51黑料

ST. LOUIS 鈥� Explosive allegations made public last month about a 51黑料 clinic that treats transgender children have flung parents into a vortex of emotions: shock, confusion, anger, fear.

Kim Hutton, among those confused by the reports, views the treatment her son, now 19, received from as vital to making him the outgoing college freshman he is today.

鈥淭he idea that nobody got information, that everybody was pushed toward treatment, is just not true. It鈥檚 devastating,鈥� Hutton said. 鈥淚鈥檓 baffled by it.鈥�

Almost two dozen parents of children seen at the clinic, which opened in 2017, say their experiences sharply contradict the examples supplied by Jamie Reed, a case manager who left the WU center after being employed there for more than four years. Reed outlined her concerns in an article published online Feb. 9; her sworn affidavit, which included additional allegations, was released that day by Missouri Attorney General Andrew Bailey, who is leading a state investigation.

Bailey demanded an immediate moratorium on prescriptions of puberty-blocking drugs and cross-sex hormones for new patients. Leaders at Washington U. and BJC HealthCare rejected that, but pledged to establish 鈥�additional oversight.鈥�

Reed, of south 51黑料 County, alleges that families were rushed toward medical interventions without regard to whether adolescents were in extreme mental health distress. She claims side effects were glossed over, and drugs were prescribed even if one parent did not consent.

But parents interviewed by the Post-Dispatch cast doubt on 搁别别诲鈥檚 ability to know what happened inside exam rooms as an employee who did not have a medical or managerial role, and whom they rarely saw. The case manager鈥檚 job duties, as described in a Washington U. posting, comprise patient intake, scheduling appointments and providing information about community resources to families.

Reed emailed parents with reminders, asking them to contact her with questions. The printouts that were attached detailed medical protocols, including side effects, risks and reversibility. They listed contact information for dozens of local wraparound services, LGBTQ advocacy organizations and licensed mental health professionals.

Patients recounted that the staff explained procedures using both medical and everyday vocabulary.

鈥淭he doctor reached out to me after hours to answer my questions and make sure I understood what my treatment plan was,鈥� said a 16-year-old from the 51黑料 area.

Rather than the 鈥渞apid medicalization鈥� and 鈥減oor assessment of mental health concerns鈥� that Reed cited in a in January, parents reported a well-defined, step-by-step approach that could be halted at any time.

Slow, methodical adjustments began at home, long before medications were used: testing out new names, using different pronouns, cutting hair short or growing it long. The social transitions ran concurrently with mental health care, sometimes lasting years. Only then, parents said, was medication considered.

Many parents spoke on the condition of anonymity to protect their children. Anti-trans rhetoric has heated up in the fallout from 搁别别诲鈥檚 allegations, energizing lawmakers in the Republican-led Capitol. At least 27 bills targeting LGBTQ rights have been introduced in the Missouri Legislature this session, including half a dozen that seek to limit health care.

Reed declined to be interviewed for this story, but responded in a statement, provided by 51黑料 County Councilman Ernie Trakas, one of her lawyers with the .

鈥淚t is not surprising to me that the negatively affected families have not yet come forward. Parents have a strong instinct to protect their children鈥檚 privacy 鈥�,鈥� the statement reads. 鈥淐onflating short-term patient satisfaction, which some patients refer to as the period of 鈥榟ormone high,鈥� with good medical outcomes is the kind of misguided thinking that contributed to the opioid epidemic.鈥�

Regret often comes years later, according to the statement. 鈥淗arm will ensue,鈥� it concludes.

Major medical organizations, such as the American Academy of Pediatrics and the Endocrine Society, endorse puberty blockers and hormones as . They say the mental health ramifications of not addressing the needs of such patients put them in peril.

Mental health concerns

In her allegations, Reed references patients with severe mental illnesses, claiming in a published online by the Free Press that 鈥渙ur doctors viewed gender transition 鈥� even with all the expense and hardship it entailed 鈥� as the solution.鈥�

One 51黑料-area parent interviewed by the Post-Dispatch questions the need for transgender centers across the board, saying they push families to funnel all their concerns about their child into one issue. The parent鈥檚 teenager has been diagnosed with a long list of mental and behavioral issues and, in the past, has threatened suicide.

