Missouri launched a multi-agency investigation into a transgender pediatric center after a former caseworker alleged that children were routinely prescribed puberty blockers or hormone therapy without «appropriate or accurate» mental health evaluations, the court announced. Thursday the state attorney general.

Missouri Attorney General Andrew Bailey speaks to reporters after being sworn in in Jefferson City on January 3.David A. Lieb/AP

“We have received disturbing reports that individuals at the St. Louis Children’s Hospital Transgender Center have been harming hundreds of children each year, including using experimental drugs on them,” said state Attorney General Andrew Bailey. said in a statement. «We take this evidence seriously and are investigating fully to make sure children are not harmed by people who may be more concerned with a radical social agenda than children’s health.» The investigation was launched two weeks ago after Jamie Reed, who worked as a case manager at the Transgender Center from 2018 to November 2022, alleged that the center caused permanent harm to many of the patients treated for gender dysphoria. The attorney general’s office, which said she had previously received an affidavit and supporting documentation from Reed, confirmed the existence of the investigation Thursday after Reed went public with her allegations earlier that day in a opinion piece published in The Free Press, a news website started by Bari Weiss, a former op-ed writer and editor at The New York Times. Reed concluded his op-ed by calling for a «moratorium on hormonal and surgical treatment of gender dysphoric youth.»

in a 23 page affidavit Shared on the attorney general’s website, Reed alleged that staff repeatedly violated the center’s treatment guidelines. He said the center required minors to meet four criteria — a minimum age, a referral to a therapist, parental consent, and a clinic visit with an endocrinologist or adolescent medicine specialist — before they could receive antidote blockers. puberty, which temporarily pause puberty, or hormone therapy. like estrogen or testosterone. But he alleged that center staff would provide the medication «without the full informed consent of the parents and without an adequate or accurate assessment of the child’s needs.»

Reed alleged in the affidavit that providers at the center prescribed hormone therapy to patients as young as 13, despite the nonprofit Global Professional Association for Transgender Health recommending at the time that minors have at least 16 years for such treatment. . It also alleged that the center’s providers only used therapists they «knew would accept» a patient’s medical transition and that parents were «routinely pressured» to consent to their child receiving transition-related care.

In his affidavit, Reed also alleged that doctors at the Transgender Center failed to share information with patients and their parents about the possibility of infertility after hormone therapy, although, in his opinion piece, he said that patients «were reported some side effects, including infertility,» but that «he came to believe that adolescents are simply not capable of fully understanding what it means to make the decision to become infertile while still a minor.» He also said he witnessed minors experience «shocking injuries» from the drug, including a patient who experienced «severe vaginal tissue atrophy» after receiving testosterone and had to undergo subsequent surgically treated vaginal lacerations.

Reed alleged that he raised his concerns with center physicians and university administrators for years and was discouraged from following up on adverse patient outcomes, he said in the affidavit. She wrote in her opinion piece that her experience at the Transgender Center led her to support a national moratorium on gender-affirming care for youth because of “the secrecy and lack of rigorous standards that characterize youth gender transition in the whole country».

Washington University in St. Louis, the parent institution of Children’s Hospital, said in a statement shared on his website on Thursday that he is «alarmed by the allegations reported in the article published by The Free Press describing practices and behavior that the author says she witnessed while working at the university’s Transgender Center.»

“We are taking this matter very seriously and have already begun the process of investigating the situation to determine the facts,” the statement said. “As always, our highest priority is the health and well-being of our patients. We are committed to providing compassionate, family-centered care to all of our patients and hold our physicians to the highest professional and ethical standards.»

The state’s Division of Professional Registration, one of the agencies assisting in the investigation, is investigating whether any licensed professionals at the Transgender Center are violating the respective licensing board’s policies, while the Department of Social Services will investigate the concerns. related to fraud. waste or abuse in the state’s Medicaid program, according to the attorney general’s press release.

Missouri is one of at least 24 states that have introduced measures this year to ban gender-affirming care for minors. Five states (Alabama, Arkansas, Tennessee, Arizona, and Utah) have already placed restrictions on such care, though federal courts have blocked the Alabama and Arkansas laws from taking effect until the dispute is resolved.

Transition-related care for minors is supported by major medical organizations, including the American Medical Associationhe American Academy of Pediatrics and the American Psychological Association. These associations oppose government restrictions on care, including puberty blockers and hormone therapy, which they say are safe and have been used for decades to treat other conditions in minors.

The most recent report from the Global Professional Association for Transgender Health Guidance on standards of care, which is widely used by physicians providing transition-related care, recommends that transition care be provided to minors by a multidisciplinary team of physicians with expertise in a variety of fields, including psychology and endocrinology. The group does not recommend any medical intervention for children before puberty. Rather, it recommends that children make a social transition, for example, by using a different name and pronouns or by wearing a different hairstyle or clothing. Adolescents beginning the early stages of puberty, typically between the ages of 8 and 14, may be eligible for puberty blockers, but the group recommends that they meet a list of criteria, including receiving a comprehensive psychosocial evaluation. .

The group also recommends that older youth meet a list of criteria before starting hormone therapy. For example, the standards say that adolescents must demonstrate the emotional and cognitive maturity required to give informed consent for treatment, the adolescent’s other mental health concerns must be addressed, and the adolescent and parents/guardians must be informed about the possible reproductive effects of the treatment.

Minors rarely undergo surgery, but when they do, the group recommends that they receive hormone therapy for at least 12 months beforehand, receive ongoing mental health assessments and support, and be informed about the possible health effects of surgery. including infertility.

More than half a dozen studies published in major medical journals in recent years have found that access to puberty blockers and hormone therapy improves mental health outcomes, including significantly reduced suicidality, for young people. trans.