An Interview with Gender Clinic Whistleblower, Tamara Pietzke

“Why can’t we just let people be people without making them think there’s something wrong with the way they’re wired?”

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About the Author

Ben Appel has written for Newsweek, The Free Press, Quillette, UnHerd, and many other publications. His memoir, Cis White Gay, about his experience in LGBT activism and Ivy League academia, is forthcoming. Subscribe to his Substack and follow him on X @benappel.

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On February 5, 2024, The Free Press published the whistleblowing account of Tamara Pietzke, a Washington State mental health therapist. For six years, Pietzke worked at MultiCare, one of Washington state’s largest hospital systems. In her essay, Pietzke explained why she chose to leave MultiCare in January.

“In the past year I noticed a concerning new trend in my field,” Pietzke wrote. “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 other mental health conditions 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.”

Pietzke described the case studies of three patients she treated at MultiCare. One was a 13-year-old girl who had an abusive mother, was a victim of multiple sexual assaults, and had been diagnosed with “depression, PTSD, anxiety, intermittent explosive disorder, and autism.” After the girl was diagnosed with gender dysphoria, despite the girl’s complex history, the Mary Bridge clinicians recommended she take medication to suppress her periods and consider taking testosterone. When Pietzke voiced her concerns to her program manager, she was told to “examine [her] personal beliefs and biases about trans kids.” The girl was then promptly removed from her care.

Another patient, a 16-year-old client who had anxiety, depression, and ADHD, told Pietzke that, during the pandemic, after reading online about gender, she didn’t feel like a girl anymore. Soon, she started using she/they pronouns and wearing a chest binder. In 2022, she went to Mary Bridge, where she was prescribed birth control to stop her period, since the girl’s father wouldn’t consent to allowing testosterone treatment. After a hospitalization for swallowing a bottle of pills, the girl told Pietzke she identified as a “wounded male dog” and talked about wearing ears and a tail in order to feel more like her true self. Pietzke’s concerns were minimized by her colleagues, who seemed to have no issue with patients identifying as animals if it made them happy.

In 2022, Pietzke began treating a female in her early twenties who had transitioned as a teen. The patient, who rarely left the house and spent most of the day in bed, had been diagnosed with autism, anxiety, gender dysphoria, depression, Tourette syndrome, and a conversion disorder. Mary Bridge prescribed the girl testosterone in 2018, when she was 17, “despite the fact that this patient is diabetic and one of the hormone’s side effects is that it might increase insulin resistance,” wrote Pietzke. “The patient’s mother, who has another transgender child, strongly encouraged it.”

“My biggest fear about the gender-affirming practices my industry has blindly adopted is that they are causing irreversible damage to our clients,” wrote Pietzke. “I am desperate to help my patients. And I believe, if I don’t speak out, I will have betrayed them.”

In mid-February, I spoke to Pietzke over Zoom. She had just been fired from her new job.

After Pietzke left MultiCare, she was hired by a therapy clinic to provide mental health counseling and neurofeedback, a treatment that helps patients produce more positive brainwaves. From the beginning, Pietzke’s new boss had insisted that, if neurofeedback wasn’t for her, she could switch to counseling full time. And yet, when Pietzke requested this change, her boss said that wasn’t an option and promptly let her go.

The way Pietzke described it, it sounded like her whistleblowing had contributed to her boss’s decision. Now, Pietzke hopes to open her own practice in order to avoid running into this issue at yet another clinic.

“I just want to be able to do my job and help people,” she told me.

In Washington, conversion therapy laws include “gender identity” along with sexual orientation, which means that therapists can face legal repercussions for failing to properly affirm a patient in his or her trans identity. I asked Pietzke if this concerns her.

“Believe me, I’m making it very clear that I’m not trying to change anybody,” she said. “All I want to be able to say is, ‘Let’s put a pin in it. Let’s process this and work through this and not rush to medicalize. You’re a child.’”

I explained to Pietzke how I first got involved in this issue. After I learned that gender-nonconforming youth were being medicalized, I began to wonder what the difference was between a “trans kid” and the effeminate little boy that I had been growing up.