While in elementary school, the child was evaluated by an endocrinologist. The family went to conferences and tried a support group, and their child made a social transition.

鈥淚 was apprehensive,鈥� the parent said. 鈥淚 was open to all the options for treatment. You have a child, you want the best outcome with the least amount of impacts.鈥�

The teenager has been seeing a psychiatrist for about a decade, but with the teen鈥檚 complicated history, the parent wants additional time in therapy before any future medical interventions. The parent believes more therapy 鈥� focused on the other mental health concerns 鈥� could resolve the gender dysphoria.

鈥淭hey have not forced us to do anything,鈥� the parent said about the WU center.

But there was still pressure. Doctors and therapists often mentioned the suicide risk of untreated transgender youths, which the parent took as a scare tactic. The conflict has been a strain on the family.

The parent does not want the Transgender Center shut down but said the approach should be broader, with extended psychotherapy for patients.

A 51黑料 County mother recounts a different experience. Her daughter鈥檚 mental health crisis escalated when she started middle school and began cutting herself. The girl鈥檚 depression spiraled. By freshman year, she could barely crawl out of bed, her mother said. The family met with the team at the Transgender Center.

鈥淓veryone was in agreement that we needed to get her depression under control before we talked about hormones,鈥� said the mother. 鈥淭he focus was getting her healthy.鈥�

Her ex-husband had a lot of questions, and 鈥渢he clinic was adamant we be in agreement鈥� before moving forward, the mother said. Their daughter, now 18, was ultimately the one who convinced him.

Their daughter鈥檚 depression didn鈥檛 disappear, but its symptoms abated. The teen finally felt comfortable in her body.

Many of the families interviewed said their children had worked with multiple mental health specialists to address diagnoses ranging from anxiety and autism to more debilitating conditions such as borderline personality disorder. Depression, self-harm and suicidal ideation among transgender youths occur more frequently than in the general population, with research indicating a .

One study published in the last year found that gender-affirming care lowered the risk of depression and suicide for transgender teenagers. The same study asserts that transgender youths are 鈥渄isproportionately burdened by poor mental health outcomes,鈥� likely due to social rejection, lack of parental support and bullying.

Amy Cafer of Columbia, Missouri, credits the treatment her daughter, now 19, received at the WU center with saving her life.

By the time she was 12, Cafer鈥檚 daughter had attempted suicide. Cafer and her husband pulled the girl out of school. She met with a psychologist every week.

鈥淚t took six months to tease out what was going on,鈥� Cafer said.

At 13, the girl was able to tell her parents she was transgender. She chose a new name and wore 鈥済irl鈥� clothes. Two years later, she started on estrogen. At clinic appointments, Dr. Christopher Lewis, the pediatric endocrinologist who co-founded the WU center, would draw pictures on the exam table鈥檚 paper cover to illustrate what the hormones do, what side effects to watch for, and what she could expect her body to look like as estrogen levels inched up toward a maintenance dose, Cafer said.

Blockers and hormones

The daughter of a Clayton couple articulated her gender identity at a much earlier age than Cafer鈥檚 daughter.

鈥淪he鈥檚 a cut-and-dried story,鈥� said the mom. The parents talked to their pediatrician while the girl was still a preschooler. They found a therapist; a social transition followed. When their daughter was 9, they visited the Transgender Center.

鈥淲e didn鈥檛 take this lightly. We wanted to give her every choice,鈥� said her mom.

They waited for signs of puberty. After a threshold of estrogen or testosterone has been reached, .

Blockers are considered off-label for gender issues but have been used for decades to suppress precocious puberty in very young children and to treat cancer and endometriosis. Puberty blockers can cause bone-density loss, so adolescents undergo regular bone screenings. If patients discontinue blockers, they go through the typical pubertal changes of their gender assigned at birth.

