Allegations that physicians at the Transgender Center at St. Louis Children’s Hospital failed to inform patients of potential side effects of treatment and overlooked their mental health needs are “unsubstantiated,” according to an internal investigation conducted by Washington University and released Friday.
Washington University oversees the Transgender Center and has been under fire since Jamie Reed, a former case worker at the center, went public with allegations of misconduct earlier this year.
The university released a summary of conclusions Friday from the internal probe, saying the focus of the review was on Reed’s accusations, “with a particular emphasis on allegations of patient harm and the consenting process.”
Neither Reed nor the Missouri attorney general’s office, which is investigating Reed’s allegations, could be immediately reached for comment.
The university said it compared the center’s process with recognized standards of care, like those set by the World Professional Association for Transgender Health (WPATH) and the Endocrine Society. Major medical associations, such as the American Academy of Pediatrics and American Medical Association, recognize these standards for gender-affirming care.
Washington University found that Transgender Center physicians “adopted appropriate policies and procedures to treat patients according to the currently accepted standard of care.”
In her article she wrote for the news and opinion site the Free Press, Reed said: “The majority of (patients) received hormone prescriptions that can have life-altering consequences — including sterility.”
Less than half of Transgender Center patients receive cross-sex hormones, the university found, although just over half receive some form of medical intervention.
Washington University says 1,165 patients have received care at its transgender center. Of those, 531 received cross-sex hormones and 67 were prescribed puberty blockers without hormones.
Puberty blockers are reversible when a patient stops taking the medication, but doctors monitor for side effects. A parent of a child receiving puberty blockers from the Transgender Center told the Independent last month that her son has regular scans to ensure his bone density is adequate.
Few studies have looked at fertility outcomes for transgender people. However, a 2020 Mayo Clinic review concludes that transgender youth and adults have options to preserve fertility in multiple stages of medical transitions. Beginning hormone treatment does not necessarily make a person sterile.
The university found that since 2018, when an internal prohibition was put in place, the Transgender Center has not referred any patients for surgery. If information about surgeons is requested by a family, the center will provide names but will not send patient information to another provider.
Since 2018, the center has performed six chest surgeries for adolescents transitioning to male for patients referred through another source.
A key part of an affidavit Reed gave to the Missouri Attorney General is the mental health of patients. Reed alleges the center did not treat mental health and prescribed puberty blockers and cross-sex hormones to patients with ongoing mental illness.
Washington University says it requires “appropriate mental health assessment” and a letter of support from a mental health provider for patients under 18.
“Most patients had ongoing relationships with mental health providers and the center providers recommend resources to patients who may need ongoing treatment for mental health concerns,” the university said.
Parents of transgender children and patients who spoke to the Independent earlier this year said they had multiple therapy sessions before beginning a medical transition and that they felt fully informed of the process. Their mental health providers treat any diagnosed conditions, but gender-affirming care provides relief to anxiety and depression as well, they said.
Washington University said it gathers parental consent “as required by the university and the state of Missouri and consistent with the general practice for prescribing medication to minors by university physicians.” But it is also planning to expand its consent procedure.
Its oversight committee recommended requiring written parental consent prior to prescribing gender-affirming medications, and the university has added this step to the process.
The center will also be asking for custody agreements prior to a minor’s first visit. Previously, it required custody agreements before medical intervention “in cases where decision-making authority was in question.” The university also said it wants to “be more intentional about public engagement on the topics of gender dysphoria and transgender care.”
Missouri Attorney General Andrew Bailey has not indicated whether the investigation his office is leading is complete. The university said it has provided “a large number of documents to the Missouri Attorney General in response to his ongoing review.”
It also said it has gathered information requested by Sen. Josh Hawley.
The investigation on gender-affirming care providers is not occuring in a vacuum. The attorney general has also issued an emergency rule, which is set to go into effect April 27. The rule would limit access to certain procedures not only for minors but for transgender adults.
The university said it is still analyzing the impact of the emergency rule.
Missouri’s lawmakers are debating restrictions on transgender athletes and a ban on gender-affirming care for transgender youth.
This story was originally published by the Missouri Independent, part of States Newsroom.
