Jamie Reed

Can I just ask, what is the other option besides satisfaction that you're pushing for?

It just struck me when you were speaking about your own experience while you were working at the clinic and you weren't feeling like a whole person. You were having to push away who you really were. It just seemed like it mirrors a lot of the experience of trans people when they are young and not able to... be who they are.

It just kept feeling like... And rather than treat those underlying issues, Jamie wrote that doctors were just prescribing puberty blockers and hormones, and routinely doing so without the willing consent of their parents.

So I think it comes down to then... At this point, Jamie grabbed a notebook and pen on the table and started drawing. On one side of a page, she drew a cluster of dots meant to represent a group of kids. On the other side, she drew just one.

Jamie said that after the leadership of the hospital didn't address her concerns, she quit her job at the clinic. A few months later, she filed her affidavit with the state.

The next morning, Azeen and I arrived at a courthouse in Springfield for the hearing.

Inside the room where the hearing was being held, the public seating area was full. About 50 people, a lot of them older, sitting on a few rows of benches. There were people wearing shirts that said, God's disciple and God's children are not for sale. One man told us he was there with his church group.

Azeen pointed to only a few people she recognized as parents from the clinic, seated in the front row. Over the next two days, we would all sit through hours and hours of testimony. The state called on expert witnesses who questioned the role of medical intervention. One was an American psychiatrist who was involved in the early treatment of trans adults in the 70s.

And he had worked with the Dutch clinicians like Peggy Cohen Ketnes on the first WPATH guidelines that included recommendations for children and adolescents. But in the time since, he'd grown disillusioned with the field and felt that groups like WPATH had become dominated by politics and ideology rather than by a scientific process.

He said that he now believed the Dutch study was too weak to support medical transition for kids. Another witness was a child and adolescent psychiatrist from Sweden. The country had first begun offering care based on the Dutch protocol, but had recently moved to a more cautious approach and now recommended puberty blockers and hormones only in exceptional cases.

He testified about similar restrictions that had recently been put in place in other Nordic countries. Through much of this testimony across these two days, the crowd sat quietly, fidgeting, trying to pay attention. That changed when Jamie Reed was called to the stand. People started leaning forward in their seats and whispering to each other. They seemed to know who she was.

For over two and a half hours, she talked about her experience, walking through many of the claims she made in her affidavit. As the lawyers encouraged her to expand on her account, she said clinicians would pressure parents into treatment by saying things like, would you rather have a dead daughter or a living son?

She said she believed the rise in demand was being driven by social contagion, that kids were seeking medical care to transition because of what they were seeing on social media or because their friends were doing it. At multiple points, people in the audience muttered to themselves and each other about the treatment that was being described. I saw people shaking their heads a lot.

At one point, I heard a guy in front of me say, horseshit. And at the same time, I saw a parent in the room, crying. There was one woman in particular who was clearly agitated by Jamie's testimony. When Jamie was talking about a medication used at the clinic with the risk of liver toxicity, the woman stood up from her seat and left the room. Azeen gave me a look and then followed her out.

Hello, hello.

After Jamie's testimony was over and I got my recording equipment from the car, I spotted Jamie standing alone just outside the courthouse.

As we were talking, we saw Azeen and the woman that she'd followed out of the courtroom heading in our direction.

In going public with these claims, Jamie Reed became the first whistleblower from a pediatric gender center in the U.S. And it wasn't just that she had worked at the clinic.

The woman stopped a few feet away from Jamie.

This was the parent whose daughter's case had been misrepresented in Jamie's affidavit. It was a case Jamie had pointed to as one of the most egregious examples of harm she had seen at the clinic.

She said the teenager had experienced liver damage after being prescribed a drug to block testosterone, and that this parent had then made a kind of threat to the clinic, saying she was not the type to sue, but that, quote, this could be a huge PR problem for you.

In actuality, Azeen had learned, the patient did experience liver damage, but the medical situation had been more complicated than the affidavit had accounted for. And the girl's mother, this parent, had never threatened the clinic. When Azeen went to Jamie with this, Jamie acknowledged that she'd gotten the information secondhand from the clinic's nurse.

But she said it didn't change what she thought was the most important part of the story, that the kid had been harmed.

She self-identified as a progressive and as a queer woman. And she was married to a trans man. So for opponents of the care, she was an incredibly potent messenger.

The parent shook her head, turned, and walked to her car. Jamie headed to her own car and drove off. The next morning, the Times published Azeen's story about Jamie Reed, the clinic where she worked, and the testimony she had just given in support of Missouri's ban.

The response was immediate.

Not long after, a few of the parents who Azeen interviewed for the story, including the mom outside the courthouse, spoke to a trans rights news site about how they felt Jamie had been given too much of a platform by the Times. The headline of that piece was, You Betrayed Us, Azeen. Back in Missouri, the judge issued his order.

Within days of Jamie coming forward, Senator Josh Hawley from Missouri opened an investigation into the clinic.

He allowed the ban to go into effect, while the challenge to it continued to play out in court. In 2020, there were no bans on youth gender medicine in the U.S. In 2021, Arkansas had become the first state to pass a ban. In 2022, Alabama and Arizona followed.

In 2023, Utah, Mississippi, Iowa, Kentucky, North Dakota, Oklahoma, Florida, Georgia, Tennessee, Indiana, South Dakota, North Carolina, Missouri, Texas, Nebraska, Montana, Louisiana, and Idaho, they all passed bans, bringing the total number of states to have passed bans on youth gender medicine to 21.

