A handful of Republicans running for Missouri’s highest offices secured crucial support from former President Donald Trump ahead of the primary election on Tuesday — a boost for candidates who have all promised to further restrict LGBTQ+ rights in the deep-red state.

Missouri has already enacted several anti-trans laws, including a ban on trans youth playing on sports teams that align with their gender identity and a ban on gender-affirming care for minors, incarcerated people and residents enrolled in the state’s Medicaid program.

But the front-runners for governor and attorney general could champion even more stringent anti-trans policies if they win in November.

Trump, the Republican presidential nominee, praised three candidates for governor: state Sen. Bill Eigel, Missouri Secretary of State Jay Ashcroft and Lt. Gov. Mike Kehoe.

“They are MAGA and America First all the way,” he posted on Truth Social, a conservative social media platform owned in large part by the former president.

A few days later, Trump endorsed both GOP candidates for attorney general: incumbent state Attorney General Andrew Bailey and Will Scharf, an attorney who helped secure a ruling giving Trump immunity from criminal prosecution.

Missouri has not elected a Democratic attorney general or governor since 2017, and Trump won the Show Me State with more than 56% of the vote in both the 2016 and 2020 presidential elections.

The candidates Trump endorsed each have a long track record of supporting anti-LGBTQ+ legislation, sharing misleading anti-trans rhetoric and targeting transgender youth. Here’s a look at what’s at stake if any of these candidates take office.

The State Attorney General Race

Bailey ― who has been endorsed by both of Missouri’s Republican senators, Josh Hawley and Eric Schmitt; the National Rifle Association; and several state law enforcement unions — is the most well-known crusader of anti-trans policies in the state.

In April 2023, while the Missouri legislature was deliberating on a ban on gender-affirming care for youth, Bailey signed an emergency rule that created vague and overly broad requirements for both trans youth and adults seeking that care.

Under his order, patients would have to satisfy an onerous list of requirements, including undergoing 18 months of therapy to prove that any prior mental health issues had been resolved. At the same time, the rule required patients to be screened for autism and have three years’ worth of medical documentation of gender dysphoria, and it forced providers to prove that a patient was not “experiencing social contagion.” (The “social contagion” theory, which posits that adolescents, especially those assigned female at birth, are being influenced by their peers to identify as transgender, has been disproved in numerous scientific studies.)

The rule was heavily criticized by legal advocates and medical professionals, who saw it as an overreach of Missouri’s consumer protection law.

Adult trans Missourians at the time said the rule had immediate consequences, with some doctors telling patients they would no longer be able to fill their hormone prescriptions.

Bailey withdrew the emergency order after the Republican-led legislature passed a ban that applied to youth, Medicaid recipients and incarcerated people.

Bailey has also been among the Republican attorneys general nationwide who have instigated investigations into hospitals and clinics that provide gender-affirming care for transgender youth.

In January 2023, he launched a probe into the Washington University Pediatric Transgender Center at St. Louis Children’s Hospital.

This came after Jamie Reed, a former caseworker, accused the center of rushing minors into medical procedures, providing medication without parental consent and harming children. Based on these claims, Bailey asked the hospital for patient medical records and a list of patients who had received care there. He later sought information on therapists and social workers across the state who were working with trans youth.

A Missouri judge determined that Bailey’s office had no right to private medical information.

Bailey is named in a report by the U.S. Senate Finance Committee about four state attorneys general who have used their oversight authority and consumer protection powers to target trans youth and adults and obtain private medical records.

Throughout his tenure, Bailey has opposed a swath of “culture war” issues, including raising alarm over the Biden administration’s new Title IX guidance, which extends protections to trans students, and supporting a college’s effort to discriminate based on sexual orientation and gender identity.

Bailey’s actions have “created a hostile environment for medical providers where they are afraid to stay and practice medicine,” said Katy Erker-Lynch, the executive director of PROMO, a Missouri LGBTQ advocacy group.

Scharf, the other Republican running for Missouri attorney general, hasn’t had the same opportunities to craft anti-trans policies in the state, but his views on LGBTQ+ issues appear to be nearly the same as Bailey’s, according to reporting from NPR affiliate KCUR. Scharf has supported banning gender-affirming care for minors and barring trans athletes from competing in women’s sports.

Scharf applauded Bailey’s emergency order last year, telling Breitbart at the time that “we’re winning on this issue” and criticizing the left for being “increasingly violent.”

Scharf has also criticized how Bailey has run his office and accused the current attorney general of inserting himself into hot-button issues “quite clumsily” without doing thorough investigations. Scharf has been selling himself as a MAGA loyalist. He played a major role in the U.S. Supreme Court case that ended up granting presidents immunity from criminal prosecution for official acts taken while in office.

The lawyer has been bankrolled by a large network of traditional conservatives who have worked alongside Trump, including mega-donor Leonard Leo, the chairman of The Federalist Society who has been instrumental in helping reshape the Supreme Court to have a far-right conservative majority. The Concord Fund, a shadowy nonprofit that has routed millions to Republican attorneys general races in the past and has strong connections to Leo, gave at least $3.5 million to two pro-Scharf PACs.

The Republican winner of Tuesday’s primary will face off against Democrat Elad Gross, who has heavily criticized Bailey and other Republicans for their laser focus on rolling back rights for transgender people in the state. If elected, Gross proposes launching the state’s first civil rights division in the attorney general’s office, which would help protect LGBTQ+ residents against discrimination, according to his campaign website.

The Gubernatorial Race

The three Trump-backed front-runners in the nine-person Republican gubernatorial race have all taken varying degrees of anti-trans stances.

Eigel, a state senator, has likened “transgender ideology” to “child abuse” and said he believes gender-affirming surgeries “are harmful” for people of any age. He has suggested that it may eventually be necessary to expand a ban similar to Bailey’s emergency order affecting all adults seeking care.

Eigel also wrote in a Facebook post that if elected he would call the cops and arrest any “woke liberals” who bring “transgender drag queens” to elementary schools on the ground of “child abuse,” echoing many Republicans’ rhetoric that falsely tries to link LGBTQ+ to pedophilia.

The other candidates for governor have been less flagrant. Kehoe, the lieutenant governor, has supported bans on transition care for minors and the sports ban, but he also voted in favor of adding anti-discrimination protections into state law in 2013. Ashcroft, the current Missouri secretary of state, has also backed legislation to restrict care but disagreed with Bailey’s emergency order, saying it negatively affected adults seeking care.

“I don’t think people should do it,” Kehoe told St. Louis Public Radio about gender-affirming care, “but there’s a difference between what I think and where I think the government should be involved. If you’re an adult and you want to spend your own money, I disagree with you, but it’s not my place to tell you that you can’t.”

Several candidates are vying to become the nominee in what will be the first significant primary contest among the Democrats in the Missouri gubernatorial race since 2004. Many of these candidates have signaled that they see reproductive health care as a key issue with which to court voters, and Missourians are close to putting abortion rights on the ballot through a state constitutional amendment in November.