“I was teased all the time as a kid,” I said. “In middle school, I was often asked, ‘Are you a boy or a girl?’ Most of my friends were girls and I loved girly things. I was really athletic, but I wanted to play with the girl's lacrosse stick rather than the boy's lacrosse stick. So, to imagine that there would be this ideology, for lack of a better word, that said, 'Which sex do you feel like? Which sex do you identify as, according to these gender norms?’ I can’t imagine, being young, I would’ve been able to answer, ‘Oh, I know I feel more like a boy.’”

“It would’ve been so confusing,” said Pietzke.

“And, because I was raised really religious, I couldn’t reconcile my sexuality with my upbringing,” I said. “So, I’m sure I may have thought, ‘Good, this isn’t a moral defect, it’s just a medical problem that I can fix. I’ll feel more comfortable, I’ll blend into society more, and the bullying might stop.’”

That was why I asked about the conversation therapy laws, I told Pietzke. “Like you said, you’re not trying to change anybody. But there needs to be some exploring here, because there can be other things at play, including the possibility that you’re just dealing with a gender-nonconforming kid who will grow up to be gay.” In other words, “gender-affirming care” can be a new form of gay conversion therapy.

“My understanding is that about 85 percent of gender-distressed youth who are allowed to progress through puberty normally resolve that distress,” said Pietzke. “And oftentimes they do end up being gay. For a kid to even have the thought that they might have been born in the wrong body is just so unfair.”

She continued. “And that is what kids are talking about now. They don’t even need an adult to say it. Their peers start to identify as another gender, and they think, ‘OK, maybe I am, too.’”

To describe what’s occurring in the medical system when it comes to “gender-affirming care,” Pietzke said that, in the past, she has hesitated to use the word “corruption,” only because “it feels so extreme.”

“But that’s what it is,” she said. “A level of corruption that makes me heartsick. I have to wonder, do people really think they’re doing what’s best for people? Or, are they personally benefiting from providing these treatments in some way? I’m trying to figure it out. But it’s scary to me.”

Last year, I spoke with Dr. Laura Edwards-Leeper, the founding psychologist for the first hospital-based pediatric gender clinic in the U.S. During our conversation, Dr. Edwards-Leeper, who adapted the “Dutch Protocol”—puberty blockers followed by cross-sex hormones and surgery—to be used in the U.S., used the word “cult” at least five times to describe what’s become of her field. Practitioners, she said, are ignoring nearly everything they’ve learned about childhood development and instead taking cues from colleagues who might have the “lived experience” of being trans but who lack medical training. Often, practitioners fear being labeled transphobic if they fail to follow the dictates of these colleagues.

I asked Pietzke if she agreed with Dr. Edwards-Leeper’s observations.

“Absolutely,” she said. “I definitely think people are afraid of being labeled transphobic.” She described a virtual gender-affirming care training she attended while working for MultiCare. For asking basic questions about possible side effects and health consequences of cross-sex hormones, and about the high correlation between gender dysphoria and other mental health disorders in girls, “that [label] was thrown out at me almost immediately,” she said. “They said I was harming people and that I need to keep ‘politics’ out of it.” After the training session, four people reached out to Pietzke to say that they had the same concerns, but they were afraid to speak up because they saw how she had been treated. “They’re scared,” she said.

When it comes to the politicization of this issue, I told Pietzke, I’m often reminded of Newton’s third law of motion: for every action in nature, there is an equal and opposite reaction. That is, if one side objects to, say, cross-sex hormones for gender-distressed teenagers, the other side doubles down by proposing even more radical interventions or by fear-mongering about suicide. It becomes a game of ping-pong, with vulnerable kids stuck in the middle.

Another activist tactic that really bothers me, I continued, is when they accuse people who object to sex-trait modification for minors of opposing gender-nonconformity in general.

“In reality, it’s the exact opposite,” I said. “I want society to make more space for young people who innately transgress gender norms. All I’m saying is that defying stereotypes is not a medical problem that needs to be fixed.” Especially when the “fixing” means severe health consequences, infertility, and often, particularly for males, anorgasmia.

Pietzke agreed. “Why can’t we just let people be people without making them think there’s something wrong with the way they’re wired?” she said. “Adolescence is uncomfortable for everybody. Let’s be the adults in this situation and guide them through it, rather than rushing to medicalize them.”

