Dallas facility that serves transgender children can accept new patients, judge rules

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A Dallas-based program that offers mental health services and hormone treatments to transgender children may resume the therapy for new patients for the first time since November, after a judge temporarily cleared away legal barriers to the practice.

The program director, Dr. Ximena Lopez, had filed a lawsuit in March against Children’s Medical Center in Dallas for shutting down operations to new patients last fall at the GENder Education and Care, Interdisciplinary Support (GENECIS) program, which is housed at the hospital and run jointly by it and UT Southwestern Medical Center.

The May 12 temporary restraining order banned those restrictions for two weeks, and within hours after the decision, five new patients had been scheduled at the center. On May 23, Dallas County Court-at-Law Judge Melissa Bellan granted an injunction that will remain until a trial scheduled for April 18, 2023, The Dallas Morning News reported. Bellan will decide then whether to make the injunction permanent.

“It’s powerful,” said Dallas lawyer Charla Aldous, who represents Lopez. “This is going to affect the lives of children. It really is.”

The GENECIS center was formally dissolved in November, which meant that patients already enrolled in the program still had access to the hormone therapies, but that new patients had to be turned away for those services.

Since November, the clinic has had to turn away about 100 families with children who wanted to begin the treatment at the center, Aldous said. The center had also been told that starting in June, it would no longer be allowed to start gender-affirming hormone therapy for any patients, including those already being seen by mental health doctors there.

Lopez's lawsuit demands the hospital allow clinic doctors to offer what they describe as lifesaving treatment to young people with gender dysphoria and similar issues.

The clinic does not offer surgical options or gender confirmation surgery for either children or adults. Under the gender-affirming model of care, 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.

GENECIS was dissolved after facing months of pressure by socially conservative political leaders and activists, who organized protests targeting hospital board members and accused the program of committing child abuse.

Bellan wrote in her May 12 order that Children’s Medical Center had violated the law by “interfering with, controlling, or otherwise directing any physician’s professional judgment” and by “discriminating against patients on the basis of the patient’s gender identity and directing (Lopez) to violate the law by discriminating against patients on the basis of a patient’s gender identity.”

The ruling barred Children’s Medical Center from prohibiting GENECIS doctors from restricting puberty blockers or hormone therapy to existing or new patients to treat gender dysphoria as part of gender-affirming care.

“Dr. Lopez is very relieved that she can now treat her patients in the manner in which she has been trained to do and what the standard of care requires,” Aldous said. “She’s thrilled with the court’s decision.”

Officials at UT-Southwestern declined to comment after the temporary restraining order was issued earlier this month, saying they don’t talk about pending litigation. Asked if they could confirm what the ruling means for the services offered by the center, they did not respond.

Officials with Children’s Medical Center did not respond to a request for comment for this story.

The decision comes as parents of transgender children clash with state child welfare investigators over assertions by Texas Attorney General Ken Paxton that hormone therapy for minors constitutes child abuse.

“These are families in crisis,” Aldous said. “We filed this lawsuit because we were desperate for these children to get the care they need, to save lives.”

Last year, criticism of the program came amid an already growing wave of anti-transgender political sentiment in Texas.

Lawmakers last year banned transgender student athletes from participating on the school sports teams that match their gender identity. That new law came after unsuccessful legislative attempts to ban treatments like those offered through GENECIS and define such health care as child abuse.

Medical experts have pushed back on those portrayals. Leading health care organizations in Texas have said gender-affirming care is the best way to provide care to transgender children. That includes the use of puberty blockers, a type of medical treatment that delays puberty and is completely reversible. Such treatment has been approved for children for decades.

Gov. Greg Abbott last summer directed the Texas Department of Family and Protective Services to determine whether some gender confirmation surgeries for transgender children are child abuse. But medical experts say the surgeries Abbott cited — orchiectomies, hysterectomies and mastectomies — rarely, if ever, are part of gender-affirming care for transgender children.

That request came after former state Sen. Don Huffines, who unsuccessfully challenged Abbott in the March Republican primary, criticized the governor for not doing enough to protect Texas children from what he called “mutilation.”

GENECIS serves families through referrals from psychologists, pediatricians and other providers as well as from families contacting them directly.

The clinic offers hormone replacement therapy to older children after a rigorous screening process, but also counseling and mental health services that involved no medical intervention.

The rate of suicide attempts among transgender youth is three times higher than among their cisgender counterparts, according to recent studies by the U.S. Centers for Disease Control and Prevention. Experts say that some 40% of transgender children who can’t get gender-affirming care they need attempt suicide, and one in four of them die by suicide.

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Editor’s note: This story has been updated to reflect that Dallas County Court-at-Law Judge Melissa Bellan has granted an injunction that allows doctors at Children’s Medical Center Dallas to continue offering mental health services and hormone treatments to transgender children, according to The Dallas Morning News. The injunction will last until April 18, 2023, when Bellan will decide whether to make the injunction permanent.

Disclosure: UT Southwestern Medical Center has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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