Following the explosive allegations of wrongdoing by former employee-turned-whistleblower Jamie Reed, the Washington University Transgender Center (WUTC, or the Center) at St. Louis Children’s Hospital conducted an internal investigation of its practices. In a report it released late last month, WUTC claimed that it found no evidence of serious problems. Reed’s allegations, it concluded, were “unsubstantiated.”
WUTC’s report has four basic problems. First: in its eight-week investigation, the Center never bothered to interview Jamie Reed herself. One would think that hearing about allegations of misconduct from the individual making them is a key part of an internal review. WUTC’s lack of interest in what Reed has to say—whether, for instance, there is relevant information she did not include in her sworn affidavit or whether she has learned anything in the months since complaining to the attorney general—suggests a lack of good faith on WUTC’s part. This deficiency alone calls the report’s conclusions into question.
As Reed said through her lawyers, some of the report’s findings constitute a tacit acknowledgment of her allegations. For example, WUTC concedes that it did not require written informed consent from parents prior to initiating hormonal interventions for minors. Nor did it require that parents or legal guardians provide copies of custodial agreements.
Second, the WUTC report is evasive about the standards of care that guide its practice. It says that “physicians and staff at the Center follow appropriate policies and procedures and treat patients according to the currently accepted standard of care, as recommended by the American Academy of Pediatrics and other nationally recognized organizations.” To be clear, the AAP’s 2018 statement on pediatric gender medicine explicitly says that it “does not . . . serve as a standard of care.” If they are to be called evidence-based, practice guidelines should ideally be based on systematic reviews of evidence, which the AAP has thus far refused to conduct. Whether WUTC is aware of these facts, or cares, remains unclear.
Setting that aside, last August, the AAP’s president said that the “vast majority” of minors seeking “gender-affirming care” need “the exact opposite” of drugs and surgeries. Yet in its report, WUTC finds that over half of its patients since 2018 did undergo medicalization. Reed’s own records show that two-thirds ended up on hormones, according to the press release from her lawyers.
WUTC claims that it is also following the World Professional Association for Transgender Health’s (WPATH) standards of care, but conveniently doesn’t mention which version. In her sworn affidavit, Reed noted that the Center would prescribe cross-sex hormones to children as young as 13 despite the WPATH Standards of Care 7, which were operative at the time, recommending them only from age 16. WPATH’s new standards of care (version 8), issued in September of last year, notoriously did away with age minimums for both hormones and surgeries. Thus, WUTC might be right that its practices during Reed’s tenure align with the current WPATH standards, but Reed’s allegation is that the clinic wasn’t following WPATH standards at the time.
A third discrepancy in WUTC’s findings involves surgeries. In testimony before the Missouri legislature in 2022, WUTC’s two top doctors, Christopher Lewis and Sarah Garwood, declared that “at no point are surgeries on the table for anyone under 18” and that “surgeries are not an option for anyone under 18 years of age” (see here, at 9:15:20). Yet, WUTC concedes in its report that double mastectomies for teenage girls who identify as boys (“chest masculinization”) are “within the defined standard of care,” that the Center did in fact refer minors for surgeries such as double-mastectomies (“chest masculinization”) prior to 2018, that since 2018 it has provided families with the names of surgeons who can perform the procedure for their distressed daughters, and that Washington University surgeons have performed six double mastectomies for teenage girls since 2018 (albeit not by direct referral from the Center’s providers). In her affidavit, Reed notes that between 2018 and 2022, the Center referred patients to surgeons “for educational purposes” (i.e., consultations).
The fourth and arguably most important problem with the report, however, concerns this statement: “Interviews with Center providers and a review of medical records identified no patients who had adverse physical reactions caused by medications prescribed by Center providers.” Let’s assume that WUTC did its due diligence and interviewed all Center employees since 2018 (except, of course, for Reed). Let’s also assume that these employees told the truth. The fact that no provider reported adverse physical reactions hardly means that none occurred, and it raises troubling questions about what kind of follow-up providers at the Center do on their patients.