To learn more about Pietzke’s preferred approach to counseling young people, I posed a scenario. “Let’s say a thirteen- or fourteen-year-old comes to you for therapy. She’s really masculine-presenting, likes hanging out with boys, is rough and tumble, and she says that she doesn’t feel like a girl. How would you handle this?”

Pietzke didn’t take long to respond. “I have a few thoughts,” she said. “My first inclination would be to ask her, “What does being a girl mean to you? What does feeling like a girl mean? Because if what you’re saying is that you don’t like fake nails and fake eyelashes and going shopping, well, that doesn’t mean you’re not a girl. That’s just one type of being a girl.”

Pietzke continued, “I’ve puzzled over this a lot. I’ve thought, what if a kid came in and said she was going to kill herself because she thought she was in the wrong body? Well, that made me ask myself, what would I do if a person with depression said she was going to kill herself? The solution isn’t fixing the thing that appears to be causing distress. You need to treat the resilience piece, so that when hard things happen or difficult feelings arise, you don’t automatically default to thinking, ‘I don’t want to be alive anymore.’ Of course I’d tell my patient, ‘Yes, I absolutely hear that you’re in pain and I care so much about that. But this suicidal piece, we need to work on that. Because life is hard, and I certainly want to help you have the resilience to be able to navigate the hard things.’”

Pietzke and I talked about the data, in particular the fact that there is no evidence showing that kids and adolescents who don’t receive puberty blockers or cross-sex hormones are at greater risk of suicide, despite activists’ dogged insistence on peddling this narrative. In reality, these treatments could be making things worse for many people.

Pietzke said, “If we just assume that someone’s struggles are strictly because of gender distress and we don’t teach them the skills to navigate depression, anxiety, or whatever else they might be struggling with, we’re not doing them any favors.”

I told Pietzke that I sometimes fear that the LGBT organizations that push this false suicide narrative are actually creating a greater risk of suicide contagion among young people.

“Exactly,” said Pietzke. “If I were 14, and I was told that, if the adults in my life don’t let me do this one thing, I might commit suicide, there’s a good possibility that I would start to think, ‘Maybe I am suicidal.’ I think it just amplifies the distress.”

Since Pietzke went public with her story, she said that no one from MultiCare has contacted her. This doesn’t surprise me. But it surprised Pietzke.

“I really thought, ‘How can people hear this information and the facts and statistics and still think that I’m in the wrong?’” she said. “I know that makes me sound naïve, but I just don’t understand.”

“It’s crazy-making,” I said.

“It is crazy-making. I’ve thought, ‘What is wrong with me?’ I feel like it’s The Twilight Zone, where I’m screaming that the sky is blue and everyone says, ‘No, it’s orange.’”

As Pietzke spoke, I thought back to just a few of the myriad times I’ve questioned my own sanity when it comes to this issue. I told her that I’m constantly asking myself whether I’ve missed some important detail.

“I don’t think the other side is questioning themselves like we do,” said Pietzke. “At least I don’t hear them doing it. If you’re not willing to reconsider your position on things, then you’re pushing for an ideology rather than what’s best practice for the people you’re treating.”

What has helped Pietzke is the support she’s received since she came forward with her story. “I have had people contact me and thank me for speaking out,” Pietzke said. “I’m so grateful for that, because this is a lonely process.”

She mentioned Jamie Reed, the whistleblower from the pediatric gender clinic at Washington University in St. Louis. Reed, who is now the executive director of the LGBT Courage Coalition, which advocates for gender medicine reform and is a resource for whistleblowers, helped Pietzke through the process.

“I listen to Jamie talk and I think she’s so smart, she has so much knowledge,” said Pietzke. “I’m just a mom and a therapist who wants to give people the best treatment that they deserve. Having the support now has meant a lot to me.”

Today, Pietzke has no regrets about blowing the whistle. She said that she would be “devastated” to learn that a young person she had helped transition came to regret it.

“This isn’t a gray area,” Pietzke said. “Kids can’t adequately consent to these treatments. As a therapist, my loyalty isn’t just to them at 13, 14, or 15. My loyalty is to them 10 years down the road, too.”

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