'it took a long time to become the thing I am to you"

Jamie Reed

Ever since The Free Press published my article about my experiences at the Washington University School of Medicine Pediatric Transgender Center at St. Louis Children’s Hospital, I have heard from so many people.

I have heard from doctors from within my own institution offering support. I have heard from amazing gay, lesbian, and transgender people welcoming me into their circles of support and trust. I have heard from the parents: the anguish, the pain, and the outpouring of thanks. Some have called me a hero.

It is as a mother of five that I process my involvement in the medicalization of children in the gender center. Every day I feel that I let a little more go, but in the quiet moments I still think a lot about the parents. The providers that I worked with followed a protocol that most gender centers in the United States agree with, a protocol that some states have even mandated into law. They side with the affirming parents, and they malign the parents who ask questions. The parents who ask for more time. The parents who ask the providers to “do no harm.”

I believed in that protocol for a long time. Too long. Even now, as I have been called a hero by so many parents, please know that “it took a long time to become the thing I am to you.” I struggle with that word, hero. I do not feel particularly heroic most of the time. I feel like I was complicit. I feel like I was a coward, that I could have and should have done more. Because I did not just help medicalize children; I helped to tear families apart.

At the gender clinic, I completed intakes, a fancy description for a long phone call to triage a patient. I was almost always speaking with an affirming parent, but when I wasn’t, I would substitute my judgment for theirs. If a parent told me their child had a preferred name and pronouns, I would use these even if the parent wouldn’t. I would use subtle shaming tactics to point out to any non-affirming parent that they were wrong and we were right. I would explain to parents what it meant to be affirming. I would only provide parents with affirming resources. I trained staff at the hospital to do the same. I trained staff to affirm the child even against the wishes of the parents.

The affirming parents sometimes would make it known on the phone that the other parent did not agree to affirmative treatment, that the other parent was in opposition to “this gender thing.” I would side with the affirming parent on the phone. I would give them the green light to schedule for their children an appointment with doctors who prescribe hormones. I initially did that even when the affirming parents reported that they shared legal custody of the child under a custody agreement. I did that because the doctors at the clinic told me that it was an appointment for “information only,” and that since I hadn’t seen the custody agreement or heard directly from the other parent, we were in the clear.

It took a long time, but eventually I started to insist that we have the custody agreement before we schedule the appointment. I was told to back down. But I saw what was happening. We were seeing the child with the affirming parent. We were getting them all the way through the minimum necessary steps and then calling the other parent afterwards. We would talk to them on the phone and say: “If you say no, you’re the red light.” So many times, the other parent would say things like, “You’re going to do this anyway,” or, “I feel like I can’t say no.”

I knew how much it had cost some parents to achieve joint custody. I knew how hard it was for divorced parents to just make life work. I was a wedge in the relationship between the parent and their child. I also knew—because it happened multiple times—that the affirming parents would lie and claim that they had sole legal custody. I came to push and push so that at least we were getting the custody agreements before we sent in the prescriptions.

But how many people like me work in gender centers in the United States?

We were not treating ear infections. We were prescribing puberty blockers and cross-sex hormones. We were permanently sterilizing children, and we were permanently changing their bodies.

And it wasn’t just the divorced parents who had internal disagreements over how to help their children. There were married parents who didn’t agree. We didn’t bother to ask if both of the married parents consented. We assumed consent if one parent showed up to the visit; no signatures needed. One parent’s verbal consent was good enough to permanently sterilize his or her own child.

Then there was the handful of parents (primarily dads) who fought for their kids. They fought against the moms, our team, and sometimes the kids themselves. Often the dads were fighting for the most reasonable things: more time in therapy, therapy with a provider who would actually explore where his child’s desire to escape his or her own body was coming from, time to allow mental health professionals to do proper psychotherapy.

They had a Herculean task. They had to fight the mom for information (including basic information like the date and time of the appointment). They had to fight to maintain a relationship with their kid, they had to fight the prestige of the university hospital, and they had to fight the doctors. These are doctors who would know close to nothing about a family’s history or its internal dynamics, but who would show up in court and fight for the affirming moms.

