Washington University Transgender Center announced that it would stop providing puberty blockers and hormone therapy to transgender minors under Missouri’s recent restrictions to gender-affirming care. 

While the new law includes a provision that allows minors that had been receiving care before August 28, 2023, to continue to get it, it also gives patients grounds to sue for medical malpractice for up to 15 years following treatment or until their 21 birthday, whichever falls later. Missouri law usually provides patients receiving other medical care with two years in which to bring similar actions. 

According to the Center, “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 Center will now refer patients under the age of 18 to other providers while continuing to make therapeutic support and educational resources available to all age groups. 

Following New York Times reporting on Jamie Reed’s claims about the Washington University Transgender Center, Sen. Josh Hawley called for a “fresh evaluation” of the clinic. 

SB 49, which bans trans youth from accessing gender-affirming care in Missouri, took effect. The law also prohibits the state’s Medicaid program from covering gender-affirming care for people of any age. 

St. Louis Circuit Judge Steven Ohmer refused to grant an injunction in a lawsuit against Missouri’s gender-affirming care ban. While the suit, which has been brought by a number of civil rights groups including the ACLU, continues to move forward, the ban will take effect on August 28 as the legislature initially intended. 

The New York Times published an article about Jamie Reed’s whistleblowing, reporting that “some of Ms. Reed’s claims could not be confirmed, and at least one included factual inaccuracies,” while still lending her credence. Bari Weiss claimed that the story “confirmed” Reed’s account, while Assigned Media’s Evan Urquhart noted the piece only gave that illusion to those who are unfamiliar with the situation.

In response to criticism over her conscription of an anti-LGBTQ lawyer in February, Reed told the paper that she had become more conservative because of gender-affirming care, saying, “I support a national moratorium on the medicalization of kids,” parroting now-common right-wing rhetoric.

The Times also reported that Reed’s 2022 performance evaluation said she “responds poorly to direction from management with defensiveness and hostility.” This detail is consistent with Jennifer Dault’s March 14 story of Reed blocking her from receiving clinic resources for her child.

Moreover, one parent named Heidi told the New York Times that Reed had “twisted” her child’s story in the February affidavit. Her daughter suffered from liver damage while taking the testosterone blocker bicalutamide, and while this is a rare side-effect of the drug, she also had other comorbidities and took medications that exacerbated the risk. In response to the situation, Heidi said, “In our world, it’s like a P.R. nightmare,” referring to internal family conflict over gender-affirming care. Reed, however, spun her statement as a vague threat of a lawsuit in page 19 of the affidavit.

“My daughter’s situation was exploited,” Heidi told the Times.

 

Outlets from St. Louis Public Radio to the Associated Press reported that hearings would soon be held to decide if the state’s ban on youth gender-affirming care would be upheld while challenges to the ban are assessed in court. Without judicial action, it is still slated to take effect on August 28.

According to AP reporting, plaintiffs argued that the law unconstitutionally discriminates against trans people “by denying them medically necessary care and insurance coverage because of their sex and because of their transgender status.” This tactic was successful in Georgia just days prior.

Lawyers for the state claimed that the law is not discriminatory because it “applies evenly to boys and girls” and that it does not bar hormone replacement therapy in all situations, but only its use as an “experimental response to gender dysphoria.”

The claim that gender-affirming care for youth is experimental because it is “off-label” is misleading; “off-label” use means the FDA has not approved a specific drug for a specific treatment in a certain population, which is common in pediatric medicine.

Gov. Mike Parson signed legislation banning minors — and some adults — from accessing gender-affirming care in Missouri.

Senate Bill 49 blocks trans youth from accessing puberty blockers, hormone therapy, and gender-affirming surgery, although it does include exceptions for patients already receiving care. The legislation also denies adults seeking any kind of gender-affirming care through Medicaid, as well as prisoners and inmates seeking gender-affirming surgery. 

The legislation will take effect on August 28, but is set to expire in four years. 

St. Louis Mayor Tishaura Jones signed an executive order that “calls for city agencies to pursue policies that will reduce the impact of transgender laws restricting gender-affirming care and sports participation passed earlier this month by Missouri lawmakers.” The order was drafted following discussions with LGBTQ advocates about how state legislation would impact their daily lives. 

