Underground Network Helps Minors Obtain Puberty Blockers and Hormones in Ban States
Updated
Journalist Christina Buttons released an investigative report for City Journal detailing a nationwide network to bypass statewide bans on pediatric gender-transition treatments. Buttons said she spent several months on the investigation that included interactions with a 501c3 nonprofit Campaign for Southern Equality (CSE) and phone calls to clinics about methods to obtain cross-sex hormones and puberty blockers in states with explicit bans.
The report confirms that clinics are fraudulently using general “endocrine disorder” diagnostic codes to obtain hormones and blockers for children in states that explicitly ban these treatments for children experiencing gender dysphoria. HHS released its own report in August called “Wolves in White Coats” that details this practice. The agency said that nearly $50 million was billed for puberty blockers in patients aged 9-17 under endocrine-disorder codes from 2015-2025.
In Buttons’ article, she describes a discussion with Amanda, a “care navigator” for CSE who was helping her as a mother of an 11-year-old daughter who identifies as non-binary. Amanda said, “The thing is that the prescribing of that medication is not illegal. It is the prescribing for gender dysphoria from a local doctor that would not be ok.” Amanda said there are “all sorts of ways” for people to obtain the medications locally in states that have bans on gender treatments for minors.
CSE partners with clinics, pharmacies, and mail order services to bypass state regulations so children with gender dysphoria can get access to puberty blockers and cross-sex hormones.
“There are numerous credible leads in my investigation involving potential civil and criminal violations, as well as grounds for professional disciplinary action,” Buttons explained on an X post. “It’s now up to state and federal authorities to conduct their own investigations and decide what to do about it.”
HHS has been taking action under the guidance of President Trump’s executive order to protect children from “chemical and surgical mutilation,” with the scientific backing from the Cass Report and an HHS report released last year. Many clinics have been halting all medical treatments for gender dysphoric youth under the weight of the pressure. Texas Attorney General Ken Paxton successfully won a lawsuit that led to the opening of the country’s first detransition clinic to help children and young adults who underwent medical transition before they changed their identification to align with their biological sex.
City Journal’s investigation also revealed that CSE has a partnership with Elevated Access, which is a nonprofit that provides free flights to help people obtain gender-transition procedures or abortions. A CSE care navigator named Gracey was willing to connect a parent with Elevated Access and provide a $500 travel grant to help a 16-year-old get a double mastectomy. CSE asked for a Venmo or PayPal account and said they could send the payment on the day of the call. No receipts would be needed to ensure the funds were spent correctly. City Journal noted that they did not accept the $500 payment from CSE.
Buttons reported that CSE’s financial disclosures show that Jeff Bezos’ ex-wife MacKenzie Scott donated at least $1 million to the nonprofit in 2024. The organization also received large donations from the Arcus Foundation, the Chicago Community Trust, and the Ford Foundation, among others. CSE has reportedly provided $1 million in travel grants and another $1 million to partner organizations that provide services to trans-identified children. The organization’s financial disclosures are available on its website.
City Journal contacted clinics in several different states to inquire about the potential of receiving puberty blockers or cross-sex hormones in Tennessee, where the practice is explicitly banned, to treat children with a diagnosis of gender dysphoria. Clinics in Illinois, Pennsylvania, Minnesota, Colorado, and Wisconsin all said they could send the medication to a local Tennessee pharmacy or directly to the patient’s home. They discussed using “different tricks” and other diagnostic codes to bypass regulations in states that have banned the practice.
CSE also partners with telehealth companies, and Buttons inquired with one of the recommended options of QueerMed. QueerMed tells patients that they just need to drive into any state that does not have a ban on medical treatments for gender dysphoria to conduct the single telehealth appointment. After that, the company could arrange for the medication to be delivered to the patient’s home.
Buttons reported a contradiction in statements from Dr. Izzy Lowell, the founder of QueerMed. A Reddit forum reposting of an email from the company states that they have no way to track the location of individuals appearing in a telehealth appointment and that they rely on the patient’s verbal confirmation that their location is in a state that legally allows this treatment.
Buttons said Lowell “first appeared to confirm” that verbal acknowledgment is the standard, but that she requested the confirmation not be shared or printed. Dr. Lowell reportedly sent a follow-up email stating the company does not mail medications to anyone and the providers for QueerMed “verify every patient’s location for every visit, in compliance with applicable telemedicine laws.”
In February, detransitioner plaintiff Fox Varian won a $2 million verdict in the first medical malpractice lawsuit related to childhood transition. The Federal Trade Commission started an active investigation into WPATH for potential unfair or deceptive practices in February and announced a lawsuit in June against the organization that advocates for gender transition for children who experience gender dysphoria.
States have banned the practice of pediatric medical transition, which includes prescriptions of puberty blockers and masculine or feminine hormone treatments, on the basis that there is low-quality evidence supporting the safety and efficacy of “gender affirming care” for minors. A long-term Finnish study published in April found that those who went through feminizing gender reassignment protocols were six times more likely to need special psychiatric care. The authors concluded that psychiatric needs do not subside after medical gender reassignment, which is the goal and purpose of pursuing this kind of treatment.