If patients press forward with , they acquire secondary-sex characteristics that align with their identity. Estrogen redistributes weight in transgender girls, so they develop breasts and wider hips. Testosterone deepens the voice, broadens the shoulders and thickens body hair on transgender boys. If hormones are stopped, some changes reverse; others are permanent. Side effects include increased risks for blood clots, diabetes and heart disease.

Five years ago, the National Institutes of Health embarked on a comprehensive $5.7 million study of medical treatments on transgender youths, the first of its kind. But long-term outcomes remain largely unknown.

Side effects are no minor concern for Tim and Melissa Dierker of Maplewood. Their 12-year-old daughter is on the cusp of being ready for puberty blockers. In each of their four appointments so far, they鈥檝e meticulously reviewed options with the medical staff at the center, which include an endocrinologist, a doctor of adolescent medicine, a gynecologist, a nurse, a nurse practitioner, a nutritionist, a psychologist and a psychiatrist.

Each appointment involves blood tests to check their daughter鈥檚 hormone levels, a mental health survey, question-and-answer sessions and paperwork.

鈥淓very time we go in there, it鈥檚 more informational,鈥� said Tim Dierker. 鈥淚 wouldn鈥檛 say it鈥檚 the easiest decision. It鈥檚 OK to admit that you don鈥檛 understand. Life鈥檚 not a binary.鈥�

Lewis, the endocrinologist, declined to comment for this story, citing legal advice. In January, he and Dr. Sarah Garwood, the Transgender Center鈥檚 other founder, submitted written testimony for a hearing at the state House on a bill that aims to prohibit gender-affirming care for minors. Most of their patients are neither on puberty blockers nor hormone therapy, the doctors testified.

鈥淔or prepubertal children, the focus (at the center) is on psychosocial support and family education only 鈥�,鈥� the statement reads. 鈥淣ot every teen needs, or wants, to begin hormones or have a puberty blocker before age 18 or ever. The experience of being trans is different for each individual.鈥�

搁别别诲鈥檚 affidavit asserted that the center 鈥渘ever discontinues cross-sex hormones, no matter the outcome,鈥� but 17-year-old Chloe Clark of 51黑料, who told her parents she was transgender in middle school, halted her estrogen therapy a year ago. She was happy with her transformation 鈥� leaving her somewhere in the middle of the gender spectrum, she said 鈥� and didn鈥檛 feel she needed the drugs anymore.

Her parents and doctors were supportive of her decisions, she said.

鈥淚t was amazing,鈥� Chloe said.

鈥榃e don鈥檛 do that here鈥�

The whistleblower report also claimed Lewis and Garwood lied about not doing surgeries on minors, saying the center 鈥渞egularly refers minors for gender transition surgery.鈥� In an April interview, Lewis said: 鈥淪urgery is not offered to anyone under 18.鈥�

Surgery is what Christine Hyman鈥檚 17-year-old son wanted from his very first appointment at the Transgender Center, when he was just 12. He brought a blue Post-it with him, with three questions written: When can I start testosterone? When can I have top surgery? How can I get my dad on board quicker?

The answer he received for all three, said Hyman, was to give it time.

鈥淧ut it out of your mind. We don鈥檛 do that here,鈥� Hyman, of St. Charles, recalled the nurse telling her son about surgery. 鈥淵ou don鈥檛 walk in Tuesday morning as a girl and walk out Tuesday afternoon as a boy. That鈥檚 not a thing.鈥�

He had to be patient with the other two questions as well. His dad pored over studies, which they discussed as a family. He came around.

Hyman鈥檚 son saw a therapist for more than a year 鈥� 89 times, Hyman said 鈥� before he started testosterone. Ahead of that, he was also counseled on preserving his fertility, which is usually compromised once cross hormones are introduced. A window can be opened between blockers and hormones to allow eggs or sperm to be collected and frozen.

The center helped with nonmedical issues, too, Hyman said. It recommended barbers, clothing stores and legal aid agencies.

