It caught providers and patient families by surprise when the GENECIS clinic was removed from the Children’s Health and UT Southwestern websites, but it wasn’t a glitch. The clinic, the first of its kind in the southwest and the only option for transgender youth in the region, has been disbanded and will not provide hormone therapy for new patients for gender dysphoria.
Formed by UT Southwestern pediatric endocrinologist Dr. Ximena Lopez, the GENder Education and Care Interdisciplinary Support (GENECIS) program was one of only a handful in the country when it was founded in 2014. But the clinic and the practice had come under fire in recent months.
Several bills were filed in Texas’ last legislative session attempting to limit gender-affirming care to transgender youth. Senate Bill 1311, which passed the Senate but not the House, would have revoked the medical license and liability insurance coverage of any physician who prescribed hormone therapy or puberty suppression treatment for the purpose of gender transition.
In September, conservative advocacy group Save Texas Kids called on state officials to investigate Children’s Health because of its treatment of transgender children. “The Board Members of Dallas Children’s refuse to promise they will limit ‘gender dysphoria’ patients under 18 to therapy only!” the group wrote on its Facebook page. “That is our only ask. Children and young teens look for belonging and identity throughout their youth. This is normal. What is NOT normal, is allowing children to undergo irreversible ‘Puberty blocking therapy,’, which is akin to chemical castration. We demand the GENECIS clinic cease this practice at once.”
Save Texas Kids also pressured Children’s board members to shutter the clinic. In Facebook post the week before the branding was removed, the group urged its members to protest at the home of Robbie Briggs, a Children’s Health board member and owner of Briggs Freeman Sotheby’s International luxury retail firm.
But just months before removing the clinic’s branding and no longer accepting new patients, Children’s Health was defending its practices. It issued its own statement: “With a suicide attempt rate of up to 41 percent for children and adolescents with gender dysphoria, there is a need for comprehensive care for these youth. Given the significant suffering and extraordinarily high suicide rate in these children, offering a comprehensive, multidisciplinary approach is needed to help treat this medical problem.”
The clinic never offered gender-altering surgery but used hormone treatments to delay puberty, which the clinic says is a reversible process. Now the comprehensive care will be divided between specialist groups at the hospital for existing patients. New patients won’t receive hormone treatment, though existing patients won’t have their treatment interrupted, Children’s Health and UTSW told D CEO in a joint statement.
“Pediatric endocrinology, psychiatry and adolescent and young adult care coordinated through this program are now managed and coordinated through each specialty department. We do not anticipate any interruption of care or services for our existing patients who already receive care with these specialty teams. The choice to remove branding for this care offers a more private, insulated experience for patients and their families.
“New patients will be seen in the appropriate specialty departments. We accept new patients for diagnosis, including evaluation of gender dysphoria, but will not initiate patients on hormone or puberty suppression therapy for only this diagnosis. Coordination of care continues to be available, including support from social work.”
Few doctors possess the know-how to provide these patients with the care they need. The unique combination of mental health needs, hormone treatment, and affirmation is a unique skill set that most pediatricians lack. Dr. Lauren Gore is a pediatrician at Pediatric Associates of Dallas and has referred patients to GENECIS. “I don’t know how to talk about puberty with a child who has gender dysphoria and the emotions that come with that,” she says. “These mental health professionals are specifically trained in gender dysphoria, and they design a whole system of gender-affirming care with the experience to help people through some rough transitions like puberty that I don’t have.”
Areana Quiñones, executive director for the Texas nonprofit organization Doctors For Change, described gender-affirming care to the Texas Tribune as “judgment-free, individualized care oriented toward understanding and appreciating a person’s gender. More time is spent allowing kids to socially transition instead of focusing on medical treatment. A social transition consists of the steps a child takes to affirm their identity. An example could include allowing a child assigned male at birth to wear clothing, grow their hair, or use a different name that better fits their identity.”
For existing patients, the unbranding of the clinic may provide a more private, insulated experience. Perhaps the practice won’t be a lightning rod for conservative activists, even though the services for existing patients will be the same. But newcomers who want that same level of treatment, which has been affirmed by the American Psychiatric Association and American Academy of Pediatrics as the standard of care, have to go elsewhere. According to the Human Rights Campaign, Children’s Health was the only such program in the state. The nearest clinics are now in Oklahoma and Arkansas.
The bundled services and branded clinic not only were a signal to children that there was a place for them to receive care affirming care, it was convenient as well. The marginalized group of children are much more likely to suffer from mental health issues as a result of their diagnosis. “I’ve had some patients who have come to me on a low dose of depression medication,” says Amy Barrier, a nurse practitioner and leader of PHNTX’s Transgender Care Task Force who treats adult patients, may of which were unable to receive gender-affirming care as children. “Once they’ve been able to start their transition, they have no longer needed their depression medication. Depression runs rampant among the LGBT community concerning worry about acceptance, both from their peer group, adults, and within the trans community. There’s a lot of emotional labor that goes into living life as a transgender person.”