Dr. Ximena Lopez didn’t expect her life to be transformed by a fellowship at Massachusetts General Hospital. This was in 2006. The pediatric endocrinologist had begun her career researching Type 2 diabetes, but she found herself in Boston assisting at the country’s first pediatric transgender treatment clinic. The stigma around the treatment of transgender children was still strong, despite the pressing need and life-or-death stakes. A recent study found that 30 percent of transgender youth report at least one suicide attempt, and 42 percent report a history of self-injury, such as cutting. One kid in Boston still stands out for Lopez.
“The patient’s mother found that no one was willing to treat this child,” she says. “For me, that was a revealing experience. I knew nothing about it. And this patient told us his story. He was a perfectly normal kid, and he got all the medical support to be himself.”
After she moved to Children’s Health in Dallas and joined the faculty of UT Southwestern Medical Center, in 2012, she founded the GENECIS program, the first treatment clinic in the Southwest for children with gender dysphoria.
The challenges were multifaceted. For one, the limited number of programs—only three or four in the country at the time, though that number has risen to around 40—meant few doctors possessed the experience required for treating transgender children. The treatment is, likewise, multifaceted, requiring a team that includes a pediatric endocrinologist, pediatric gynecologist, mental health experts, social workers, and other doctors. Even though being transgender is not a mental health issue, Lopez says, the social and cultural environments trans kids live in often contribute to a high risk for suicide and necessitate a treatment program that closely involves parents. All of this takes a huge amount of time, energy, and hospital resources. That’s even before confronting the issues of stigma and discrimination that still surround the treatment of transgender children.
“There is still some controversy in the field,” she says. “There are physicians that don’t want to jump in the water.” The families, too, sometimes have a difficult time facing the challenge. “It is not a decision that parents jump on and are excited about. Most say this is a difficult road, that it is not something you chose, but you have to support.”
The GENECIS program does not offer surgery but rather employs a hormonal treatment similar to one used to help children who are suffering from early onset puberty. It is a reversible process, but most transgender children who undergo the treatment do not opt to reverse it. Instead, what happens is a remarkable transformation, one that begins with the patients but extends to their parents, who develop a strong, almost familial bond with the team at Children’s. Lopez tells a story about one family from Arkansas who drove five hours to Children’s because there was no hospital near them that would treat their child. Even though they have since moved to California, where there are accessible clinics, the family continues to fly back to Children’s for treatment.
“This is something we hear a lot,” she says. “I want to point out it is teamwork. We have the most grateful families I have ever had in my professional experience. It is the most satisfying work I have ever done. Every single encounter is so rewarding. They tell us, ‘You are my hero. You are saving my kid’s life. We don’t know what we would do without you.’ ”