A controversial clinic at Washington University in St. Louis (WashU) said it will cease the prescription of puberty blockers and cross-sex hormones to minors for purposes of gender transition following the Aug. 28 implementation of a new state law barring the practice for new minor patients. 

The Washington University Transgender Center at St. Louis Childrens Hospital said it made the decision due to an “unacceptable level of liability,” according to a statement. Patients who are currently receiving blockers and hormones will be referred to other providers for these services, the clinic said.

The clinic, open since 2017, said it will continue to offer other services, including “education and mental health support for all patients, and medical care for patients over the age of 18.”

“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,” the clinic said. 

“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.”

The new law, signed by Republican Gov. Mike Parson on June 7, bars puberty blockers and hormone therapy for minors who weren’t receiving care prior to Aug. 28 but exempts patients who were receiving medications before the law took effect, the St. Louis Post-Dispatch reported Sept. 11. The law includes a minimum liability of $500,000 with a judgment that would be three times the amount of damages assessed.

The law expires on Aug. 28, 2027, and also prohibits transgender adults from access to transgender health care under Medicaid, and bars “gender-affirming” surgery for prisoners and inmates.

The Sept. 11 announcement makes WashU the second major hospital in Missouri to shut down the practice of gender transition for minors following an Aug. 28 announcement from the University of Missouri Health Care, based in Columbia. MU Health Care similarly cited “significant legal liability for prescribing or administering cross-sex hormones or puberty-blockings drugs to existing minor patients.”

Doctors at the WashU clinic have been accused of prescribing puberty-blocking drugs to minors without parental consent, a charge the clinic has denied. In a Feb. 9 blog post, a former case worker at the clinic, Jamie Reed, said she left in November 2022 because the hospital was, in her view, “permanently harming the vulnerable patients in our care.” 

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Reed claimed her former clinic put numerous minors on puberty blockers and other drugs, “regularly refers minors for gender transition surgery,” and performed at least one double mastectomy on a minor at St. Louis Children’s Hospital. The clinic claimed, Reed said, that a gender “transition” would make it less likely that the patient would commit suicide and appeared eager to suggest gender transition as the response for almost any mental health issue that patients presented.

After Reed went public with her allegations, WashU said in a statement that it was “alarmed” by what was alleged.

“We are taking this matter very seriously and have already begun the process of looking into the situation to ascertain the facts,” that statement read.

The offices of Missouri Attorney General Andrew Bailey and Sen. Josh Hawley both announced investigations into the clinic’s practices earlier this year after the allegations surfaced.

Bailey on Feb. 10 directed a letter to Trish Lollo, president of St. Louis Children’s Hospital, and Andrew Martin, chancellor of Washington University in St. Louis, urging the institutions to place a moratorium on prescribing puberty blockers or cross-sex hormones to new patients at the Transgender Center at St. Louis Children’s Hospital until the completion of the investigations. The clinic refused to do so, saying a moratorium would “deny critical, standards-based care to current and new patients.”

The clinic’s practices also prompted a lengthy investigative piece by the New York Times, which described the clinic as “buckling under an unrelenting surge in demand” and corroborated a number of Reed’s allegations while being unable to corroborate others. 

Bailey applauded the clinic’s Sept. 11 announcement, calling it in an X post a “big win for Missouri’s kids and a step in the right direction to properly addressing gender dysphoria and taking woke ideology out of health care.”

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The Republican Hawley also praised the decision in a Sept. 11 post on X, saying: “Good news for parents and children and basic common sense — but we still need answers about what happened at WashU and why university officials won’t cooperate with investigators.”

A Feb. 14 statement from Washington University said the university is “committed to providing lifesaving, evidence-based care that aligns with the standards set by the American Academy of Pediatrics [AAP].” AAP’s standards, as well as those of the U.S.-based Endocrine Society and the World Professional Association for Transgender Health, have come under scrutiny recently for failing to cite compelling evidence for their claims. 

An article from the British Medical Journal criticized AAP’s guidance on pediatric gender dysphoria, which was drafted primarily by a single doctor, Jason Rafferty, and released in 2018. The document, which recommends against pediatric transgender surgery except on a “case-by-case basis,” has been described by its author as a “policy statement … not meant to be a protocol or guidelines in and of themselves.” The AAP told the British Medical Journal that all its policy statements are reviewed after five years and so a “revision is underway,” based on its experts’ own “robust evidence review.”

Several other countries, such as Britain, Finland, Sweden, and the Netherlands, have begun in recent years to restrict the use of puberty blockers for minors, citing insufficient evidence of their efficacy outweighed by evidence of harm. In addition, Finland and Sweden reserve transgender surgery for adults.