Oklahoma City is now the closest place for North Texas patients to receive pediatric transgender treatment. That could mean more than six hours in the car for Dallas kids each trip. For children in other parts of the state, it may take a full day’s drive to receive the care they need.
In December, Children’s Health quietly removed branding from its website about the once-heralded GENECIS clinic, which provided gender-affirming care to transgender children. The clinic was closed after a conservative group organized a protest at the homes of some Children’s board members against the services GENECIS provided. It was the only one of its kind in Texas.
Those services are not completely gone—yet. Similar services will be offered to existing patients, but no new patients will be admitted for hormone therapy, an essential part of gender-affirming care. As these patients age out of the program, they won’t have another place to go. Texas children will be forced out of state to receive the care that is considered best practice by the American Academy of Pediatrics.
But what exactly is gender-affirming care, and why is it essential that these services be co-located in one clinic? Dr. Shauna Lawlis, an adolescent medicine physician at the OU Children’s Physicians Adolescent Medicine Clinic in Oklahoma City, says the proof is in the patients.
“It is amazing to see these kids transform in a positive way,” she says. “They are often so happy that there’s a doctor that understands them and listens to them and is supportive of them, and there are interventions we can do to improve their dysphoria. You see improvements by leaps and bounds.”
The clinic in Oklahoma includes a social worker who connects the family to resources and an adolescent physician to guide their specific needs. The patients are between 10 and 25 years old. Physicians who work in the clinic have experience navigating puberty, relationships, independence, and mental health conditions that tend to develop during this period. The clinic also has a dietitian, as gender dysphoria is often accompanied by eating disorders. It also has gynecology services.
The clinic offers endocrinology services for puberty blockers and hormone therapy. There are mental health providers to provide care for a population that is often bullied, excluded, and isolated. According to The Trevor Project’s third annual National Survey on LGBTQ Youth Mental Health, 52 percent of transgender and nonbinary youth in the U.S. contemplated suicide in 2020. The clinic has gynecology services as well.
Because these services are located within one clinic, multiple providers can see the patient in one day, which is especially important because these clinics are so few and far between. Patients come from all over the region to seek care. The clinic also works with a network of therapists that offer gender-affirming care to patients closer to home, so they don’t have to drive to the clinic for more frequent therapy sessions.
Finally, patient comfort is paramount. They need to feel welcomed, affirmed, and supported, which is often the opposite of what they experience outside the clinic’s walls.
“They know that they’re going to be addressed correctly, they’re not going to be misgendered, and they’re not going to be dead-named (being called their name before transitioning),” says Amy Barrier, a nurse practitioner and the leader of Prism Health North Texas’ Transgender Care Task Force, which treats transgender adults in Dallas. “They’re going to be treated with respect, and that lack of discrimination is the best thing that we provide outside of helping them get to the body that they belong in.”
While many of these patients experience mental illness, Lawlis says that gender dysphoria is not a symptom of mental health problems. The differences are biological; patients with gender dysphoria have brains that look more like the brains of those with whom they identify. “The mental illness diagnosis is actually caused by the distress at their body and their brain not matching up,” she says.
Over the past several years, Lawlis has seen the clinic grow from 100 patients to more than 1,300. When I asked her if she had seen an influx of Texas patients since GENECIS closed, she told me she didn’t know because they were still working to schedule appointments for requests that came in before the announcement. It is a service in high demand, but it is also under threat.
The 2021 Texas legislative session included dozens of bills that threatened the transgender community, including denying transgender children access to puberty blockers, hormone treatment, or surgery for gender confirmation. House Bill 25 was signed by Gov. Greg Abbott last year and requires public school students play in athletic competitions based solely on their assigned sex at birth.
This type of care is also under attack in Oklahoma. Last year, Oklahoma lawmakers introduced a bill that would make it a felony to provide gender-affirming medical treatment other than counseling to anyone under the age of 21. Lawlis isn’t particularly hopeful for the future of gender-affirming care in Oklahoma, either. “I only expect it to get worse, which is of course upsetting,” she says. “We’re all worried about these kids and where they will get care if we all get shut down.”
Legislation like that is making some families leave the state. I spoke with the Tran family, which uprooted and moved to Seattle from Dallas when their child came out as transgender. “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,” she told me. “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.”
Despite the opposition at home and around the country, Lawlis is on a mission to provide care to those who need it. That list of patients now includes any new patient in Texas.
“We feel very strongly about providing care in a place where there aren’t a lot of options for care. I could go to California and be one of 200 providers, but I can make a bigger impact here,” she says. The stakes are high. “It’s literally life or death for these kids. They are so unhappy in their bodies that shutting down these clinics might cause an uptick in suicide rates.”