Jamie Reed stood before a room full of Republicans in St. Louis County in September, clicking through a presentation about pediatric gender medicine.
The former social worker at a St. Louis transgender clinic described puberty blockers and hormones in stark terms and warned of what she sees as lasting harm to children. The audience gasped, groaned and, at one point, a woman called her a hero.
But Reed had come to make a political case, too.
Amendment 3 would reinstate Missouri’s abortion ban with limited exceptions while also constitutionally prohibiting gender-transition treatments for minors. And Reed, who describes herself as a lifelong liberal and supports legal abortion with some restrictions, told the room which part of the measure she thought could help carry it.
“If we talk to people about the trans part of this amendment,” she said, “we can get it to pass.”
That calculation has become increasingly visible in the campaign for Amendment 3, as supporters emphasize restrictions on transgender healthcare in television ads, yard signs and public appearances — even though most gender-affirming medical care for minors is already banned in Missouri.
Chelsea Freels, 20, noticed that strategy as she passed signs on the way to visit her grandmother at the Lake of the Ozarks over the summer.
“Yes on 3,” they read. “Ban transgender surgeries for minors.”
The signs surprised Freels, who received puberty blockers as a minor in Missouri. Gender-affirming surgeries for minors are already banned, as are puberty blockers and cross-sex hormones.
Two years earlier, Freels, who grew up in St. Louis, helped canvas across Missouri in support of the 2024 reproductive rights amendment. Voters narrowly approved it, overturning the state’s near-total abortion ban and protecting abortion rights until fetal viability.
A year later, the Republican supermajority in the statehouse put Amendment 3 on the ballot.It would ban most abortions, with exceptions for medical emergencies, fetal anomalies and pregnancies caused by rape or incest during the first 12 weeks.
Polling points to another very close race in Missouri. Abortion access remains popular, as does banning hormone therapy or medications and gender-transition surgeries for minors.
“It’s really telling that the Republicans have shifted a lot of their messaging about A3 away from abortion,” Freels said. “And towards demonizing children.”
The campaign to ban abortion argues both issues fall under the same goal: protecting children by legislating reproductive healthcare.
“We’re not anti-anyone,” said Amanda Sanders, a spokesperson for Her Health, Her Future, the campaign for Amendment 3. “This is pro-protecting their childhood, their innocence.”
Many major healthcare coalitions, including the American Academy of Pediatrics and the American Medical Association, support gender-affirming care for transgender youth, though surgery is uncommon for minors and some groups recommend deferring it until adulthood.
Opponents call the transgender provision “ballot candy,” arguing lawmakers added an already-banned practice to make an abortion ban more attractive to voters.
“The politicians pushing Amendment 3 are lying,” said Tom Bastian, a spokesperson with the No on 3 Stop the Ban campaign, which includes Planned Parenthood, Abortion Action Missouri and the ACLU of Missouri. “The facts are that healthcare for transgender youth is already banned in Missouri and it will remain banned no matter how people vote.”
If Amendment 3 passes, Missouri will be the first state to place a ban on gender-affirming care in its constitution. Twenty-six other states have statutory bans in place.
On Tuesday evening, Missouri Gov. Mike Kehoe on a webcast fundraiser for Her Health, Her Future, emphasized that Missouri is a battleground for abortion and transgender issues. The message laid out the larger stakes: If Missouri voters champion Amendment 3, other conservative states could follow suit with a similar amendment framework.
“What happens here doesn’t just matter to the people of St. Louis or Kansas City, or Springfield, or the small towns across our state,” Kehoe said. “People around the country are watching to see what Missouri does.”
‘Political scapegoat’
“It starts with drag queen story hour and ends with children under the knife,” begins the first of two TV ads for Her Health, Her Future. “Irreversible sex change surgeries on minors, that’s the goal of the trans extremists.”
Such surgeries were rare in Missouri before the state banned them in 2023. An internal Washington University review found its transgender center stopped referring minors for surgery in late 2018. Six chest surgeries were performed by university physicians on adolescents transitioning to male between 2018 and 2023, but the referrals came from outside providers.
Sara Burke, a Syracuse University psychology professor who studies stereotyping and discrimination, called the campaign rhetoric political scapegoating that could worsen prejudice against transgender people.
“Abortion is quite popular; whereas, there seems to be a wave of knee-jerk, anti transgender sentiment in politics right now,” Burke said. “They’re just trying to score points, and it’s a cynical ploy with real human consequences. Transgender children are highly vulnerable. Treating them as a political scapegoat makes their lives worse.”
Those now championing Amendment 3 point to the August 2027 sunset on the ban restricting cross-sex hormones and puberty blockers as a reason for asking voters to ban something that’s already banned. The ban on gender-affirming surgeries for minors has no expiration.
“We do not want to leave the protections for children to the winds of the political change of whoever is in office in the legislature and courts,” Sanders said.
Earlier this year, the Missouri Supreme Court upheld the ban on gender-affirming care for minors, known as the SAFE Act, rejecting a challenge brought by families represented by the ACLU of Missouri and Lambda Legal.
Opponents of Amendment 3 say lawmakers could extend the expiring restrictions before they sunset.
