Kansas City-based endocrinologist Brandon Barthel has provided care for transgender adults for six years, including helping them go through hormone therapy.
When he sees patients and talks to colleagues these days, he sometimes hears fear.
The onslaught of legislation across Missouri, Kansas and much of the country targeting gender-affirming care has unsettled the region’s small community of providers and the patients who turn to these doctors, counselors and others to help them navigate difficult questions of gender and sex.
Barthel worries the measures have created a chilling effect on doctors and other professionals, who fear the loss of funding if too much attention is drawn to the care they provide. And patients are worried, he said, because they view the legislation as an attack on their existence and their ability to access medical care.
“Everybody’s afraid,” Barthel said.
Republican lawmakers in both Missouri and Kansas have filed legislation to prevent doctors from providing gender transition surgeries or hormone therapies to minors. They have also pursued legislation to ban transgender athletes from women’s sports and bar transgender women from female designated spaces, including bathrooms and locker rooms, and transgender men from male designated spaces.
Interviews with doctors, transgender individuals and family members in Kansas and Missouri reveal an atmosphere of alarm over the attacks on transgender care. Collectively, they are concerned about the potential for the legislation to cast a pall over providers and patients – even if the measures never become law.
“That terror, that very real, ‘Oh, we’re in danger, we’re in very real, very immediate danger’ – that kind of seeps through the community whether or not these bills pass,” said Adam Kellogg, a transgender 19-year-old University of Kansas student who hopes to one day work as a counselor for transgender individuals.
“Because we know the sentiment is there enough for it to be acceptable to put these bills into committee or even on the House or Senate floor.”
St. Louis investigation casts shadow over debate
At the same time, an ongoing investigation into Washington University Transgender Center at St. Louis Children’s Hospital has only added to fears among patients and providers that transgender care is under threat. Washington University declined to comment for this story.
Missouri Attorney General Andrew Bailey, a Republican, launched the inquiry after Jamie Reed, a former employee at the center, alleged that the center harmed children, rushing mentally ill children into hormone therapy without properly treating their underlying mental health issues.
“During my time at the center, I personally witnessed center healthcare providers lie to the public and to parents of patients about the treatment, or lack of treatment, and the effects of treatment provided to children at the center,” Reed said in an affidavit.
Reed is being represented by Georgia-based attorney Vernadette Broyles. Broyles is the founder of the Child and Parental Rights Campaign, a law firm that pushes back against “the harms caused by gender identity ideology,” according to its website. Broyles did not respond to an email asking for comment.
The allegations against the St. Louis center have been disputed by patients and parents of patients.
Joey, a 22-year-old transgender man who started receiving care when he was 16 at the St. Louis clinic now under investigation, said the allegations against the center don’t align with his experience. He said the process of transitioning is extremely slow and Republicans have engaged in fear-mongering about the procedures.
He asked The Star to identify him only by his first name out of fear of retribution.
“No one is rushed into this treatment, especially kids,” he said. “No one is being pressured to be transgender in a world where it’s extremely difficult to be transgender.”
Republicans have seized on the allegations as they seek to advance restrictions on gender-affirming care. They say the measures are needed because minors should have to wait until they turn 18 before undergoing treatment.
“I call it mutilation because they’re taking functioning body parts from the top and the bottom, cutting them off and trying to replicate something of the opposite sex there that really has no function except for visual appeal,” state Sen. Mike Moon, an Ash Grove Republican, said on the Missouri Senate floor last week.
Moon sponsored a bill that would ban all “gender transition procedures” for people under 18.
“It just doesn’t make any sense to me why we as a civil society would say it’s OK.”
Across the Kansas City region, few clinics offer gender-affirming care for minors. Gender Pathway Services at Children’s Mercy provides family-centered services for transgender and gender-questioning children, including behavioral health services and hormone therapy, according to its website.
The hospital’s leaders, in a statement to The Star, said they were “monitoring the proposed legislation closely, and continue to be dedicated to providing the best evidenced-informed care focused on the long-term physical and mental health outcomes for every child we see.”
Barthel, the Kansas City endocrinologist, said a person under 18 who is transitioning genders typically has to visit three different medical providers during the process: a psychologist or therapist, a primary care pediatrician and an endocrinologist.
Doctors typically do not start hormone treatments until a patient reaches puberty and has gone through extensive psychological work, he said. He said lawmakers are targeting the overall procedures instead of specific doctors who may be operating outside of the standard of care.
“If you found some surgeon who was not following the standard of care when they’re doing appendectomies and cholecystectomies, you wouldn’t outlaw that procedure. You would investigate that surgeon,” he said.
Parents and providers say treatment has been misrepresented
Ryan Cox works as a therapist for transgender adults in Kansas City. He said he has had to reassure many of his patients that there are people advocating for them as lawmakers debate bills that target gender-affirming care. He said the legislation has caused fear and anxiety among the transgender community.
Cox, who is gay, rejects arguments that transgender patients are rushed into treatment — it’s typically something a patient has waited years for, he said.
“Part of the hysteria is around somebody who just wakes up one day and decides they’re going to transition and makes some doctor’s appointment, walks in and gets hormones and walks out and suddenly they’re the opposite sex and that’s just not how it works,” he said.
Daniel Bogard, a St. Louis rabbi and father of a young transgender boy, pushed back on arguments that doctors were performing gender-affirming surgeries on minors, calling it a lie by Republicans to rally their base.
“My kid transitioning means he got a haircut and wore boys clothes and uses boy words and has a new name,” he said. “That’s what we’re talking about, OK? Nothing more than this.”
Beth Oller, a family physician who provides gender-affirming care in rural western Kansas, told state legislators last month that she fears what will happen if children don’t receive care – not what will happen if they do.
She recounted stories of patients whose lives had improved from treatment, such as a 15-year-old who had been suicidal but was beginning to see a “path to hope” and a 19-year-old who had begun hormone therapy and now appeared confident and excelling at college.
Oller, testifying to a Kansas Senate hearing, urged legislators to “trust the professionals doing this work.”
“I am not a monster, a groomer, a child abuser. I am a physician, a rural Kansan, a parent,” Oller told lawmakers.
Missouri state Sen. Lauren Arthur, a Kansas City Democrat, said one of the biggest impacts of the proposals will be families questioning whether they want to remain in the state. She dismissed the idea that a crackdown on doctors is warranted.
Doctors are already well aware of their legal and ethical obligations to provide appropriate care, she said.
“There may be examples of providers violating those standards, and those people should be held accountable,” Arthur said. “But I think the vast majority are very controversy averse and know that their medical licenses will be on the line if they do anything that’s deemed inappropriate.”
Much of the fear among health professionals is that the legislation may have far-reaching consequences beyond banning gender-affirming care for minors.
The Missouri bills would ban both surgical and non-surgical gender-affirming care for people under the age of 18 except for a few specific instances. Under a bill that was debated in the state Senate last week, doctors who violate the restrictions could face professional discipline as well as lawsuits.
In Kansas, the state Senate last month passed legislation that would threaten the licenses of physicians who provide gender transition surgery or hormone therapy to patients under 18. It would allow civil lawsuits against doctors who provide those services. The Kansas House may not act on the bill, however.
Cox said the bills are written vague enough where they could create a chilling effect for all transgender care, including the work he does with transgender adults, as well as other procedures.
“If this law passes,” Cox said, “I don’t really know what I’m going to be allowed to do or not.”
