A therapist in Washington state has become the latest whistleblower to raise concerns about so-called “gender-affirming care,” revealing that she was “bullied” into approving all requests from minors seeking gender transition procedures.
In an op-ed published by The Free Press on Monday, Tamara Pietzke outlined her experience working at MultiCare, which she described as “one of the largest hospital systems in the state” of Washington. Pietzke, who obtained a master’s degree in social work from the University of Washington in 2012, worked as a therapist at MultiCare for six years until she resigned from the post last month.
Pietzke began the op-ed piece by detailing the philosophy that guides how she treats her patients: “The therapeutic relationship is a special one. We are the original ‘safe space,’ where people are to explore their darker feelings and painful experiences. The job of a therapist is to guide a patient to self-understanding and sound mental health. This is a process that requires careful assessment and time, not snap judgments and confirmation of a patient’s worldview.”
“In the past year I noticed a concerning new trend in my field,” she recalled. “I was getting the message from my supervisors that when a young person I was seeing expressed discomfort with their gender — the diagnostic term is gender dysphoria — I should throw out all my training. No matter the patient’s history or the other mental health situations that could be complicating the situation, I was simply to affirm that the patient was transgender, and even approve the start of a medical transition.”
Expressing concern that “the rise of ‘affirmative care’ for young people with gender dysphoria challenges the very fundamentals of what therapy is supposed to provide,” Pietzke noted that she feels obligated to speak out against the effort to “medicalize youth and cause them potentially irreversible harm” despite concerns that doing so would cause her to lose her job and thereby lead to the single mother finding herself unable to care for her three young children.
Pietzke detailed the underlying mental health conditions facing three anonymous minor patients in her care who were encouraged by other medical professionals at MultiCare’s Mary Bridge Children’s Gender Health Clinic to pursue body-disfiguring gender transition procedures. “In order to get that prescription, patients first need a recommendation letter from a therapist,” she wrote. “Patients were often referred to therapists like me who were in their system.”
The first patient Pietzke discussed had an abusive mother who suffered from bipolar disorder and experienced multiple sexual assaults at the hands of relatives and a classmate and was on the autism spectrum. The girl had also been expelled for threatening to blow up her school and engaged in activities that amounted to what Pietzke referred to as an “age-regress” such as watching “The Teletubbies” and sucking on a pacifier.
Explaining that the patient’s autism made it “difficult for us to engage in introspective conversations,” she talked about how the 13-year-old girl would frequently show her “sadistic and graphic pornographic videos on her phone” in addition to indicating that she found solace in horror and porn movies because “they were the only ones available in her house” growing up. According to Pietzke, “She went by a boy’s name, but she never raised gender dysphoria with me directly.’”
“One time she told me she would get mad at the sound of her own voice because ‘it sounds too girly.’ When I asked her how she felt about an upcoming appointment at the gender clinic, she told me she didn’t know she had one,” Pietzke added. The therapist saw this client for three sessions but when she tried to schedule a fourth session, her guardian asked Pietzke to “write her a letter of recommendation for cross-sex hormone treatment,” which would involve prescribing the girl testosterone.
Pietzke lamented that “In Washington State, that’s all it takes — a few visits with a therapist and a letter, often written using a template provided by one’s superiors — for minors to undergo the irreversible treatments that patients must take for a lifetime.” She maintained that she was “scared for this patient” who had “so many overlapping problems that need addressing,” adding, “it seemed like malpractice to abruptly begin her on a medical gender transition that could quickly produce permanent changes.”
When Pietzke shared her concerns with her superiors, one of them told her that her client’s “trauma history had no bearing on whether or not she should receive hormone treatment.” The program manager told Pietzke that “There is not valid, [evidence]-based, peer-reviewed research that would indicate that gender dysphoria arises from anything other than gender (including trauma, autism, other mental health conditions, etc.)”
Additionally, the response email Pietzke received from her superior stated that “there is potential in causing harm to a client’s mental health when restricting access to gender-affirming care” and instructed her to examine her “personal beliefs and biases about trans kids.” Her supervisor reported Pietzke to MultiCare’s risk management team, who removed the girl from her care and placed her with a different therapist.
Another client Pietzke saw was not initially referred to her for gender dysphoria but only began to question her gender after “reading online a lot” about the subject during the COVID-19 lockdowns. Shortly thereafter, the teenager started identifying as pansexual, using “they/them” pronouns and “wearing a binder to flatten her breasts.”
Pietzke diagnosed the girl, who suffered from “anxiety, depression, and ADHD,” with “adjustment disorder,” which she classified as “an umbrella term often applied to young people who are having a hard time coping with difficult and stressful circumstances.” She continued to see her patient after she began identifying as “transgender” and sought a referral to a gender clinic.
The girl’s parents disagreed on whether to place their daughter on cross-sex hormones. With her client’s father refusing to sign off on giving his daughter testosterone, the clinic prescribed her birth control to stop her period. At a session that took place last year, four years after she first started seeing the girl, the patient informed Pietzke that she now identified as a “wounded male dog” and expressed a desire to wear artificial ears and a tail to look more like a canine.
At this point, Pietzke went to her colleagues for advice and asked, “is there ever a time when acceptance of a person’s identity isn’t freely given?” Writing that “the consensus from my colleagues was that it wasn’t a big deal.” She cited a response from one of them who replied, “If someone told me they use a litterbox instead of a toilet and they were happy with it and it’s part of their life that brings them fulfillment, then great!”
The third patient Pietzke mentioned in her op-ed is now an adult but had begun to experience mental health problems as a minor. “This patient was diagnosed with autism, anxiety, and gender dysphoria,” she said. “Later the diagnoses grew to include depression, Tourette syndrome, and a conversion disorder.”
While the girl was prescribed testosterone as a minor, she is “now 23 and rarely leaves the house, spends most of the day in bed playing video games, and envisions no path to working or functioning in the outside world.” Pietzke explained that “this patient now has a wispy mustache and a deepened voice, but does not pass as male,” concluding that “it turns out that testosterone, which will be prescribed for life, did not relieve the patient’s other mental illnesses.”
“My biggest fear about the gender-affirming practices my industry has blindingly adopted is that they are causing irreversible damage to our clients. Especially as they are vulnerable people who come to us at their lowest moments in life, and who entrust us with their health and safety. And yet, instead of treating them as we would patients with any other mental health condition, we have been instructed — and even bullied — to abandon our professional judgment and training in favor of unquestioning affirmation.”
Pietzke added, “nothing will change unless people like me — who know the risks of medicalizing troubled young people — blow the whistle.” Finding herself “desperate to help her patients,” Pietzke worried that if she did not “speak out,” she will have “betrayed them.”
Pietzke elaborated on some of the long-term impacts of gender transition procedures on minors she discovered when researching the topic further, such as “infertility, loss of sexual function, increased risk of heart attack, stroke, cardiovascular disease, cancer, bone density problems, blood clots, liver toxicity, cataracts, brain swelling, and even death.”
Concerns about the side effects of such procedures have led 23 states to ban minors from obtaining some or all of them. Pietzke’s op-ed reflects the fact that Washington state has taken the opposite approach.
Pietzke is not the first medical professional to emerge as a whistleblower warning against the rush to embrace gender transition surgeries for minors. Last year, former gender clinic employee Jamie Reed wrote an op-ed for The Free Press illustrating some of the adverse medical events that have materialized in patients prescribed puberty blockers and cross-sex hormones.
Ryan Foley is a reporter for The Christian Post. He can be reached at: ryan.foley@christianpost.com
