After returning from behind closed doors at about 7:15 a.m., lawmakers quickly approved the bills and adjourned. They’ll need one more affirmative vote each before heading to the House.

The measures would ban gender-affirming care such as puberty blockers, hormone therapy and surgeries for individuals younger than 18. 

But, key changes to the health care restrictions include a grandfather clause for patients taking puberty blockers or hormone therapy before Aug. 28, 2023, when the law would take effect.

And, restrictions on puberty blockers and hormone therapy for minors would expire Aug. 28, 2027, unless the Legislature approves another law, according to the latest draft.

Restrictions on transgender athletes that would require them to play on the team matching the sex on their birth certificate would also expire Aug. 28, 2027, absent additional legislative action.

Passage followed tense debate Monday night into Tuesday morning that at times devolved into shouting.

Debate began shortly after 4 p.m. Monday, with Republicans returning to the priority legislation immediately after their annual weeklong spring break. 

The limits were the subject of a rally in the Capitol Monday by a group of activists who support the Republican effort, which has been implemented in some form by GOP legislatures in a number of states.

The extended filibuster was the first in the Senate this year after Majority Leader Cindy O’Laughlin, R-Shelbina, had worked to avoid late night debates in her first session as the Senate’s chief traffic cop.

While surgeries for minors are rare, blockers can be used when a child hits puberty. Hormone therapies can follow.

During one exchange that grew heated, Sen. Denny Hoskins, R-Warrensburg, asked Sen. Karla May, D-St. Louis, whether it was OK “for a 13-year-old boy to cut off his penis?”

“It is up to that parent to make that decision,” May responded.

“Oh my Lord! Oh my Lord! Really?” Hoskins said.

“That parent and that child and that doctor is making that decision,” May said.

Earlier, May had said “I think that’s a little drastic and radical” and “I don’t even know if that’s happening” when Hoskins mentioned “popping off their genitals.”

May, who was among Democrats taking on hourslong shifts of debate to keep the issue from being voted on, asked Hoskins what he would recommend to parents of a child with gender dysphoria.

“Try to be loving, caring, and understanding, listen to them. Go to some counseling and find out ... what the real issue is,” Hoskins said.

“You don’t think that they’ve done that?” May asked.

Hoskins’ question resembled a claim by Republican Florida Gov. Ron DeSantis last year that “they’re literally chopping off the private parts of young kids.” The governor’s office provided two examples to Politifact of teen surgeries: a California 15-year-old receiving chest surgery and Jazz Jennings, a reality TV star who received genital reassignment surgery at 17.

Hoskins’ comments drew scorn from Sen. Greg Razer, D-Kansas City.

“Nobody’s genitals are getting cut off,” Razer said. “You’re trying to scare people and divide people. Stop.

“We’re talking about kids here. This is the crap they said about people like me for decades,” said Razer, who is gay. “They can’t say it about me anymore or they would be.

“So now they’re going after another group but this time they’re kids! They’re kids they’re going after! They’re using kids as political pawns and that burns me up,” he said.

Razer said “this isn’t the end.”

He said Republicans would soon seek to punish as child abusers parents of children receiving care in question.

“We know what next year’s bill is,” Razer said. “Parents of trans kids: don’t come to the Capitol with your kids. Don’t tell these people who you are.”

The Democratic stalling on the Republican-led initiative came amid infighting among GOP lawmakers, who control the chamber by a 24-10 margin.

Before leaving on their spring break, senators debated Sen. Mike Moon’s bill to restrict transgender care. But when senators returned Monday, GOP leadership moved to debate legislation by a rival legislator, Sen. Holly Rehder, R-Sikeston, that also included limits on transgender athletes.

Moon, R-Ash Grove, criticized the bill for containing multiple subjects in violation of the state constitution.

Moon, who has repeatedly feuded with the leadership of O’Laughlin and Senate President Pro Tem Caleb Rowden, offered a series of technical amendments to Rehder’s bill, ensuring he’d get some of the last words if and when the package came up for a vote.

But when senators returned after their break it appeared Moon got his way: his legislation would pass as a standalone bill, separate from the restrictions on athletes.

The action in the Senate came as Missouri Attorney General Andrew Bailey said Monday his office will file an emergency regulation to limit access to gender-related care for minors.

The legislation is Senate Bill 39 and Senate Bill 49.