Jess Jones, who identifies as nonbinary and uses 鈥渢hey鈥� pronouns, worked at the Transgender Center from 2018 until 2020 as an . Jones led trainings at schools and coordinated with teachers, administrators and families to ensure students felt safe.

Jones bristled at the way they said Reed sometimes spoke about patients.

鈥淗ow passionately she worked as a case manager felt at odds with how she talked about transgender people,鈥� Jones said.

Jones recounted Reed telling them that 鈥渕isgendering,鈥� or using the wrong gender or pronouns to describe a person, was 鈥渆xposure therapy鈥� that would keep trans children from being coddled and encourage them to develop a thick skin.

Jones complained about Reed to the center鈥檚 directors and human resources and was not the only one to do so, they said. Reed acknowledged in the Free Press narrative that she received a negative performance review in 2021.

Jones quit the educational liaison position the year before that.

鈥淛amie was the primary reason I left,鈥� said Jones, who now lives out of state. But they still support the mission of the Transgender Center, they said, and do not harbor doubts that protocols are stringently followed or that patients鈥� mental health is being tended to.

鈥淭hey have a holistic and comprehensive approach,鈥� Jones said. 鈥淭his was an initiative that was really trailblazing.鈥�

Increase in patients

In the past few years, the number of Americans who say they are transgender has mushroomed. In 2017, an analysis by the Williams Institute, a public policy research group at UCLA, found about 1.4 million people, or less than 1% of the population, identified as transgender.

A 2021 update noted an increase of 200,000 across the population, with a spike among those younger than 25. In that cohort, 3% identified as trans.

The Transgender Center has also experienced an uptick, seeing about 250 first-time patients a year. Some migrated over from SSM Cardinal Glennon Children鈥檚 Hospital in late 2019, when the Archdiocese of 51黑料 clamped down on the treatment of transgender adolescents.

Reed argued the rise shows a 鈥渟ocial contagion鈥� at play. 鈥淲hen I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate,鈥� she wrote in the Free Press article. In her affidavit, she said social media, including TikTok, is 鈥渁t least partly responsible.鈥�

Lewis, in April, said the causes were manifold: Schools are more supportive. Families are listening. Quality of care has improved, along with insurance coverage.

鈥淎nd people are aware of the services we offer,鈥� Lewis said.

One mother from a town in northeast Missouri believes her 24-year-old child was influenced by Facebook and his social circle to come out as a transgender man at 19.

鈥淪he鈥檚 prone to hasty decisions and a chameleon-like lifestyle,鈥� the mother, still using female pronouns for her child, said.

Her child began receiving testosterone at the Transgender Center against his parents鈥� wishes 鈥� but after he was legally an adult. To the mother鈥檚 knowledge, her child believes the process has been a positive one.

鈥淪he鈥檚 happy with the care she received,鈥� the mother said.

Blindsided

A longtime friend of 搁别别诲鈥檚 may be the person most dumbfounded by her allegations. The mother, from south 51黑料, has known Reed for more than a decade, since their kids were tiny.

The mother鈥檚 younger child, now 16, began questioning gender in sixth grade. Two years ago, after several suicide attempts and four stays at a psychiatric hospital, he came out as trans. He continued with psychotherapy and, in June, met with Garwood at the Transgender Center. He has been on testosterone for three months.

鈥淚t鈥檚 not a decision you make lightly,鈥� the mother said. 鈥淵ou don鈥檛 rush into something like that.鈥�

搁别别诲鈥檚 Free Press jaw-dropper blindsided her. She felt betrayed.

Last year, the mother had texted Reed that her son would be starting a hormone regimen. If Reed 鈥� her friend 鈥� was worried it was dangerous, why wouldn鈥檛 she have said something, the mother questions.

鈥淭he worst thing about it,鈥� she said, 鈥渋s people start getting paranoid, and they start doing terrible things to trans people. My kids are scared.鈥�

Originally posted at noon Wednesday, March 1.

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