September 12, 2023 - 7:00pm

First comes the pushback, then the pullback. 

Yesterday, the Washington University Transgender Center at St. Louis Children’s Hospital announced that doctors there will no longer prescribe puberty blockers or cross-sex hormones to children and adolescents. This decision follows months of controversy and comes in the wake of a new law that just went into effect in Missouri, which limits hormonal and surgical interventions for gender transition to patients over the age of 18.

Under a “grandfather clause” in the new law, the Transgender Center could have continued to prescribe puberty blockers and cross-sex hormones to current patients. However, it decided to back away from these interventions altogether:

We are disheartened to have to take this step. However, Missouri’s newly enacted law regarding transgender care has created a new legal claim for patients who received these medications as minors. This legal claim creates unsustainable liability for health-care professionals and makes it untenable for us to continue to provide comprehensive transgender care for minor patients without subjecting the university and our providers to an unacceptable level of liability.
- Washington University Transgender Center

The Center first came under intense scrutiny earlier this year, when former case manager Jamie Reed blew the whistle on what she had come to see as dangerous practices within the clinic. In an article for The Free Press, Reed reported that: 

“During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility.

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to ‘do no harm.’ Instead, we are permanently harming the vulnerable patients in our care.”

- Jamie Reed

Reed catalogued “red flag” cases to keep track of “the kind of patients that kept my colleague and me up at night” and documented cases of youth with serious mental health struggles rushed onto life-altering drugs and even undergoing surgeries they soon regretted. The Transgender Center rejected Reed’s assessment and conducted their own internal investigation — an investigation in which they never bothered to speak to Reed — before declaring her allegations “unsubstantiated”. 

But the case for youth gender transition has been unravelling this year, under pressure from state officials and legislators and increased scrutiny from the media. At the end of August, St. Louis Circuit Court Judge Steven Ohmer allowed Missouri’s ban on hormonal and surgical interventions for youth to go into effect, writing that the evidence for youth transition “raises more questions than answers”. 

Hence the “unsustainable liability” Washington University cited in its decision to pull back from this area of healthcare. That’s because Missouri’s new law also extended the period of time former patients have to sue for damages to 15 years. Perhaps, when the Washington University investigated themselves, they found more merit to Reed’s allegations than they were willing to acknowledge publicly. They fear being made to pay for it. 

Medical scandals tend to end quietly: the “chemical lobotomy” phased out the lobotomy-lobotomy. The Satanic Panic choked not on its own absurdities but in courtrooms and insurance offices. Public reckonings are few and far between. “Unsustainable liability” may be the beginning of the end for youth gender transition. 

Eliza Mondegreen is a graduate student in psychiatry and the author of Writing Behavior on Substack.