Overview

In February 2023 Jamie Reed, a former case manager at the Washington University Transgender Center at St. Louis Children's Hospital, made public a set of allegations about the clinic's care of minors. She made them in a sworn affidavit to the Missouri Attorney General (AG) and in a first-person essay in The Free Press. She said that puberty blockers and cross-sex hormones were given to children with serious untreated mental health problems, that parents were pressured into consenting, that families were told little about side effects, and that nobody tracked patient outcomes (Reed affidavit, Missouri AG).

The case became one of the best-known whistleblower disputes in American youth gender medicine, and its facts are still contested. Washington University's internal review, published in April 2023, called the allegations "unsubstantiated". Dozens of patients and parents told local reporters that her account did not match their experience. The New York Times reported that some of her claims were corroborated and that at least one contained factual inaccuracies. Reed's account fed into Missouri's 2023 law restricting medical transition for minors. In 2024 she testified in defence of that law, and the trial judge found her credible.

For the wider set of cases, see the gender medicine scandals hub.

Background

The centre described itself as a multidisciplinary service covering endocrinology, adolescent medicine, psychology and psychiatry. Reed's affidavit says she worked there as a case manager from 2018 until November 2022, handling intake and triage. She then moved to another job inside Washington University. She also says she took the job because she supported trans rights and wanted to give good care to children who were appropriate candidates for medical transition (Reed affidavit).

Demand for the clinic's services rose sharply in those years. Reed said the centre got 5–10 calls a month when she started and more than 40 a month by the time she left. Washington University's own figures, released in April 2023, say 1,165 patients had sought care at the centre since June 2018. Of those, 531 received cross-sex hormones (some already had prescriptions when they arrived) and 67 received puberty blockers without hormones (WashU internal review).

The same rise was happening internationally. Clinics in the UK, Scandinavia and elsewhere were seeing more adolescents, more of them female, and more with other psychiatric conditions. That shift later led to the evidence reviews in England, Sweden and Finland. The UK's Cass Review (England's independent review of youth gender services) recommended that every young person referred be assessed holistically and screened for co-occurring conditions such as autism and mental illness (Cass 2024). A Finnish register study found that adolescents referred to gender services had about three times the specialist psychiatric treatment of matched controls before referral (Ruuska et al. 2026).

What Reed alleged

The affidavit runs to 86 numbered paragraphs. Everything below is Reed's account under oath. None of it has been tested in a proceeding about the clinic itself.

Mental health and assessment

• Comorbidities not treated. Reed said "nearly all" patients had serious co-occurring conditions such as autism, ADHD, depression, anxiety, PTSD, OCD or eating disorders. She said the centre's psychology and psychiatry services were advertised but almost never available for ongoing therapy. She described individual patients started on hormones despite severe OCD, a history of sexual abuse, or significant autism. She also described patients kept on hormones while their mental health got worse, including one who had stopped taking schizophrenia medication. See mental health and gender identity and autism.
• Letters on demand. She said the centre referred families to therapists it "knew would say yes", sent therapists template wording for support letters, and accepted letters after 1–2 hours with a patient.
• Effectively automatic prescribing. She said that in more than four years she saw only two patients who met the clinic's four basic criteria (age or puberty stage, a therapist letter, parental consent and a one-hour medical visit) and were not prescribed.
• Social contagion. She said referrals rose sharply and that some children said they had learned their identities from TikTok. She also said doctors dismissed self-diagnosed tic disorders and dissociative identity disorder as social contagion but accepted gender identity claims without question. See social contagion and peer influence.

Consent and information

• Pressure on parents. Reed said clinicians told parents "You can either have a living son or a dead daughter" (or the reverse), sometimes in front of the child. See suicide and transition.
• No written consent. She said that throughout her time there the centre had no written informed-consent form. She said she was told not to ask for custody agreements, and that prescribing sometimes continued after a parent withdrew consent.
• Side effects understated. She said families were told puberty blockers were "fully reversible" and were not adequately warned about sterility. She also said one doctor prescribed bicalutamide, an anti-androgen that she said can damage the liver, and that one patient developed liver damage. See informed consent critique and puberty blockers.

