Texas Youth Gender Clinic Closed Last Year Under Political Pressure
A Texas clinic for transgender adolescents closed last year amid pressure from the governor’s office, hospital officials said in phone recordings.On a tense conference call last November with half a dozen doctors and executives at the University of Texas Southwestern Medical Center, Dr. John Warner relayed a somber message: The only specialty clinic in the state to treat transgender adolescents was facing unrelenting political pressure to close.State lawmakers had already sent formal inquiries about the clinic, Genecis, which was financed by the public university and housed at Children’s Medical Center in Dallas. Activists calling the clinic’s treatments “chemical castration” had shown up at the office of one of the children’s hospital’s board members.And then there was Gov. Greg Abbott.“We received a reach from the governor also requesting information about the clinic,” said Dr. Warner, an executive vice president at the medical center, according to a recording of the call obtained by The New York Times. “And with that came an expectation that something different would occur.”“Time is not on our side,” he added. “The conversation is intensifying — not the reverse.”The next week, hospital executives closed the clinic, taking down its website before staff members or patients were informed of the change.The demise of the clinic, which saw around 500 patients in 2021, shows how treatments for transgender minors have become a highly contentious issue in Republican-controlled states across the nation, with elected officials challenging widely accepted medical practices in an echo of the debate over abortion.That fight has reached a fever pitch in Texas.Days before he won a contentious Republican primary last week, Mr. Abbott and the Texas attorney general directed the state’s child welfare agency to investigate “‘sex change’ procedures and treatments” as child abuse, arguing that even hormone therapy should be considered an “abusive procedure.” The directive drew sharp criticism from medical groups and a swift lawsuit from civil rights groups, which said the directive violated the rights of transgender adolescents and their parents.But months ago, before these moves were making national headlines, executives at U.T. Southwestern were discussing closing down Genecis because of what they described as direct outreach from the governor’s office, according to recordings of several phone discussions among hospital executives obtained by The Times.What the governor’s office purportedly said to pressure the hospital’s leadership is unclear.When asked about these interactions, U.T. Southwestern said in an emailed statement that the governor was not personally involved. But the hospital did not answer questions about whether Mr. Abbott’s office had contacted hospital executives. “Inquiries regarding actions by the Governor’s Office should be directed to the Governor’s Office,” the statement said.Mr. Abbott’s office did not answer questions about the substance of these conversations or whether they took place, but it denied involvement in U.T.’s decision to close Genecis.“The Governor’s Office was not involved in any decision on this issue,” Nan Tolson, a spokeswoman, said in an email. Genecis, the only pediatric gender clinic in Texas, was housed in the Children’s Medical Center in Dallas.AlamySince its founding in 2014, the Genecis clinic had offered patients aged 5 to 21 counseling, pediatric care and, starting at adolescence, puberty-blocking drugs and hormones. (The clinic did not perform surgeries.) With no other options for such comprehensive care, the clinic was sought out by families across the state. It also published scientific research about its patients.“The Genecis clinic has been a leader in producing data about the youth they see — data that everyone on every side of this issue has argued that we need,” said Kristina Olson, a psychologist at Princeton University who studies gender development in children.Early evidence suggests that these hormone treatments, part of what’s known as “gender affirming” care, improve the mental health of trans teenagers. But few studies have looked at the long-term outcomes of adolescents who take these medications, which may also come with risks, like fertility loss.Gender-affirming care has been endorsed by major medical groups in the United States. Although some doctors have debated which adolescents will benefit most from such treatments, many say that the decision to take them should be made by patients, their parents and their health care providers, not the state.Legal experts have also questioned whether shutting down the clinic could constitute discrimination under federal statutes. Pediatric endocrinologists around the country — including those at U.T. Southwestern — routinely prescribe similar drug regimens to children with hormonal disorders who are not transgender.“The U.S. Supreme Court has held in the ‘Bostock’ case that discriminating because of sex does include gender identity,” said William Eskridge, a professor at Yale Law School. “Ultimately they are denying medical care based upon gender identity.”The federal government has taken a similar stance. “Denials of health care based on gender identity are illegal, as is restricting doctors and health care providers from providing care because of a patient’s gender identity,” according to a statement released last week by the Department of Health and Human Services.On the campaign trail in Texas, transgender health care has often come to the forefront. Last summer, after legislation that would have banned such treatments for minors failed in the state legislature, Mr. Abbott’s primary opponent, Don Huffines, attacked the governor for not taking a bolder stance in favor of the bills.Weeks later, Mr. Abbott said on a conservative radio program that although the bills had not passed, he could “game the odds” and had “another way of achieving the same exact thing.”On a call with other hospital leaders around the same time, Dr. Warner said that hospital executives had been responding to “some questions from the governor’s office” as well as from state lawmakers, according to a recording obtained by The Times. The executives discussed how they would try to keep the clinic open in some capacity despite political pressure to close it.“There is the possibility that we as a state agency cannot provide this care,” Dr. Warner told the group on the July call. “So the question we’re going to be asking of ourselves is what should U.T. Southwestern do as a state agency that provides the most benefit to the kids but also protects the institution.”But in another call several months later that was also recorded, any possibility of the clinic staying open seemed gone.“I do not think that in our current circumstances that — without some modification of the clinic — that it would be allowed to continue,” Dr. Warner said on the November call. “People will come after it until it’s gone.”U.T. Southwestern and Children’s Health took down the Genecis website on Nov. 11. A week later, staff members were told that existing patients could still be treated at the hospital, but no new patients could be accepted. The decision was made without consulting the medical center’s ethics boards.Texas’s Push Against Gender-Affirming TreatmentsCard 1 of 6Limiting trans care. More