And the dads had to fight the courts themselves. Family courts in this country can be as ideologically captured as the hospitals. The courts would side with the affirming parent—especially when told by the clinic’s doctors that a decision for the affirming parents was a decision for the child’s health. One time, a court even granted discretion over medical decision-making to one of our teams doctors. A doctor ideologically invested in medicalizing kids—and whose contact with the kids was limited to giving them hormones—was granted preference over a parent who has to be there for the rest of the kid’s life.

The dads, some of them scientists by training, would come to the appointments with printed out articles. The dads tried everything they could but didn’t know what they were up against. We would never back down, not when one parent was saying yes. We would push and push. We would shame and malign. We would even poke fun at these dads in team meetings. We spoke as if they were idiots, as if they had patriarchal issues, as if they were deadbeats who didn’t know or love their kids. We tore these families apart, families that were often hanging by a thread when they first came to see us.

It eventually became too much to witness. As horrible as this is to say, I did see parents (primarily moms) who showed signs of Munchausen syndrome by proxy, a psychological disorder that compels a caretaker to gain attention and sympathy by seeking medical help for made-up or exaggerated symptoms of his or her child. Clinicians at the Tavistock clinic in the U.K. said they saw something similar—parents (usually moms) who seemed more invested in the gender transition than in the kids themselves. The moms we supported stood against dads who just wanted their children to have access to real assessments, real therapy.

It didn’t feel good, it didn’t feel right, and soon, something in me began to shift. There were cases when the dad was going to court and seeking medical records. I began to hope that the dads would read through the lines in my meticulous case notes, that the courts would see that the children were really the victims of one parent’s own psychological needs.

I no longer support the medical transition of children. I can’t. Not after what I witnessed, after what I was complicit in. I understand when people say that European nations haven’t entirely stopped medical transition of minors (even though many have placed major restrictions on the practice after systemic evidence reviews found justification for “gender-affirming care” severely lacking) but I just don’t trust affirming doctors to put the wellbeing of their patients first. They are blinded by ideology. They will never back down, if only because they will never admit to having harmed so many kids. I also no longer see my own divorce and custody battle in the same light. I have sole legal custody; my kids’ biological dad has visitation rights.

About three months after my story was published in The Free Press, my ex was in a horrible motorcycle accident. His recovery is slow. He was awake in the ambulance and told his wife that he didn’t want the kids to see him until he was better. My current spouse and I had anguished conversations. Do we respect that wish? Do we wake up the kids and bring them to see their father on a ventilator after major brain surgery? What about while a sign hangs above his head that reminds the nursing staff not to move anything over his head because he is missing part of his skull?

In those moments, I had forgotten all of the painful history of our custody fights. All of the anger at the costs and the time spent. Because my kids, and all kids, deserve to have a chance to have a relationship with their parents. A relationship that should never be torn apart by ideologically-driven doctors, judges, or hospital administrators.

My state has restricted medical sex changes to adults only. The law goes into effect soon. I wish that it didn’t need to come to legislation, but right now, it is the only way to protect vulnerable kids and teens from harm. Most states have no such laws. These states and the Democrats who hold power in them believe that “gender affirming care” is a choice between “parents and their doctors.” But I’ve seen too much to believe such claims. In practice, it is actually the “choice” of the parent who agrees to medicalize his or her child, typically after having received false or misleading information.

My modest hope is that in those states where gender diverse children are still offered drugs and surgeries, doctors who work in gender clinics will at least agree that if one parent says no, then no medical interventions should be offered. As parents, we are not perfect, but we have the best interests of our children at heart. And sometimes we are in a better position to see a problem than a doctor who has met our child only a handful of times. Listening to parents—especially the skeptical ones—is the right thing to do. It’s the way to “first, do no harm.”

Jamie Reed, Whistleblower from the Pediatric Transgender Center in St Louis. The title of this piece, “It took a long time to become the thing I am to you” is a lyric from the Indigo Girls song Become You from their 2002 album of the same name.

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