Surgery, follow-up and billing

• Surgery referrals. Reed said clinicians had told the Missouri legislature that surgery was "not an option for anyone under 18", but that the centre gave minors surgeons' contact details and that at least one minor had transition surgery at St. Louis Children's Hospital.
• No outcome tracking. She said the centre would not systematically track detransition, suicide attempts or adverse events, and discouraged her own attempts to do so.
• Billing. She said she had heard staff describe coding puberty blockers as treatment for precocious puberty when patients did not have that condition.

In the Free Press essay, published on 9 February 2023, Reed called what she had seen "morally and medically appalling" and called for a moratorium on hormonal and surgical treatment of young people with gender dysphoria (The Free Press).

Responses from the university and hospital

February 2023. On the day the essay appeared, Washington University said it was "alarmed" by the allegations and began a review. Together with St. Louis Children's Hospital it set up an oversight committee to review the centre's activities every week (KSDK).

April 21, 2023: internal review. After more than eight weeks, the university concluded that "allegations of substandard care causing adverse outcomes for patients at the Center are unsubstantiated". It said staff followed the standards of care recommended by the American Academy of Pediatrics, the World Professional Association for Transgender Health (WPATH) and the Endocrine Society. Its main findings were:

• Interviews and a records review "identified no patients who had adverse physical reactions caused by medications prescribed by Center providers."
• A letter of support from a licensed mental health provider was required before blockers or hormones, and "most patients had ongoing relationships with mental health providers." (WashU internal review)
• The centre had banned surgical referrals for minors in late 2018. Families were sometimes given surgeons' names on request, and the university identified six chest surgeries on adolescents by Washington University surgeons since 2018. It said these came from other providers or from the patients themselves, not from Center referrals.
• Parental consent had been obtained verbally and documented. Even so, the university said it would now require specific written consent before prescribing and custody documents before a first visit. It said these changes did not stem from any departure from accepted practice (WashU internal review).

The review did not interview Reed, a point later raised by critics (see below). The attorney general's office said the university's assertions "don't line up with what we've uncovered so far" (AP).

September 11, 2023: medications for minors stopped. Missouri's SB 49 took effect on 28 August 2023. It let minors already on treatment continue, but it gave patients treated as minors years longer to bring malpractice claims. The university announced that its physicians "will no longer prescribe puberty blockers or cross-sex hormones to minors for purposes of gender transition", including existing patients. It said the law had "created a new legal claim for patients who received these medications as minors" and that the resulting liability was unsustainable. Education, mental health support and adult care continued (WashU statement; Insight Into Academia).

July 2024: dispute over closure. In a St. Louis Post-Dispatch op-ed, Reed wrote that the pediatric centre would close permanently. A university spokesperson said the centre was still offering the care minors could legally receive (St. Louis Public Radio).

Investigations, legal and regulatory outcomes

The attorney general's inquiry was brought under the Missouri Merchandising Practices Act, the state's consumer-protection law. It is a pre-suit investigation, not a prosecution. The Missouri Division of Professional Registration, which licenses health professionals, also opened an inquiry. Records obtained by the Missouri Independent showed that the division had interviewed 57 health professionals and had 16 cases open as of May 2024 (Missouri Independent via Los Angeles Blade). We found no public outcome from either inquiry.

The 2024 trial and the credibility finding

At the trial over SB 49, Reed testified as a fact witness about her time at the centre. Under cross-examination, the plaintiffs' lawyers focused on patient privacy. Reed had given the attorney general a 23-page document listing patients by medical record number, plus a "red flag" list of 27 patients identified by name. She had given a New York Times reporter around 300 pages of documents that she described as redacted. One former patient testified that the affidavit described them closely enough that friends and family could identify them, although they had never had an appointment with Reed (Missouri Independent via STLPR).

In his 74-page ruling of 25 November 2024, Judge Carter upheld the law. He found the plaintiffs' supporting evidence to be of "low" or "very low" quality and described "an almost total lack of consensus as to the medical ethics of adolescent gender dysphoria treatment." On Reed he wrote:

Her testimony does not arise from any ideological or other bias. — Judge R. Craig Carter, Cole County Circuit Court, 25 Nov 2024 (KCUR)

The judge supported that finding with a reference to Reed's family circumstances. Lambda Legal, which represented the plaintiffs, said the ruling largely copied a brief submitted by the state (Lambda Legal). The finding was about Reed's credibility as a witness in a constitutional challenge to a statute. It was not a ruling on whether the clinic broke the law.

