Wash U. says ex-employee’s claims about transgender center in St. Louis are unfounded

st. LOUIS — Washington University says accusations about its youth transgender clinic by an ex-employee are unsubstantiated and that its internal review found the clinic is not violating any policies.

“The review affirmed that physicians and staff at the Center follow appropriate policies and procedures and treat patients according to the accepted standards of care,” the university said in a statement Friday, accompanying a summary of its findings.

The former employee is Jamie Reed, who worked as a case manager at the Washington University Transgender Center at St. Louis Children’s Hospital for more than four years before leaving last November. She alleged in February that doctors introduced medical interventions without informed parental consent; that puberty blockers and hormones were prescribed without adequately addressing mental health issues; and that the center regularly referred to patients younger than 18 for surgery.

Reed outlined her claims in a first-person narrative published online by the Free Press on Feb. 9. Her sworn affidavit, which included additional accusations, was released that day by Missouri Attorney General Andrew Bailey, who is leading a state investigation.

In the wake of the whistleblower report, two dozen parents recounted their experiences to the Post-Dispatch, contradicting many of the claims, which included that children were rushed to treatment and possible side effects weren’t explained.

In its summary report, Washington University said Chancellor Andrew Martin initiated a review following the publication of Reed’s article, collaborating with Children’s Hospital to establish an oversight committee. It did not specify how many people served on the committee or their positions.

The report concluded that no patients at the Transgender Center, which opened in 2017, had experienced adverse reactions to medicalization, and that mental health care has been prioritized. But it acknowledged that, although its process of documenting parental consent adheres to university and state requirements, a “more detailed and formalized approach” was needed, including mandating earlier evidence of custody agreements. It also disclosed that changes to its procedures regarding surgeries had already been made.

A total of 1,165 patients have been treated at the transgender center since June 2018, the year Reed was hired.

In her affidavit, Reed described hormone treatment for gender-questioning adolescents at the clinic as inevitable, characterizing it as “the prevailing narrative of immediate cross-sex hormones for all by the prescribing physicians.”

The university’s review found that fewer than half of its adolescent patients, 531, received cross hormones, which allow them to develop secondary sex characteristics of the gender with which they identify, such as breasts and wider hips for girls and deeper voices and broader shoulders for boys.

An additional 67 patients were prescribed puberty blockers, which paused the physical changes of puberty, but not cross-sex hormones. The rest, 567, were not prescribed puberty blockers or hormones.

Reed did not respond to a request for comment on Friday.

Reed also noted in his affidavit the potential side effects of medicalization and described a patient who experienced liver damage after taking Bicalutamide, which suppresses male hormones. She told of patients who were in severe mental health distress, and she claimed that the Transgender Center “does not provide mental health care or refer children for mental health care.”

Washington University’s summary of conclusions noted that “no patients who had adverse physical reactions prescribed by Center providers” and that “most” patients receive continuing mental health care — but didn’t specify how many patients did not. The staff at the center includes a psychiatrist and a psychologist. A list of therapists who specialize in gender issues is supplied to families.

Patients are required to have a letter of support from a licensed mental health provider before beginning medical interventions. Depression, self-harm and suicidal ideation among transgender youths occur more frequently than within the general population.

The WU review also noted that prior to 2019, if requested, minors could be referred to for gender-affirming surgery. A policy barring such referrals was enacted in late 2018, the report said.

Six surgeries have been performed by Washington University physicians since 2018, but they were not from transgender center referrals, the university said. All six surgeries were chest surgeries for adolescents transitioning to male.

The university has since changed its policy on gender-confirmation surgery for minors, and its physicians “no longer perform gender-affirming surgeries on patients under the age of 18.” The report did not specify when the change to policy was made.

The transgender center follows guidelines set forth by the World Professional Association for Transgender Health, an international organization of physicians and researchers that has established standards of care since 1979.

The university has not revealed details regarding emergency regulations announced by the attorney general a month ago. The rules, which apply to Missourians of all ages, include a therapy requirement that creates an 18-month waiting period for care.

Both the Missouri Senate and the House have advanced legislation in recent weeks that would tightly restrict or prohibit gender-affirming care for minors.

Jennifer Goldring, whose 16-year-old son receives care at the center, said she’s not surprised the university found no violations of policies by the center.

“That’s how we feel our care is. They’re very careful, and they were always very attentive to all aspects of my child,” said Goldring, a St. Louis County resident. “Overall, we’re still pretty stressed out by the political climate here and by all the shenanigans the attorney general is doing, and of course what our Legislature is doing. But that’s a relief.”

The family is planning to leave Missouri by the end of 2024 to live in a state with protections for trans people.

Ernie Trakas, an attorney for Reed and a member of the St. Louis County Council, claimed that much of the university’s investigation was a “tacit acknowledgment” of Reed’s accusations. He said the school’s determination that the center needs evidence of custody agreements proves that parents had not been properly informed of their child’s care when there were disagreements about the child’s need for gender-affirming care.

Becky Hormuth, of Wentzville, whose 16-year-old son is a patient, said she thought, “Told you so,” when she found out about the university’s conclusions. But she said the next step is focusing on the attorney general’s regulations.

“He’s just hurting our children and our families, and he needs to stop this immediately,” Hormuth said.

Tim Dierker, of St. Louis, whose 12-year-old daughter is a patient at the center, says he’s not surprised by the findings either. But he still fears attacks from the attorney general and Legislature.

“I don’t think this will stop anyone from pursuing their agenda,” Dierker said. “But I hope Washington University will continue to fight for their patients.”