Missouri Attorney General Andrew Bailey responded to Chief Graves’ statement by promising to take “any legal action necessary,” against Kansas City if they do not enforce the impending restrictions on gender-affirming care. The restrictions, which have been sent to Gov. Mike Parson’s desk, have yet to be signed by the governor despite expectations that he will do so. 

According to The Washington Post, Kansas City is the only city in the state whose Board of Police is composed of the mayor and members appointed by the governor. Bailey argued that the board is therefore under the control of the state, rather than the city.

Kansas City Chief of Police Stacey Graves released a statement aligning the police department with the city’s recent resolution to provide “sanctuary for people seeking or providing gender-affirming care.” Graves argued that the enforcement of the looming state restrictions on gender-affirming care would be “outside the jurisdiction of the Kansas City Missouri Police Department,” given that “the provisions do not pertain to criminal conduct, but rather seeks enforcement through medical licensing and civil action.” 

Attorney General Andrew Bailey withdrew the emergency rule that would have severely restricted gender-affirming care for both minors and adults in Missouri. In a later statement, Bailey claimed that he had merely been “standing in the gap,” arguing that the emergency rule was no longer necessary now that legislation banning minors from starting gender-affirming care is expected to be signed by Gov. Mike Parson. 

According to the St. Louis Post-Dispatch, the move was “not unexpected,” given Bailey's initial losses in the legal challenges brought against the rule and inconsistent public support from his Republican colleagues.  

Kansas City officials voted 12 to 1 to make the city a “sanctuary for people seeking or providing gender-affirming care.” The resolution promises to make enforcing restrictions on gender-affirming care that may be required by the state “their lowest priority.” 

The Missouri House sent a proposed ban on gender-affirming care for youth to the governor's desk, where he is expected to sign it into law. 

Meanwhile, a committee of the Kansas City Council approved a resolution that would make the city a sanctuary for those seeking gender-affirming care. If approved by the full council, the resolution would promise not to “prosecute or fine any person or organization that seeks, provides, receives or helps someone receive gender-affirming care such as puberty blockers, hormones or surgery,” potentially giving transgender people in Missouri an opportunity to continue accessing gender-affirming care regardless of the state’s intervention. 

Judge Ribaudo postponed the date of the hearing in the case brought against the attorney general’s emergency rule until July 20, following a “joint request from both sides.” 

Correspondingly, the date of the emergency rule’s potential implementation has been postponed until at least July 24, “or until the Judge rules on whether to grant a preliminary injunction.” If granted, the preliminary injunction would stay the rule until the end of the case, by which point the legality of the attorney general’s limitations on gender-affirming care will have been decided.

Judge Ribaudo granted the request for a temporary restraining order on Attorney General Bailey's emergency restrictions of gender-affirming care. The rule, which would otherwise have taken effect at 5:00 pm on May 1, has now been stayed until May 15. 

Having obtained a temporary restraining order, the lawsuit brought by the ACLU of Missouri, Lambda Legal, and Bryan Cave Leighton Paisner will have its first hearing on May 11. Following this hearing, the court will decide whether to place a temporary injunction on the attorney general’s emergency rule for the remainder of the trial period or whether the severe restrictions on gender-affirming care will be allowed to take effect in the state even as their legality is being determined.  

Missouri Gov. Mike Parson threatened to call a special session in order to ensure that gender-affirming care would be banned in the state. The regular session, which ends on May 12, has already seen a version of a gender-affirming care ban pass both the House and the Senate, but the chambers have yet to debate a unified piece of legislation. 

Implementation of Attorney General Andrew Bailey’s emergency rule was halted by a judge until at least May 1 after a game of legal hot potato between federal and state courts.

Bailey filed a motion to move to the ACLU, Lambda Legal, and Bryan Cave Leighton LLP petition for a temporary restraining order of his emergency rule to federal court. Bailey’s motion, which was filed hours before the petition was scheduled to be heard in state court, was described by Lambda Legal attorney Nora Huppert “as an attempt to draw out the legal process” and ensure that the new regulations on gender-affirming care would take effect, as initially planned, on April 27. 