Another court weighed her evidence differently. In May 2026, a Kansas district judge blocked that state's ban on medical transition for minors. Reed's affidavit was submitted there but she did not testify. According to Erin in the Morning, a trans advocacy outlet, the ruling gave the affidavit "little weight" because Reed is not a medical or mental health professional and her account concerned a clinic outside Kansas (Erin in the Morning).

The records fight

The appeals ruling of 16 September 2025 rejected the attorney general's claim to be a "health oversight agency" under HIPAA, the US health-privacy law. It left open a law-enforcement route and sent the case back to the trial court. That court must decide whether the investigation could make do with de-identified data and must manage any disclosure through tools such as in-camera review (private examination by the judge). The court wrote:

This Court is very mindful of the breadth and depth of the Attorney General's requests to examine 1,165 minor patients' most personal medical information. — Missouri Court of Appeals, Eastern District (Washington University v. Hanaway)

The ruling also records that the centre had at first given the AG's office remote, read-only access to its electronic records before changing its position (Post-Dispatch). We found no public report of the remand proceedings or of any findings as of October 2026.

Significance and wider impact

• Legislation. Reed's affidavit was cited repeatedly while Missouri lawmakers debated SB 49. Missouri Independent reporting describes it as the root of the attorney general's probe and of the legislative push (Missouri Independent). The New York Times reported that lawmakers in Missouri and other states pointed to her allegations as they passed bans (NYT). Amicus briefs to the US Supreme Court in United States v. Skrmetti (2024) cited her account too (Skrmetti amicus brief).
• A model for insider testimony. Reed was one of the first US gender-clinic staff to go public under oath. The 2025 US Department of Health and Human Services (HHS) review of pediatric gender dysphoria treatment includes her in a section on whistleblowers (HHS review). She went on to co-found and lead the LGB Courage Coalition, which campaigns against medical transition for minors (Queer Majority).
• Clinic practice. The university's own review led to written consent and custody checks. These are the procedural gaps Reed had complained about, though the university said they were not departures from the standard of care.
• Outcome tracking. Her claim that clinics do not know how many patients detransition matches a wider methodological criticism: reported detransition rates rely on short follow-up and heavy loss to follow-up, so the true rate is unknown (Cohn 2023).

Criticisms of how the case has been framed

Both supporters and critics of Reed have been accused of overstating what the record shows.

Against Reed's account:

• Families and patients. The Missouri Independent and the St. Louis Post-Dispatch spoke with numerous former patients and parents. New York Magazine counted at least 20 people contradicting her key claims. Several described waits of months and multiple visits before treatment (Missouri Independent; New York Magazine). A former colleague, the centre's educational coordinator from 2018 to 2020, said the affidavit did not match what they saw. FAIR, a progressive media-criticism group, reported that Reed declined to be interviewed by either local outlet about the discrepancies (FAIR).
• The bicalutamide case. The family of the patient in Reed's liver-damage example told the St. Louis TV station KMOV that the affidavit misrepresented their child's care and their message to the clinic (KMOV). Erin in the Morning (advocacy) reported that the family linked the liver injury to a COVID medication rather than to bicalutamide (Erin in the Morning). The affidavit also says bicalutamide's approved use is for pancreatic cancer, but it is licensed for prostate cancer.
• Patient privacy. At trial, families objected that identifiable details of their children's care had been shared with the attorney general and a journalist without their consent (see above).
• Trans advocacy outlets such as Assigned Media argued that the New York Times overstated how far her claims were corroborated (Assigned Media).

Against the clinic's and critics' framing:

• The internal review. City Journal, a conservative outlet, noted that the university never interviewed Reed. It argued that a review by the institution under investigation could not settle the matter and called for an independent inquiry (City Journal).
• Partial corroboration. The New York Times found that some claims could not be confirmed and at least one was inaccurate, but that "others were corroborated". It reported that, with its psychologists overbooked, the clinic relied on outside therapists, some with little experience in gender issues. It also interviewed patients and parents who were positive about their care (NYT; National Review).
• Who was interviewed. Journalist Jesse Singal argued that the local stories mostly reflected satisfied families who came forward on their own and so could not rebut claims about particular patients (Singal).
• The university's admissions. The review's own figures show six adolescent chest surgeries by university surgeons after a 2018 internal ban on referrals. It also confirms that written consent and up-front custody checks were not in place before 2023. Both points support parts of Reed's description, even though the review rejected her conclusion that patients were harmed.

