A Washington University professor and UCLA researcher co-authored an article highlighting the importance of gender-affirming care for transgender youth as the University continues to investigate allegations of malpractice at the Washington University Transgender Center at St. Louis Children’s Hospital (the Center), Feb. 24.

Jeremy Goldbach, a Professor in Sexual Health and Education at Washington University, and Shannon Dunlap, a researcher at the University of California Los Angeles, published their article titled “Trans Kids Need Access to Evidence-Based Care” on the website of the Clark-Fox Policy Institute, which is part of the Brown School of Social Work.

They wrote their article in response to an opinion piece by Jamie Reed, a former case worker at the Center, called “I thought I was saving trans kids. Now I’m blowing the whistle,” in which Reed alleged malpractice at the Center, called for a moratorium on the Center’s services and voiced general opposition to the gender-affirming healthcare for transgender minors that the Center provides. 

Her opinion piece led the Attorney General of Missouri, Andrew Bailey, and the office of Missouri Senator Josh Hawley, to start investigations into the clinic. The University is also conducting an internal review of practices at the Center. These claims and subsequent investigations generated blowback from researchers and supporters of gender-affirming healthcare.

In their article, and in follow-up conversations with Student Life, Goldbach and Dunlap outlined their arguments against Reed’s article, and warned of the “myths” they argue are apparent in her writing. 

Neither Goldbach nor Dunlap have a direct relationship with the Center, but they have over two decades of cumulative clinical and research experience related to transgender and queer youth. 

Goldbach said they wanted to publish an article that provided context and research into the conversations about the investigation and gender-affirming health care more generally. 

“The opinions of one person should not supersede the collective experience of research, clinicians, and families themselves,” Goldbach said.

Their article also addressed the topic of detransitioning that Reed brought up in her piece. Goldbach and Dunlap cited a study in their piece by the American Society for Plastic Surgeons that found that “less than 1% of transmasculine patients and only 1% of transfeminine patients report feeling regret after gender affirmation surgery.” 

Goldbach believes “that it is important that there be a fair and balanced discussion about trans-youth care.” He said he “was concerned that the author of the original opinion piece was speaking exclusively from their personal experience as a caseworker, and leaving out the critical perspectives of researchers, clinicians, trans-youth, and their parents.”

“Perhaps the most concerning statement” in Reed’s article, Goldbach and Dunlap wrote, is Reed’s claim that “‘there are no reliable studies showing’ that if left untreated, gender dysphoria has consequences including self-harm and suicide.” They referenced studies which “show that access to affirming care reduces behavioral health problems among transgender youth.”

Goldbach said he wants the article to help provide scientific evidence to the conversation surrounding Reed’s piece.

“My concern is that people may not be taking the extra step, and just saying this is how I feel, but not thinking about what the actual science is saying,” he said. “People are not exploring this beyond their gut reaction.”

In an interview with Student Life, Dunlap questioned Reed’s qualifications to make the claims she wrote in her piece.

“There was a lot of speaking of confidential conversations that a case manager, or even me, a social worker, wouldn’t be privy to,” she said. 

Dunlap and Goldbach questioned Reed’s qualifications more at length in their article. They wrote that Reed’s background doing “intake work” does not give her the training or expertise to comment on the clinical decisions made by medical doctors, nurses, psychologists, social workers, and others with years of formal clinical training in transgender adolescent health.

The researchers’ article and interviews also emphasize that gender-affirming care is necessary even if it alone does not completely alleviate the mental health struggles of transgender and nonbinary individuals. 

“We cannot expect gender-affirming care to be the silver bullet where it is magically going to make everything 100 percent better,” Dunlap said. “A lot of these youth still live in communities with stigma, discrimination, and hate, gender-affirming care does not treat stigma, transphobia, hate, or discrimination.” 

Goldbach added that a few negative experiences at a medical office do not necessarily indicate a problem with its processes.

“In a clinic of this size with any specialty, it is not hard to find an email from an unhappy person or two,” Goldbach said. “That to me does not suggest that there is a systemic problem at the clinic.” 

Both researchers also said that discussing the Center and gender-affirming care based on the views of only one individual leaves out the key perspectives of transgender people.

“That article did not bring in the perspective of transgender youth and their families,” Dunlap said. “They became invisible in that article. The only thing that was visible was the lived experience of one person.”

Dunlap also responded to Reed’s claim that seeking out gender-affirming care became a kind of “social contagion” for some young people.

“Yes, we are seeing more visibility of trans and non-binary youth and young people, but that is a good thing because prior to the internet, a lot of families did not have representation in their own communities,” she said. “This is the first time that they have found someone who speaks to their own experience, and had that access to those people who can speak to their own experience.”

In addition to addressing the overall value of gender-affirming care, Goldbach directly addressed WashU and its handling of the ongoing investigation.

“I hope that the University will be slow and intentional about their internal investigation,” he said. “I want to make sure that we are not overly reactive or jumping to conclusions.” 

Dunlap also spoke to what she hopes to see for the future of gender-affirming care. 

“I want to see parents and youth being represented,” she said. “I want to see the research about gender-affirming care being represented. I do not want to see clinics closing because of a few powerful voices that are shining through.”