The small Midwestern gender clinic was struggling to keep up with a surge in demand. Last year, numerous young patients sought appointments each month, overwhelming the clinic’s two psychologists. Doctors in the emergency room downstairs raised concerns about transgender teenagers arriving in crisis, receiving hormones without therapy. The clinic, established in 2017 at a children’s hospital affiliated with Washington University in St. Louis, was seen as a lifeline by many families. It was the only place within hundreds of miles where distressed adolescents could receive expert assistance in their gender transition. However, as the number of patients grew, the clinic became overwhelmed and found itself in the midst of a political controversy.
In February, a former case manager named Jamie Reed made explosive allegations in a whistle-blower complaint, claiming that the clinic’s doctors were prescribing hormones too hastily to adolescents with pressing psychiatric issues. Missouri’s attorney general launched an investigation, and lawmakers in Missouri and other states used these allegations to pass bans on gender treatments for minors. LGBTQ advocates pointed out that some parents disputed Ms. Reed’s account, and a Washington University investigation found her claims unsubstantiated.
Interviews with patients, parents, former employees, local health providers, and 300 pages of documents shared by Ms. Reed revealed a more complex reality than what was portrayed by either side of the political battle. While some of Ms. Reed’s claims couldn’t be confirmed and were factually inaccurate, others were corroborated, shedding light on one of the many gender clinics in the United States currently at the center of the transgender rights debate.
The situation in St. Louis highlights a critical question in gender care for young people today: How much psychological screening should adolescents receive before beginning gender treatments? These clinics, influenced by European ideas, have emerged in the past decade to address the increasing number of young individuals seeking hormonal medications to transition. Many patients and parents have praised the St. Louis clinic for providing necessary care and helping adolescents feel more comfortable in their bodies for the first time. However, as the demand grew, more patients with complex mental health issues arrived. The clinic struggled to navigate how to best assist them, often seeking external therapists with limited experience in gender issues to evaluate their readiness for hormonal treatments. Patients with red flags in their medical histories were still prescribed hormones, and some later stopped identifying as transgender without receiving much support from the clinic.
Challenges similar to those in St. Louis have been reported by clinics around the world. Pediatric gender medicine is a relatively new specialty with limited long-term outcome studies, making it difficult for doctors to determine who would benefit most from gender treatments. European countries have imposed limitations, though not bans, on these treatments while expanding mental health care and collecting more data. Meanwhile, health groups in the United States have endorsed affirming care, while conservative lawmakers in over 20 states have banned or severely restricted gender treatments for minors.
Missouri’s ban is currently being challenged by civil rights groups, and Ms. Reed testified in favor of it, providing detailed descriptions of her allegations. Washington University established an oversight committee to review the gender clinic’s operations weekly. The investigation conducted by the university claimed that none of the clinic’s 598 patients on hormonal medications reported any adverse physical reactions. The university declined to address specific allegations, citing patient privacy, but stated that physicians and staff followed the existing standard of care.
Doctors in St. Louis and elsewhere face evolving standards, uncertain scientific evidence, intense political pressure, and a crisis in adolescent mental health as they navigate gender care.