"With its psychologists overbooked, the clinic relied on external therapists, some with little experience in gender issues, to evaluate the young patients’ readiness for hormonal medications."

"Doctors prescribed hormones to patients who had obtained such approvals, even adolescents whose medical histories raised red flags. Some of these patients later stopped identifying as transgender, and received little to no support from the clinic after doing so.... Pediatric gender medicine is a nascent specialty, and few studies have tracked how patients fare in the long term, making it difficult for doctors to judge who is likely to benefit.... In the United States, health groups have endorsed what’s known as affirming care even as their peers in Europe have grown more cautious.... In a statement to The Times, [Washington University] said that it would not address specific allegations because of patient privacy, and that 'physicians and staff have treated patients according to the existing standard of care.' But doctors in St. Louis and elsewhere are wrestling with evolving standards and uncertain scientific evidence — all while facing intense political pressure and an adolescent mental health crisis...."

From "How a Small Gender Clinic Landed in a Political Storm/Washington University’s youth gender clinic in St. Louis, like others around the world, was overwhelmed by new patients and struggled to provide them with mental health care" (NYT).