Several things are still not publicly known: what the attorney general's office found in the records it already holds, whether any individual patient described in the affidavit was harmed as Reed said, and how many of the centre's former patients have since detransitioned.

What detransitioners say

Detransitioners on /r/detrans did not see the clinic's patient records. What they offer is their own experience of the practices Reed described: brief assessments, unaddressed mental illness, suicide warnings given to parents, and clinics that lost track of them. Their accounts come from many clinics and countries, not from St. Louis.

On the "living son or dead daughter" line Reed described, several commenters say they heard it themselves:

I was in the room when my endocrinologist said to my parents "would you rather an alive daughter or dead son." It's such a dangerous statement, especially in front of the child. —Even_Discipline_7474, socially trans, regrets entire transition

I was told by the doctor at the gender clinician, essentially, that I should do this or I might end up killing myself, and they used that old same threat on my dad too, saying "would you rather have a dead daughter or a living son?" it's highly emotionally manipulative —shadowthehedgehoe, detrans

On mental health problems being overlooked:

I was so worried that they would be concerned about the fact that I was literally testifying in court against someone who raped me, had an eating disorder, had a history of depression and suicide attempts, had severe lifelong anxiety and panic attacks but they weren't concerned about these things at all. —Admirable_Treacle_97, detrans female

I was prescribed estrogen and puberty blockers when I was 16. Only two hour long appointments with a psychiatrist at Children's hospital then I was given the green light to start hrt. … I was hospitalized when I was 14 for suicidal ideation and severe self harm. … Somehow none of this was ever looked into. —Dear-Shift-7636, detrans male

One young commenter responded in the r/detrans thread that discussed Reed's essay when it was published:

I got top surgery at 16 despite NEVER speaking to an "actual" therapist. I spoke to one at the clinic for all of 10 mins and I got a letter. Now I'm 18 and my voice and body are permanently altered. —insane_taco, questioning own gender transition

On outcome tracking, a recurring theme is that clinics never learn who stops:

I never talked to the doctor at the gender clinic ever again after I stopped hormones so how would they even know I detransitioned? —Lurkersquid, detrans female

Many also see a double standard in whose testimony is believed. One commenter put it in a single line: "Interesting how trans youth should be believed, but detrans youth should not" (Outrageous_Proof_812, detrans female). These accounts do not prove what happened at Washington University. They show that the practices Reed described are familiar to many people who went through youth gender services elsewhere.

Trans perspectives

Many trans people and families of trans youth in Missouri experienced the case mainly through the law it helped pass. The families quoted by local reporters in 2023 said the centre had helped their children. When the university withdrew medications in September 2023, the Post-Dispatch reported that some parents were angry, having thought their children were safe there (Post-Dispatch coverage). One trans man who grew up in Missouri described crossing the state line to keep his care:

Missouri unfortunately banned care for transgender minors but I was able to go to the same doctor at a hospital in Kansas, and also got top surgery in Kansas. —Serious_Basket_6870, trans man (FTM)

Another trans man, in a different state, described being forced off testosterone when a state law ended insurance coverage:

When I was forced off T, I suffered so much. I was the most miserable I'd been in YEARS. —Odd-Wrangler-2855, trans man (FTM)

These experiences are real. They sit alongside the detransitioners' accounts above rather than cancelling them out. Both point to the same gap: no one has followed up the centre's patients systematically, so neither side can show how most of them are doing now. As the Cass Review argued, high-quality follow-up data would serve both groups (Cass 2024).

Related pages

• Gender medicine scandals and whistleblowers (hub)
• Informed consent critique
• Mental health and gender identity
• United States: law and policy
• Puberty blockers
• Suicide and transition
• Detransitioner lawsuits
• Evidence reviews
• Study archive and detransition statistics