However, a federal judge quickly remanded the petition back to a Missouri state court, where Judge Ellen Ribaudo “issued a ruling to temporarily stay the implementation” of the regulations. According to the ACLU of Missouri, “The stay was issued to permit the court time to more fully consider” plaintiffs’ request for a formal temporary restraining order. 

The attorney general’s order on gender-affirming care is now dated to take effect on May 1, by which point the court intends to have ruled on the request for a temporary restraining order. If the temporary restraining order is granted, the court will then further delay the attorney general’s rule in order to consider the case filed against it before any new regulations take effect in the state. 

Also on April 26, according to the Missouri Independent, self-described whistleblower Jaime Reed visited the Missouri State Capitol to speak in favor of the proposed bans on gender-affirming care for minors. 

Lambda Legal, the ACLU of Missouri, and Bryan Cave Leighton LLP announced that they had “filed a petition seeking a temporary restraining order to block implementation of the Missouri Attorney General’s unprecedented and extreme restrictions on gender affirming care for trans people of all ages in the state,” scheduled to take effect on April 27. 

The Missouri Independent also reported that Reed had reaffirmed her “allegations of misconduct” toward the Washington University Transgender Center after an internal investigation found that hormone therapy was given to less than half of its patients. Reed claimed that the numbers reported in the probe’s findings did not align with those she had secretly compiled as an employee of the clinic and dismissed the restated standards of care, arguing the World Professional Association for Transgender Health is an “advocacy organization.” Reed also claimed that changes made to internal procedures at the clinic following the results of the internal investigation confirmed the “validity” of her accusations. A Washington University spokesman said that the Transgender Center “stands by its conclusions.” 

After an internal probe, Washington University found Reed’s allegations against the Transgender Center to be “unsubstantiated.” The university determined that the clinic’s physicians “adopted appropriate policies and procedures to treat patients according to the currently accepted standard of care” as defined by both the World Professional Association for Transgender Health and the Endocrine Society.

The report also disproved Reed’s allegation that the “majority” of patients received hormone therapy without mental health treatment; per the university, less than half of the clinic’s patients receive hormone therapy, and patients under 18 require an “appropriate mental health assessment” and a letter of support from their mental health provider before initiating further interventions.

A spokesperson for the Missouri attorney general told the Washington Blade that a web form encouraging people to report gender transition interventions in the state had closed after an influx of false reports and attempts to “hack our system.”

The Associated Press reported that on April 14, Kansas City-based Children’s Mercy Hospital filed suit against Attorney General Bailey. The hospital said it was suing Bailey in response to 54 “burdensome” requests for records regarding gender-affirming care, even though the hospital faces no allegations of wrongdoing.

According to the filing, Bailey requested information on prescriptions of hormone blockers and administration of gender-affirming surgeries, as well as instances when the hospital reported child abuse.

Missouri Attorney General Andrew Bailey released the language of the “emergency rule” concerning gender-affirming care in the state. As promised, the regulation severely restricts gender-affirming care under the claim that “gender transition interventions lack a solid evidentiary foundation.” According to the Office of the Missouri Attorney General, the “emergency regulation becomes effective April 27, 2023, and expires February 6, 2024.”

Lambda Legal and the American Civil Liberties Union of Missouri released a statement “reassuring the transgender community of Missouri that they will take any necessary legal action against Attorney General Andrew Bailey’s emergency regulation restricting access to gender-affirming care.” The statement argued that the rule “ignores the overwhelming body of scientific and medical evidence supporting this care as well as the medical experts and doctors who work with transgender people every day,” and both organizations urged “any person being affected by this regulation” to contact them for “more information on their legal rights.” 

Media Matters found that the account allegedly belonging to Caroline had been deleted. 

The alleged child at the center of the Yoffe story posted that they and their father were likely “going to be facing very powerful lawyers in court soon” and linked to a GoFundMe for legal fees, though they did not not clarify who they would be fighting in court. The fund raised more than $18,000, nearly double the original goal.

The Associated Press reported that Missouri Planned Parenthood was suing the attorney general over the inquiry into trans health care, which included an investigation of care provided by the organization. 

Also on April 4, an account claiming to be the child discussed in Yoffe’s article countered some of its claims and wrote, “My real name is Alex but my mom decided it would be best to hide it for anonymity. But this is my story, not hers. This is not the free press’s story.”  