Asked about the strategy to leave abortion out of TV ads, Sanders said the campaign was leaning into all sides of the amendment.
“We will continue to put out content on all aspects of this abortion vote,” she said. “But this was so important that I think it could get lost in the conversation if it wasn’t pointed out.”
Opponents argue abortion is what has been lost.
“The legislature banned transgender care for minors a couple years ago,” Michael Wolff, a retired chief justice of the Missouri Supreme Court and dean emeritus of St. Louis University School of Law, said in a political ad for Stop the Ban. “Misleading? That’s what it is. Don’t let politicians fool us into banning abortion again.”
A court challenge last year argued unsuccessfully that Amendment 3 violated Missouri’s single-subject rule by combining abortion and gender-affirming care. An appeals court ruled the subjects were sufficiently connected because transition-related treatments may affect fertility and therefore could be considered related to reproductive health care.
What is reproductive healthcare?
Reed has become a prominent voice in the Yes on 3 campaign and appears in one of its television ads. Her public profile dates to 2023, when she accused the Washington University Transgender Center of rushing minors into puberty blockers and cross-sex hormones without adequate mental health assessments and failing to fully inform families about potential side effects.
“I probably was the last expected person to speak in the room tonight,” Reed told the crowd. “And maybe the last expected person to speak up in support of Amendment 3.”
Those familiar with her story might not be so surprised.
Reed became a national name in the trans healthcare debate in 2023, when she gave an affidavit to the Missouri attorney general with her accusations against the Washington University center.
Families whose children received care at the clinic for yearshave disputed Reed’s characterization in testimony and interviews with The Independent, describing evaluations that lasted months and saying providers discussed fertility preservation, including egg and sperm storage.
Reed rejects the idea that she is sacrificing abortion rights to secure a ban on gender-affirming care. She does not believe people can change sex and sees medical transition as harmful to gay and gender-nonconforming people.
“This is a fundamental attack on gender, non-conforming homosexuals,” Reed said. “And for me to have that message in a room of Republicans goes to show how challenging this issue is for the left … it kills me that the Democratic party is willing to die on this hill.”
TJ Billard, a Northwestern University communications professor who studies media and transgender politics, said pairing abortion and transgender care reflects a broader political argument about gender, sexuality and traditional social roles.
Billard said describing the transgender provision simply as a political “pill hidden inside the cheese” risks missing why the issues appeal to many of the same voters.
Both can be framed around anxieties over changing ideas about gender and sexuality, Billard said, making transgender issues an increasingly potent political flashpoint.
So far, they said, trans advocates have been woefully unsuccessful in garnering more support in the face of these arguments, which Billard characterized as misinformation and fear-mongering.
“The vast majority of people had never given thought to a trans person, certainly didn’t necessarily care about trans people, and definitely, even if they opposed it, didn’t think it was a problem at a scale that needed immediate political addressing,” Billard said.
A 2025 study by St. Louis University’s Transgender Health Collaborative found that 35% of parents of LGBTQ youth were considering leaving the state; 96% of parents to LGBTQ youth reported feeling the same or more stress and increased concern for their child’s safety.
Katie Heiden-Rootes, a St. Louis University family therapist and researcher who works with transgender young people and their families, said clients have told her the election-year visibility has made it harder to sleep, work and parent.
She accused Missouri Republican leadership of creating “boogeymen” out of the trans community to sway a vote.
“It stokes fear and hatred towards a group of people who really just want to live and be seen as full humans in the state of Missouri,” Heiden-Rootes said. “And that’s not what’s happening right now.”
Kelly Storck, a private practice therapist who focuses on gender care in the St. Louis area, said because of the 2023 law, her minor patients and their parents have to drive to Chicago and beyond to access medical treatment options. Now, she said, they’re also facing a “smear” campaign.
“It keeps people quiet. It keeps people hidden. I promise you legislation like this has killed children and will continue to enact great harms to children,” she said. “They will not see a way or a place for them to exist in the world, because of these conversations, and because these anti-trans sentiments and ideologies exist.”
Rene Freels, Chelsea’s mother, still lives in the St. Louis suburbs with her husband. Their home once felt politically insulated, she said. Then Yes on 3 signs appeared in the churchyard down the street.
Chelsea has become more hesitant to visit home, her mother said.
The family has considered moving but decided instead to save money in case they eventually feel they need to leave the country with their daughter.
“Us parents are trying to end this so that when we pass away, our kids don’t have to deal with this type of discrimination, this vile discrimination, so that they just can live their lives free and have free movement,” Rene Freels said. “Nobody’s life is easy, but at least they can just be free to be themselves. But this is just an onslaught against our kids.”
Chelsea Freels said when she canvassed for abortion rights in 2024, she met conservatives all over the state whose political beliefs were rooted in loving their neighbors and treating one another with kindness. It’s why, she believes, Missourians voted to raise the minimum wage and establish paid sick leave, why they expanded Medicare access and why they voted for abortion rights.
“When you ask those people if they want to protect the people around them, it’s always a yes,” she said, reflecting on the 2024 election. “And that’s why I’m confident that we’re going to win this one.”
This story was originally published by the Missouri Independent.
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