different restrictions.

Aro Royston, a 35-year-old transgender man in St. Louis, mentioned he was shocked by the brand new coverage. He mentioned he had been taking testosterone for eight years, with month-to-month refills prescribed by his physician. If he might not have entry to the remedies, he can be “devastated,” he mentioned, and would journey out of state to obtain care.

“I believe what upsets me most is, I’m a functioning member of this society,” mentioned Mr. Royston, a program supervisor at a U.S. protection contractor. “I’ve labored on protection applications to guard my nation. And my nation can’t shield me?”

Missouri’s new coverage goes into impact on April 27 and expires in February 2024, when the state legislature will probably be again in session. (Two payments that may have banned take care of minors — and prohibited Medicaid from overlaying it for all ages — haven’t superior on this 12 months’s session.)

Though Mr. Bailey’s order applies to all ages, his public feedback have targeted on kids, echoing the rhetoric of Republican politicians throughout the nation and in Missouri. “As Legal professional Normal, I’ll at all times combat to guard kids as a result of gender transition interventions are experimental,” Mr. Bailey mentioned on Twitter.

In February, his workplace launched an investigation of a youth gender clinic at Washington College in St. Louis after a former worker filed a whistle-blower criticism claiming that sufferers there have been rushed into therapy and never given satisfactory psychological screenings. (The clinic mentioned that it adopted the accepted requirements of care.)

When requested why his order contains adults, Madeline Sieren, a spokeswoman for Mr. Bailey, mentioned, “We’ve severe considerations about how kids are being handled all through the state, however we imagine everyone seems to be entitled to evidence-based medication and satisfactory psychological well being care.”

Fourteen different states — Alabama, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, South Dakota, Tennessee, Utah and West Virginia and, as of Wednesday, North Dakota — have handed legal guidelines proscribing gender take care of minors.

Though there’s some debate amongst medical professionals about which kids will profit from gender-affirming care and when they need to start remedies, a number of giant medical teams in the US, together with the American Academy of Pediatrics, have condemned the legislative bans.

For transgender adults, many research have proven that transition care can enhance psychological well-being and high quality of life.

Terry Schilling, the president of the American Rules Challenge, a right-wing advocacy group pushing for restrictions on transgender rights, mentioned in an interview earlier this 12 months that specializing in minors had been a short-term political calculation. His group’s long-term objective, he mentioned, was to get rid of transition care altogether.

“I view this complete difficulty the identical as I view lobotomies or eugenics — it’s a foul medical fad,” he mentioned.

Mr. Schilling mentioned insurance policies would possibly embrace outright bans for individuals of all ages, or payments to make it simpler for individuals to sue medical suppliers in the event that they remorse transitioning. He additionally raised the opportunity of classifying transition care as “shopper fraud” — the identical strategy put ahead by Mr. Bailey — as a result of he contends that it’s not possible to vary genders.

Over a few years, seven states — Arizona, Florida, Missouri, Nebraska, South Carolina, Tennessee and Texas — have enacted insurance policies banning Medicaid from overlaying some kind of gender-affirming care. (The federal insurance coverage program for low-income individuals is partly funded by states, which even have broad latitude to find out eligibility.).

The Medicaid bans are “on shaky authorized floor,” mentioned Christy Mallory, authorized director of the Williams Institute. Courts in Wisconsin and West Virginia have dominated that such bans violate the Reasonably priced Care Act, which prohibits intercourse discrimination, in addition to different federal guidelines.

However some legislators are introducing broader payments that may prohibit gender-related care at government-owned or operated well being facilities, or at people who settle for state funding.

In Oklahoma, for instance, a invoice launched this 12 months by State Senator Nathan Dahm would withhold Medicaid reimbursement — for any process or therapy — from any well being heart that gives gender care or works with a supplier who provides it.

In an interview in January, Mr. Dahm mentioned that his solely objective was to cease taxpayer cash from overlaying transition procedures. “If an grownup needs to make that call and pay for it themselves, then they’ll achieve this,” he mentioned. He additionally acknowledged, nevertheless, that the coverage might spur some well being care suppliers to cease providing care to adults.

Over the previous few many years, medical doctors have more and more eliminated boundaries, reminiscent of psychological evaluations, for adults to get hormone remedies, shifting decision-making to sufferers themselves.

“There’s very, very broad consensus that gender-affirming take care of adults is suitable and useful,” mentioned Erica Anderson, a scientific psychologist and former president of the U.S. Skilled Affiliation for Transgender Well being.

Dr. Anderson, a transgender lady, has publicly voiced considerations in regards to the rising variety of adolescents, particularly these with advanced psychiatric points, searching for gender-related care. She has additionally supported the insurance policies of sure European international locations, together with Sweden and Britain, which have lately restricted when kids can endure sure medical remedies.

However final month, Dr. Anderson joined a whole bunch of clinicians in signing a letter that emphasised gender-affirming care is helpful and necessary for many transgender kids and denounced the legislative bans in the US. The efforts to increase such restrictions to adults will add vital hurt, she mentioned.

“The blurring between youth and grownup care is ominous,” she mentioned. “It’s an ominous signal of overreach by individuals who suppose that the state ought to resolve individuals’s private lives.”

The Missouri rule has additionally acquired pushback amongst some conservatives within the state. Secretary of State Jay Ashcroft, a Republican who lately introduced he was operating for governor, advised St. Louis public radio that though he supported bans for youngsters, he didn’t imagine the state ought to prohibit take care of adults.

“I don’t suppose individuals ought to do it,” Mr. Ashcroft mentioned, referring to gender remedies for adults. “However there’s a distinction between what I believe and the place I believe the federal government needs to be concerned.”

Maggie Astor contributed reporting.