An account claiming to be the mother quoted in Yoffe’s piece responded, tweeting: “I am Alex's mother. Please do not harrass my child. Any questions that you have, you can ask me. Alex, you are very welcome to say how you feel, and I encourage that.” The two accounts engaged in a public back and forth in the comments. 

The Daily Dot published an article about the tweets, followed by more coverage from other left-leaning outlets.

Journalist Emily Yoffe relayed the account of Caroline, a parent of a Center patient, in an article titled “‘I Felt Bullied’: Mother of Child Treated at Transgender Center Speaks Out” that was published in The Free Press. Weiss publicized the article on Twitter. The piece, which deliberately misgenders the child, glosses over the mother’s underlying lack of support for her child’s identity, revealed when she dismissively stated in an email, “[They’re] not transgender. [They’re] a 15 year old child.”

Amid a legislative session with multiple bills targeting LGBTQ people and trans health, the Missouri attorney general announced emergency regulations that would strictly limit gender-affirming care, claiming to be protecting children from “inhumane science experiments.” 

A press release described stringent regulations on the false grounds that gender-affirming care is experimental and trans identification is socially contagious. The new rules indicated that a mandatory screening for autism and confirmation that “existing mental health comorbidities … have been treated and resolved” would be required before allowing treatment. Research finds that mental health issues in trans youth such as anxiety and depression are alleviated by gender-affirming care.

Jennifer Harris Dault, a pastor whose trans daughter was a patient at the Center, claimed that Reed had blocked clinic resources when advising on how to educate her transgender child. 

Singal published a second piece about Reed’s claims. Several accounts on Twitter accused him of violating the Health Insurance Portability and Accountability Act of 1996, although journalists are not referred to under the regulation and Reed could potentially be protected as a whistleblower working within a state investigation. However, following this backlash, Singal suspended his account. 

Some, including journalist and podcaster Michael Hobbes, questioned whether Reed had contradicted herself in some of her statements to Singal, specifically regarding the amount of therapeutic care patients were given before beginning medical treatments.

Following the pushback on Reed’s claims, investigative journalist Jesse Singal and commentator Jonathan Chait took interest in her case. Singal reached out to the whistleblower to corroborate her story and published further details of her account. 

He also questioned the scrutiny of Reed’s claims, arguing that the reporting of the Post-Dispatch had “badly misinformed readers” about Reed’s role and her relationship with Jess Jones, another former employee the Post-Dispatch quoted as refuting Reed’s claims. Singal also argued that the coverage had neglected to mention that one of the parents who was outspoken in favor of the Center was also a professional advocate for transgender youth.  

The St. Louis Post-Dispatch published an article reporting that “almost two dozen parents of children seen at the clinic, which opened in 2017, say their experiences sharply contradict the examples supplied by Jamie Reed.”  

While right-wing media uncritically spread Reed’s claims, the Post-Dispatch and other local outlets spoke with parents and patients who described a very different perspective on the Center and the treatment provided there. Danielle Meert, whose child was treated at the Center, said that “her family’s interaction was nowhere near” what Reed described. 

The St. Louis Post-Dispatch reported critics’ claim that the “choice of lawyers for whistleblower at St. Louis transgender clinic taints her motive.”

On Twitter, queer researcher Erin Reed and Harvard instructor Alejandra Caraballo pointed out Reed’s ties to the right-wing anti-trans movement. They noted that Reed’s legal counsel was Vernadette Broyles, the executive director of the Child and Parental Rights Campaign, a notable anti-LGBTQ organization involved in recent anti-trans legislative efforts across the country. Broyles is also an allied attorney with the extremist group Alliance Defending Freedom, another force behind several current anti-LGBTQ legal efforts as well as the current effort to ban the abortion medication mifepristone.

In an article published by The Free Press, former caseworker Jamie Reed described the patients for whom she completed intake and oversight at the Washington University Transgender Center, and alleged medical misconduct. Her descriptions include graphic details from patients’ medical, social, and sexual histories, as well as emails sent to, from, or about her clients. 

Sen. Josh Hawley (R-MO) and Missouri Attorney General Andrew Bailey announced investigations into the Transgender Center. A letter from Reed to the state attorney general and her sworn affidavit completed in cooperation with the state investigation relayed information mirroring that of the Free Press article.