“Gender and weed fucked up my head,” Robin Westman wrote in a manifesto published before he/she killed two children and injuring 20 others at a Minneapolis Catholic church in August 2025. “I wish I never tried experimenting with either. Don’t let your kids smoke weed or change gender until they are like 17.”
Six mass shooters between 2018 and 2026 share a pattern no red flag law addresses. All were under medical treatment for mental health conditions. All were taking psychiatric medications, hormone therapies, or both. All fell within or near FDA black box warning age ranges for medications documented to increase suicidal ideation and aggressive behavior. Five of the six had authorities or family members who knew about mental health crises but failed to intervene on medication protocols.
The U.S. Food and Drug Administration conducted meta-analyses of 372 randomized clinical trials of antidepressants involving nearly 100,000 participants. The rate of suicidal thinking or behavior reached 4% among patients assigned antidepressants compared to 2% on placebo. In 2004, FDA required black box warnings on all antidepressant medications for children and adolescents under 18. The agency expanded the warning in 2007 to include young adults ages 18 to 24.
Systematic reviews of testosterone therapy document increases in aggression-related constructs. The behavioral tendency to react aggressively increased in three studies out of four at three months follow-up. The World Professional Association for Transgender Health guidelines warn of aggression increases in transgender men taking testosterone treatment. Medical literature documents “greater readiness to act on anger” and “increased anger expression” particularly among those on masculinizing hormone therapy.
Jesse Van Rootselaar was 18 when he/she killed eight people at Tumbler Ridge Secondary School in British Columbia on February 10, 2026. Police had responded to Van Rootselaar’s residence “multiple occasions over the past several years” for mental health concerns. Authorities apprehended him/her under Canada’s Mental Health Act multiple times for assessment. He/she was taking antidepressants and antipsychotics for ADHD and OCD at the time of the shooting. Two years before the massacre, police seized firearms from the home. The lawful owner petitioned for their return. Authorities returned the weapons approximately one month before the shooting.
Robin Westman was 23 when he/she killed two children and injured 20 others at Annunciation Catholic Church in Minneapolis on August 27, 2025. Westman had legally changed names at 17 to identify as female. The manifesto he/she published on YouTube hours before the attack detailed depression, suicidal thoughts, and explicit regret about gender transition. Minneapolis Police Chief Brian O’Hara stated authorities had “no previous indication” that Westman suffered from mental illness. Westman legally purchased three firearms one month before the attack with no background check flags.
Audrey Hale was 28 when he/she killed six people at Nashville’s Covenant School on March 27, 2023. Metro Nashville Police Chief John Drake confirmed Hale “was under doctor’s care for an emotional disorder.” Hale’s parents felt he/she should not own weapons due to mental health concerns. The parents were unaware Hale had hidden seven firearms in the house while under treatment. Hale legally purchased those seven firearms between October 2020 and June 2022. All purchases occurred while Hale was under doctor’s care for the emotional disorder. Chief Drake stated that had law enforcement known about Hale’s treatment and mental health condition, “they would have worked to remove weapons from the home.”
Alec McKinney was 16 when he/she killed one student and injured eight others at STEM School Highlands Ranch in Colorado on May 7, 2019. McKinney had been diagnosed with adjustment disorder. His/her mother knew McKinney was cutting at age 13 but took two years to seek professional help. McKinney told therapists he/she felt “overburdened” in 2015. Authorities hospitalized him/her more than once for mental health crises. McKinney asked for help several times.
Snochia Moseley was 26 when he/she killed four people at a Maryland Rite Aid distribution center on September 20, 2018. Friends confirmed to the Washington Post that Moseley suffered from bipolar disorder and depression linked to rejection after coming out as gay then transgender. Moseley had started hormone therapy one year before the shooting and planned gender-reassignment surgery. A friend described Moseley as “struggling with the transition.”
Anderson Lee Aldrich was 22 when he/she killed five people at Club Q in Colorado Springs on November 19, 2022. Defense attorneys told the court Aldrich was “drugged up on cocaine and medication” at the time of the shooting. Fourteen months earlier, Aldrich had threatened grandparents with a homemade bomb and firearms, vowing to be “the next mass killer” and “go out in a blaze.” Authorities found a tub of bomb-making chemicals, handguns, hundreds of rounds of ammunition, and body armor. Relatives warned Aldrich would “hurt or murder grandparents if freed.” El Paso County prosecutors dropped all charges when family members refused to cooperate.
Four of the six shooters were taking medications or hormones at ages within FDA black box warning ranges. Van Rootselaar was 18. Westman was 23. McKinney was 16. All three fell within the FDA’s identified risk groups for antidepressant-induced suicidal ideation and behavior.
State and federal legislators debate red flag laws targeting firearm ownership. No comparable laws restrict prescription of medications carrying FDA black box warnings for suicidal ideation in the exact age ranges these shooters occupied. No laws prevent hormone therapies documented to increase aggressive behavior in systematic medical reviews. Treatment protocols continue. Firearms purchases proceed legally. Young people remain “under doctor’s care.”
The pattern persists because the policy debate focuses on the weapon while ignoring the treatment.
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