References

• Reed, J. (2023). Affidavit of Jamie Reed, 7 Feb 2023. Missouri Attorney General. source.
• Reed, J. (2023). I Thought I Was Saving Trans Kids. Now I'm Blowing the Whistle. The Free Press, 9 Feb 2023. source.
• Washington University (2023). Washington University Transgender Center Internal Review: Summary of Conclusions, 21 Apr 2023. source.
• Washington University (2023). Statement on Washington University Transgender Center, 11 Sep 2023. source.
• Missouri Court of Appeals, Eastern District (2025). Washington University v. Hanaway, 16 Sep 2025. source.
• Supreme Court of Missouri (2026). E.N. v. Kehoe, SC100933, 13 Jan 2026. source.
• Missouri Attorney General (2023). Answer and Counterclaim, Washington University v. Bailey, No. 2322-CC09640. source.
• Senator Josh Hawley (2023). Hawley Outlines Investigation of Washington University Transgender Center. source.
• Associated Press (2023). Review finds no misconduct at Missouri trans youth clinic. source.
• KSDK (2023). Missouri attorney general launches investigation into St. Louis Transgender Center after whistleblower report. source.
• St. Louis Public Radio (2023). Missouri agencies launch investigation into health center for transgender youth. source.
• Hanshaw, A. / Missouri Independent (2023). Families dispute whistleblower's allegations against St. Louis transgender center. source.
• Missouri Independent (2023). Wash U alleges Missouri AG illegally sought patient records from transgender center. source.
• New York Magazine (2023). Whistleblower's Claims About a St. Louis Transgender Center Are Under Fire. source.
• Ghorayshi, A. / The New York Times (2023). How a Small Gender Clinic Landed in a Political Storm, 23 Aug 2023. source.
• National Review (2023). New York Times Confirms Jamie Reed's Claim That Adolescents Were Rushed Into 'Affirming' Care (conservative). source.
• City Journal (2023). Nothing to See Here (conservative). source.
• Singal, J. (2023). Journalists Are Exhibiting Far Too Much Credulousness Toward Jamie Reed's Critics. source.
• FAIR (2023). NYT Publishes 'Greatest Hits' of Bad Trans Healthcare Coverage (progressive media criticism). source.
• Assigned Media (2023). Jamie Reed's Allegations Are Not Even Partially Confirmed (trans advocacy). source.
• KMOV First Alert 4 (2023). Family says whistleblower made false claim of 'permanent harm to many patients'. source.
• Erin in the Morning (2023). Family of Missouri trans kid: Jamie Reed lied about liver damage (trans advocacy). source.
• Insight Into Academia (2023). Washington University Clinic Ends Gender-affirming Care for Minors. source.
• PBS NewsHour (2023). Missouri governor signs bill banning gender-affirming care for minors and some adults. source.
• FOX2 (2024). Missouri AG denied private records in WashU transgender center probe. source.
• Missouri Independent via Los Angeles Blade (2024). Missouri AG targets health care professionals over trans care. source.
• St. Louis Public Radio (2024). Is the Washington University Transgender Center shutting down? Here's what we know. source.
• Hanshaw, A. / Missouri Independent via STLPR (2024). Jamie Reed testifies in defense of Missouri transgender health care ban. source.
• KCUR / Missouri Independent (2024). Missouri judge upholds state ban on transgender health care for minors. source.
• Lambda Legal (2024). Court Upholds Missouri's Ban on Essential Health Care for Transgender Missourians (plaintiffs' counsel). source.
• Amicus brief in United States v. Skrmetti, No. 23-477 (2024). source.
• St. Louis Post-Dispatch (2025). Appeals court gives Missouri AG pathway to Transgender Center patient records. source.
• St. Louis Post-Dispatch. Coverage of the Washington University Transgender Center (collection). source.
• Missouri Independent (2025). How Missouri became a battleground over gender-affirming care. source.
• US Department of Health and Human Services (2025). Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices. source.
• Erin in the Morning (2026). Kansas Judge Eviscerates Anti-Trans "Experts"… (trans advocacy; quotes the Kansas ruling). source.
• Close Up Foundation (2026). Colorado and Missouri Vote on Medical Treatments for Transgender Minors. source.
• Ballotpedia (2026). Missouri Amendment 3 (2026). source.
• KRCG / Missouri Independent (2026). Transgender care takes center stage in Missouri campaign to reinstate abortion ban. source.
• Queer Majority. Jamie Reed (contributor biography). source.
• Cass, H. (2024). Independent review of gender identity services for children and young people: Final report. study page, source.
• Ruuska et al. (2026). Psychiatric Morbidity Among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019. Acta Paediatrica. study page, source.
• Cohn, J. (2023). The Detransition Rate Is Unknown. Archives of Sexual Behavior. study page, source.