Those harmed by gender medicine may not report their adverse reactions to their providers, and concerns are growing that providers steeped in the affirmative ideology do not want to hear about the downsides of treatments they believe are “medically necessary” and “life-saving.” In her affidavit, Reed alleged that the Center “refuses to track complications and adverse events among its patients. There is no standard protocol for tracking patients who have received treatment. And the Center actively avoids trying to learn about these adverse events.” Reed said she tried to track adverse events “on my own initiative” but was “discouraged . . . from doing so. “It is my belief,” she said, “that the Center does not track these outcomes because they do not want to have to report them to new patients and because they do not want to discontinue cross-sex hormone prescriptions.”
A 2021 study on 100 detransitioners found that three quarters did not report their decision to detransition to their providers, while 49 percent cited “concerns about potential medical complications from transition.” Some said their initial decision to transition was socially influenced. It is now well-known that the majority of minors seeking medical transition have comorbid psychological problems, and that the affirmative approach recommends understanding these not as a possible cause of gender issues or a reason to conduct further assessment, but as secondary to the problem of “unaffirmed gender” (the “minority stress” model) and resolvable only through medicalization.
Even activists supportive of the clinic’s work cast doubt over the information in Friday’s report. NBC’s Jo Yurcaba, an advocate of “gender affirming care” who uses “they/them” pronouns and is affiliated with the Transgender Journalists Association, a nonprofit that provides media outlets with a style guide to ensure that the language they use aligns with the transgender movement’s ideological belief system, interviewed Cate Hensley, a former WUTC employee who also uses they/them pronouns, and who accused Reed of being “transphobic” and spreading “hate.” In Yurcaba’s story, Hensley confirms Reed’s report of a patient who experienced painful and bleeding “vaginal lacerations” as a result of taking testosterone. Yurcaba hastened to note that Hensley “didn’t want to discuss [the case] in detail because it is private patient information.” Fair enough, but did WUTC not speak to Hensley in its investigation? If so, did Hensley not mention this patient? And if so, does WUTC not count painful vaginal lacerations and bleeding as an “adverse physical reaction”?
A zero percent adverse reaction rate would be highly unusual for any medical treatment, including one as benign as Tylenol for headaches. It is especially suspicious, however, when invoked in the context of a treatment protocol for mentally unstable teenagers that health authorities in progressive countries like Sweden, Finland, and Norway have rightly recognized as lacking an adequate evidentiary basis and now call “experimental.” In 2017, Stat News reported that the FDA had received over 10,000 adverse-event reports—“everything from brittle bones to faulty joints”—filed by women who had taken Lupron for precocious puberty. Lupron implants are now commonly used to block puberty in children diagnosed with gender dysphoria.
Finally on this point, it is odd, to say the least, that WUTC’s assessment of its medical value to patients depends on “adverse physical reactions.” After all, “gender affirming care” entails the use of chemicals and surgeries to treat a psychological condition (gender dysphoria). We would expect, therefore, to hear primarily about mental health outcomes, whether positive or negative.
It is not surprising that the WUTC report is mum on this question. Systematic reviews from other countries have found that the evidence for mental health benefits is exceptionally weak, and some studies have found no or negative mental health outcomes following hormones. Studies that do report improved mental health typically rely on dubious metrics (such as the “Chest Dysphoria Measure”), suffer from confounding factors, lack adequate follow-up, and fail to distinguish pharmacological from placebo effects. We have no good long-term mental health outcome data on minors treated under the American affirmative model, and we probably won’t have it for another decade or so. For WUTC to be able to say that the treatments it offers are safe and effective, it would have to show that the mental health benefits are significant enough to outweigh the physical and psychological risks.
For good reason, we do not take institutions at their word when they conduct internal investigations in response to allegations of wrongdoing. When investigative journalists refuse to do their job—the St. Louis Post Dispatch’s Kelsey Landis and Colleen Schrappen, whose ongoing coverage of this story has been heavily biased against Reed, failed to address any of the discrepancies discussed above—the task of holding medical institutions to account falls squarely on the shoulders of state authorities (or the responsive ones, at any rate).
Responding to the release of the WUTC report on Friday, Missouri Attorney General Andrew Bailey said that “the transgender center’s assertions don’t line up with what we’ve uncovered so far in our investigation.” A truly comprehensive and impartial investigation of the clinic is needed more than ever.
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