When Dr. Anna Tran’s teenage daughter came out as transgender, the first thing she wanted to do was go shopping. The request was remarkable from a child who never wanted to go out, buy new things, hang out with friends, or leave her room.
Tran’s daughter had been diagnosed with high functioning spectrum disorder, but since receiving gender-affirming care from the GENECIS Clinic at Children’s Health, her mother says she is a whole new child, and her pediatrician believes it was a misdiagnosis. “We knew there was something different about her from a very early age,” says Tran, who is an internal medicine physician. “Looking back, I think it was a misdiagnosis because she’s a completely different child now.”
I first met Dr. Anna Tran during the depths of COVID-19, when the former Medical City Dallas physician was treating COVID-19 patients by day and quarantining from her family in her own house. “I haven’t touched my kids in a month,” she told me at the time, in April 2020. But beyond the impact of the pandemic, she was dealing with other family issues.
When her daughter came out, Tran immediately supported her and researched what type of care she could find. She quickly found GENECIS, Children’s Health’s gender-affirming clinic, online. “If that weren’t on the website, we wouldn’t have found it,” Tran says. The branding provided a beacon of hope for those looking for care. “For us, that part is all so affirming. Not calling it what it should be is a terrible message to our kids.”
The clinic offered interdisciplinary care to children experiencing gender dysphoria, a unique combination of mental health needs, hormone treatment, puberty blockers, and affirmation that can’t be found in any one pediatric, mental health, or endocrinology clinic. It doesn’t offer any surgery, and the treatments are reversible. The clinic, which was operated by UT Southwestern and Children’s, closed and was disbanded after facing criticism from conservative advocacy groups, who planned a protest at a Children’s Health board member’s home against the clinic. It can no longer be found online, and UTSW and Children’s Health have said that current patients will continue to receive services from specialists but that the clinic will not be accepting new patients for hormone therapy. As these patients age out of the clinic, the treatment will no longer be available in the entire state of Texas.
The clinic isn’t closing for lack of interest. It took the Tran family six months to get an appointment with GENECIS, and Tran’s daughter began receiving treatment in May 2021. The impact, Tran says, was life-changing. Her daughter used to stay in her room and never wanted to go out in public. She didn’t engage and never asked for anything. “Now she has friendships, and she’s the one that makes plans to go out with her friends,” Tran says. “This was not something that we expected. She’s the most extroverted of our kids now.”
A physician herself, Tran wanted to ensure that the treatment was safe, effective, and not something her daughter would regret. Tran says the clinic’s processes are rigorous, and the puberty blockers and cross-gender hormones her daughter received were not prescribed on a whim. The patient must exhibit consistent and intense gender dysphoria, which causes significant distress or impairment related to the strong desire to be a different gender.
Tran’s daughter also experienced body dysmorphia, where her body’s changes were causing her pain because they didn’t align with her mind. “A lot of people think it’s a choice or it’s a phase where it is going to make somebody happy,” Tran says. “When I asked her how she feels now that she’s on hormones, her response was, ‘I’m happy it’s not going to get worse.’ She did not want her body to change. The people who are on the gender spectrum to the point where they have body dysmorphia are the ones that need this kind of treatment.”
There are studies showing that long-term cross-gender hormone use can increase a person’s risk of heart disease and blood clotting, which worried Tran at first. Despite the risks, the American Academy of Pediatrics approves the treatments because of the mental health risks of denying it. A 2020 survey by LGBTQ youth crisis intervention organization The Trevor Project polled 40,000 LGBTQ people between 13 and 24. It found that 55 percent had major depressive disorder and 40 percent say they have “seriously considered” attempting suicide in the past year. Like any other medical decision, the treatments aren’t without risk, but the benefits outweighed the potential future issues for Tran.
In a way, the Tran family predicted what would happen to the GENECIS clinic. During the last legislative session, when several anti-transgender bills were presented by state lawmakers, the family made the difficult decision to move to a place where their daughter would be legally protected. Several months ago, Tran and her daughter uprooted their lives to move to Seattle, where there are more transgender providers for children and adults and where transgender individuals have more legal protections.
“We wanted to get her to a place where they had local protections already in place, and a culture that was much more affirming. It’s not an easy move, but it’s something that we thought we needed,” Tran says. “Some of our friends and family thought we were paranoid for doing that. I wish I were wrong, but when I heard about GENECIS closing, if we had stayed in Texas, I don’t know how my daughter’s mental health or my family’s mental health would have been.”
Tran had to quit her satisfying job at Medical City and find employment in Seattle. She and her daughter are still flying back for treatment at UTSW because they were already receiving it before the health system stopped treating new patients with hormones.
“In hindsight, I think we did the right thing, but it doesn’t make it easy,” Tran says. “I’m in the middle range of my career and advancement, I had spent several decades honing my skills, and now I’m starting over again. That is something that we chose to do. We feel that we have lived our lives, and it’s time for her to live her life as well.”