Like Missouri, many of those bans were challenged, and as they were making their way through the courts, many of those bill's sponsors spoke publicly about their belief that letting children medically transition was just wrong. Some called it child abuse. But in making their cases, they leaned on the same argument that Jamie said had convinced her to support these bans. The lack of evidence.

At the same time, advocates and providers in the US argued just the opposite, that the evidence was strong, saying every major medical group agreed on the necessity of this care. Each side claimed to be acting based on the science and accused the other side of being ideological.

Then came a highly anticipated report out of the UK that cast both sides as ideological.

And claimed to answer the question of the evidence once and for all. Next time, in part five, the cast review.

Missouri lawmakers, who had struggled for the previous two years to get the support they needed to pass a ban, were finally able to push it through. And they did it in part by citing Jamie's allegations. Meanwhile, parents of patients disputed her claims.

In early 2023, a woman named Jamie Reed made headlines when she filed an affidavit with the Missouri Attorney General's office. She had been a case manager at one of the only youth gender clinics in the state, the Washington University Transgender Center. And in her affidavit, she made a number of explosive claims about the care kids were getting there.

They said she'd become some kind of tool of the Republicans. And civil rights groups filed a lawsuit to try to stop the ban from going into effect. And by August, a hearing date was set to decide whether care could be provided while the lawsuit worked its way through the courts.

So I think she doesn't testify until 1230, but... And Jamie would be testifying at the hearing in support of the ban on care in Missouri. This wasn't an interview in The Atlantic or a column in The Washington Post. It wasn't a disagreement at a medical conference. This was something totally different. And it was happening right as political opposition was reaching a new high.

It was clearly a turning point in the story.

And so we went to Missouri. From The New York Times, I'm Austin Mitchell. This is The Protocol with Azeen Gureshi. Part 4. The Whistleblower.

The hearing in Missouri was scheduled for late August, about six months after Jamie had first gone public with her allegations. And in that time, Azeen had been reporting on the clinic where Jamie worked. Because while conservative lawmakers had been quick to seize on her allegations, and advocates had been quick to dispute them, her claims had never been fully reported out.

And so Azeen had been talking to patients, parents, former employees, pediatricians, therapists. She reviewed hundreds of pages of internal documents she'd gotten from Jamie, as well as some documents and medical records from parents. And she was getting ready to publish her story. From her reporting, Azeen had been able to verify many of Jamie's claims.

She confirmed that the clinic was overwhelmed with patients. At one point, they were getting four or five new calls a day, about the same number they got in a month when Jamie first started. She also confirmed that many of the kids coming in did have complex psychiatric issues, and that the clinic didn't always do psychological assessments of patients before providing medical treatment.

Instead, they required a letter from an outside therapist. Azeen saw a text message from the clinic's co-director. It was sent shortly after WPATH released an update to its guidelines, co-authored by Laura and Analu, which reasserted the need for kids to have rigorous assessments. The co-director said in his text that he worried the clinic didn't have the ability to meet those standards.

In her affidavit, Jamie pointed to many instances where she believed this situation had led to patients being harmed. Azeen was able to confirm several of those instances.

She also found other cases independently, like a patient who had gone on to detransition who said she'd been prescribed testosterone after a single appointment without speaking to a psychologist, even though she'd previously been diagnosed with bipolar disorder. Azeen sent these findings to Washington University.

Two days later, a first-person account of her experience was published in the Free Press. And she gave them an interview where she laid out some of her claims.

A spokesperson said they couldn't comment on individual cases because of patient privacy, but said they had reviewed the allegations and concluded that, quote, physicians and staff have treated patients according to the existing standards of care. Most of the parents and kids Azeen spoke with said that had been their experience and that Jamie's account put that all at risk.

Overwhelmingly, the parents who agreed to talk with Azeen, many of them part of a parents' group associated with the clinic, said the clinic was a godsend, the only place for hundreds of miles where they could get their kids the care they needed. They said the gender care had often resolved mental health issues their kids were dealing with. Some talked about it as life-saving.

And they said they felt blindsided and betrayed by what Jamie had done. One parent whose daughter had been cited in the affidavit as an example of harm showed Azeen her correspondence with the clinic's doctors. The messages made clear that Jamie had misrepresented some of the details of the story, which made it sound more damning.

And adding to the parents' feelings of betrayal was what Jamie was about to do.

And so while we had come to Missouri to see how this case would play out in a courtroom, we first wanted to go see Jamie on the eve of her testimony to ask her why she was taking this unprecedented step.

Hello.

Jamie was living in the St. Louis suburbs with her two dogs, three cats, five kids, and her husband at the time, Tiger, who wasn't home. After Jamie got the youngest kids to bed, we took a seat at the kitchen table.

Jamie described a clinic totally unprepared for the moment.

She said when she started in 2018, the clinic had just opened and had no formal guidelines for how it should operate. Soon, it was facing the same increase in patients as so many other clinics. Often, she said, those patients had severe psychological issues. In her affidavit, Jamie wrote about kids struggling with schizophrenia, obsessive-compulsive disorder, PTSD.

Jamie told us that as she was becoming increasingly disillusioned with what she was seeing at the clinic, she began to do some research online. She learned other people were also questioning the care. Some of them were re-evaluating the evidence that had launched this treatment model. The Dutch protocol...