2 Universities Halt Treatment for Trans Youths

Two university-affiliated hospitals in Missouri have stopped providing certain forms of gender-affirming care for transgender children, including current patients, exceeding the requirements of a new law that restricts such care for trans youths and some adults.

The Washington University Transgender Center at St. Louis Children’s Hospital, which is run by Washington University in St. Louis, announced that it would stop prescribing “puberty blockers or cross-sex hormones to minors for purposes of gender transition,” according to a Sept. 11 statement. It will refer current patients to other providers. University of Missouri Health Care will do the same, according to an Aug. 28 report by KOMU, a TV news station in Columbia, Mo.

Both will continue offering mental health services and other care that is not prohibited by the law, SB 49, which forbids medical professionals from performing gender transition surgeries or prescribing cross-sex hormones or puberty blockers for individuals under 18. The legislation was passed May 10 and went into effect Aug. 28.

But the law does not apply to minors who were already receiving treatment prior to Aug. 28, meaning MU Health and WUTC could have continued treating existing patients. Both institutions cited a provision in the law that allows patients of such care to sue their doctor for malpractice for up to 15 years after they received care or 15 years after they turn 21.

“We are disheartened to have to take this step,” Wash U officials wrote in their statement. “However, Missouri’s newly enacted law regarding transgender care has created a new legal claim for patients who received these medications as minors. 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 decision by the two institutions marks the latest point of contention between health-care providers and transgender patients and their families. Earlier this summer, two patients at Vanderbilt University Medical Center’s transgender clinic sued the institution for turning over records to Tennessee attorney general Jonathan Skrmetti. The university contends that it was required by law to provide the documents; the patients argue that identifying information should have been redacted at a time when the state is pushing for “some of the nation’s most anti-LGBTQ restrictions,” the Associated Press reported.

A Polarizing Issue

When the Missouri bill went into effect, state attorney general Andrew Bailey, a Republican, contacted health-care providers to remind them of the law’s provisions, cautioning against starting new patients under the age of 18 on what he called “experimental” medical treatments, though the use of puberty blockers, which are also used to treat children who reach early puberty, dates back to the 1980s. Transgender adults have been prescribed cross-sex hormones since the 1970s.

Banning transgender medical care, especially for children and teens, has become a major political talking point for Republican lawmakers, who argue that minors are too young to make the decision to receive what opponents have called “harmful, irreversible, and unnecessary medical procedures.” According to the Human Rights Campaign, an LGBTQ+ advocacy group, 22 states have banned gender-affirming care for minors.

But research has shown that gender-affirming medical care can improve mental health outcomes for trans kids. In 2018, the American Academy of Pediatrics recommended “providing youth with access to comprehensive gender-affirming and developmentally appropriate health care” and recently reaffirmed that stance. Multiple studies have shown that gender-affirming surgeries lead to extremely low rates of patient regret across all age groups.

WUTC, specifically, found itself at the center of the political firestorm earlier this year when a former employee alleged that the center had failed to inform patients of potential side effects of treatment. An internal investigation by the center disputed the claims, as did several former WUTC patients and their parents, who were interviewed by The Missouri Independent, a nonprofit news site that has covered the controversy closely.

As a result of the claims, the center is the subject of an ongoing investigation by multiple state agencies.

Conservatives have celebrated the decision by WUTC and MU Health Care to stop offering puberty blockers and cross-sex hormones to current patients under 18.

Mat Staver, founder and chairman of Liberty Counsel, an evangelical Christian law firm based in Florida that has taken aim at LGBTQ+ rights in the past, said in a statement, “Many states are putting a stop to these so-called gender clinics and their harmful acts. These unnecessary medications and mutilating procedures irreversibly harm children. States must protect minors from these quack facilities.”

But LGBTQ+ advocacy groups have criticized the universities for turning their backs on patients who need them, arguing that they may struggle to find care elsewhere.

“The University of Missouri and Washington University made a choice to place politics and fear of politicians above the patients and families they serve by discontinuing to provide the evidence-based care supported by nearly every major medical organization,” wrote a spokesperson for the ACLU of Missouri in an email to Inside Higher Ed. ACLU Missouri is one of three legal groups currently suing to block SB 49; a judge denied their request for a preliminary injunction. “The cowardly decision to extend the ban on care in SB 49 beyond its existing limitations and to block all care for all adolescents, including those who have already begun treatment that they can continue to receive under the law, betrays the patients that have placed their health in the hands of these facilities.” (This paragraph has been updated to clarify the status of the lawsuit over SB 49.)

The spokesperson also called out lawmakers for their apparent lack of care for the well-being of the clinics’ patients.

“Politicians proved their promises were empty, allowing the suffering and cruelness to fall additionally on those who were already receiving care, despite their claims of a grandfather clause,” the email read. “These bills have never been about protecting anyone but rather erasing transness.”

In a Sept. 12 statement, PROMO, a Missouri-based LGBTQ+ public policy and advocacy organization, echoed the ACLU’s sentiment, criticizing the court for failing to grant a preliminary injunction against the law.

“St. Louis Circuit Court Judge Steven Ohmer said in his order there was not a ‘sufficient threat of irreparable injury absent injunctive relief,’” Shira Berkowitz, PROMO’s senior director of public policy and advocacy, said in the statement. “The hundreds of patients across the state who, in just two weeks, have lost access to life-saving, medically necessary healthcare prove that point invalid.”