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Wash U Transgender Center ends some treatments for minors, citing legal risk

Brian Munoz
St. Louis Public Radio

Updated at 10:30 p.m. Sept. 11 with reaction regarding the policy change

The Washington University Transgender Center at St. Louis Children’s Hospital will no longer offer gender transition surgery, puberty blockers or hormones to patients under 18, now that new legislation that outlaws such care has gone into effect.

The law, passed by the majority-Republican Missouri legislature earlier this year, exempted from the ban care for patients already receiving treatment. However, Washington University officials said in a statement Monday that the legal liabilities for continuing certain gender transition treatments even for existing patients was too risky and set their providers up for lawsuits.

“Missouri’s newly enacted law regarding transgender care has created a new legal claim for patients who received these medications as minors,” university officials said in the statement. “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 law was introduced by Sen. Mike Moon, R-Ash Grove, and went into effect late last month. It permits former patients to bring legal action against providers if they could prove infertility as a result of hormones or drugs from hormone replacement therapy. Providers also could lose their license if they provided gender transition treatment to minors. The law prohibits providers from asking patients to sign waivers that could protect them from future liability.

Sen. Mike Moon, R-Ash Grove, on Wednesday, Jan. 4, 2023, during the first day of the legislative session at the Missouri State Capitol in Jefferson City, Mo.
Brian Munoz
St. Louis Public Radio
Sen. Mike Moon, R-Ash Grove, in January 2023 during the first day of the legislative session at the Missouri Capitol in Jefferson City. Moon introduced the legislation that went into effect in late August restricting gender-affirming care for minors.

"Our medical practitioners have cared for these patients with skill and dedication," Wash U officials said in the statement. "They have continually provided treatment in accordance with the standard of care and with informed consent of patients and their parents or guardians. We are grateful to our providers for their dedication to their patients and their profession."

The clinic will continue to provide mental health treatment and education to clients under age 18 and treatment for those over 18 will not be affected, the statement said.

Washington University officials said they are working with patients and other families to find other providers for existing patients affected by the decision. A spokeswoman did not say whether those providers would be within the BJC System or at other Washington University facilities.

The clinic became the center of a controversy about transgender health care for minors earlier this year after former caseworker Jamie Reed claimed in an op-ed for the online publication The Free Press and a sworn affidavit that providers were treating transgender kids too hastily and without their best interests in mind. Some families that received care there pushed back against Reed's account.

Andrew Bailey, newly appointed Missouri Attorney General, is welcomed on Tuesday, Jan. 3, 2023, during his inauguration at the Missouri Supreme Court in Jefferson City.
Brian Munoz
St. Louis Public Radio
Missouri Attorney General Andrew Bailey is welcomed in January 2023 during his inauguration at the Missouri Supreme Court in Jefferson City. On Monday, Bailey sought to take credit for Washington University's self-imposed restrictions on gender-affirming care for minors.

Missouri Republicans have argued there is a lack of science supporting gender-affirming procedures.

Attorney General Andrew Bailey on Monday sought to take credit for Wash U’s change in direction.

“Washington University has ceased all prescription of puberty blockers and cross-sex hormones to children after a law that my office successfully defended in court went into effect two weeks ago,” he wrote on the social media platform X, formerly known as Twitter.

The American Academy of Pediatrics, the Endocrine Society, the American Medical Association and dozens of other professional medical organizations support age-appropriate gender-affirming care.

The university’s decision left parents of minors being treated at Wash U scrambling to find care, said Susan Halla, president of Transparent, an advocacy and support group founded in St. Louis for families of transgender people.

“This is forced detransition, which is medically dangerous,” she said. “The politicians are now playing God with children.”

“The politicians are now playing God with children.”
Susan Halla, Transparent president

Members of the national Transparent group later this week are meeting with other families in the region to discuss options for care with representatives from the Wash U clinic, she said.

“This is a punch to the gut,” said Rori Picker Neiss, the mother of a child who has received care at the Washington University clinic. “All I can think about is how difficult this year has been fighting the legislation in Jefferson City. … It felt like, not that things were good, but we had a little reprieve. I didn’t know what January was going to bring, but we felt like we were safe for a little bit.”

Picker Neiss said she’s struggling with the news and preparing to tell her child.

“Finding this out today has just contributed to this feeling that I kept having all this year — that you just never know where the hits are coming from," she said.

Sarah Fentem is the health reporter at St. Louis Public Radio.