‘I follow the law:’ El Paso doctor responds to Ken Paxton’s lawsuit over alleged transgender care

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Dr. Hector Granados felt puzzled when he first heard of the allegations. The El Paso pediatrician had just finished his hospital rounds early in the morning last fall when he received a call from a friend. The friend saw in the news that Texas was suing Granados.

The office of Texas Attorney General Ken Paxton filed a petition Oct. 29 claiming Granados had prescribed puberty blockers and hormones to minors for gender transition — health care the state made illegal beginning Sept. 1, 2023. The court filing accuses Granados of providing gender-affirming care under the false pretense of treating precocious puberty.

Paxton filed the lawsuit in Kaufman County near Dallas, about 650 miles east of El Paso, where one of the 21 patients in the court filing is said to reside. Granados is one of three doctors Paxton sued last year for allegedly providing gender-affirming care to minors.

Granados denied the allegations.

“I was always respectful of the law and I will continue to be because we follow what it specifically mandates,” Granados said. “You’re not able to provide transgender care to minors. We stopped.”

The AG’s office didn’t respond to El Paso Matters’ requests for comment, but called Granados a “radical gender activist” in the lawsuit.

Granados told El Paso Matters he stopped providing gender-affirming care after Texas Senate Bill 14 passed in May 2023 because he didn’t want to risk getting his medical license revoked. He began informing parents and discharging his transgender patients prior to the law going into effect. Since then, he’s continued to see youths for other concerns.

Pediatric endocrinologists treat a wide variety of hormonal conditions, including diabetes, thyroid disorders, pituitary gland disorders and growth deficiencies. Some of Granados’ youngest patients in El Paso have been preterm newborns with hypothyroidism, which, if not treated immediately, can delay growth and brain development.

Granados is one of only two pediatric endocrinologists in El Paso County, an area that has struggled to attract and retain medical specialists. The other, Dr. Sanjeet Sandhu, was a medical resident under Granados and joined his private practice about four years ago.

Most of Granados’ patients have chronic conditions that require continuous monitoring and appointments, according to a response filed by his attorney. Children with Type 1 diabetes typically see Granados every three months.

Several mothers who take their children to Granados for Type 1 diabetes told El Paso Matters they’re anxious about how this lawsuit could affect their future care — and whether they would have to travel out of town for a doctor should he be forced to stop practicing.

Jennifer Oguete said her 8-year-old daughter, who began seeing Granados for hypothyroidism and now Type 1 diabetes, already travels out of town for various specialists, including a rheumatologist in Phoenix.

“The lack of specialties here in El Paso – there’s not very many doctors that will see a child under the age of 12 here,” Oguete said.

Granados recounts another mother who told him her family misplaced a child’s medication while on vacation.

“She was telling me, ‘If you’re not able to be here in El Paso anymore, what am I going to do?’” he said. “‘If three days without medicine was a really difficult time, what’s going to happen if there’s not a doctor that is able to take care of my daughter?’”

Granados assured her, ”I follow the law. I didn’t do anything wrong. There’s no reason for me to leave El Paso.”

Why the Texas attorney general is suing this El Paso doctor

Texas SB 14 prohibits health care workers from providing certain transition-related medical treatments to people younger than 18. Treatments include puberty blockers, hormone therapies and surgeries, though doctors rarely perform surgeries on children.

Transgender people of all ages may be interested in gender-affirming care, from voice modification to hormone therapy, to treat gender dysmorphia, a distress caused when a person’s gender identity differs from their sex assigned at birth.

The state is accusing Granados of prescribing puberty blockers to seven minors and testosterone to 14 minors for the purpose of gender transition, according to the filing. Paxton’s office further accused Granados of “falsifying medical records, prescriptions, and billing records to intentionally conceal the unlawful conduct.”

Paxton said in the lawsuit that Granados wrote prescriptions as recently as Aug. 19, 2024, with patients filling those prescriptions as recently as Oct. 12, 2024.

The 21 alleged patients, who are unnamed in the lawsuit, were ages 12 to 17 at the time of the prescriptions.

Two of the patients who allegedly received testosterone for transition are described as biologically male in the lawsuit. SB 14 does not ban the prescription of testosterone doses for males younger than 18.

“Texas is cracking down on doctors illegally prescribing dangerous ‘gender transition’ drugs to children,” Paxton said in an Oct. 30 news release. “State law forbids prescribing these interventions to minors because they have irreversible and damaging effects. Any physician found doing so will be prosecuted to the full extent of the law.”

Paxton seeks both temporary and permanent injunctions against Granados, as well as more than $1 million including civil penalties and litigation expenses.

A fact sheet from the Pediatric Endocrine Society describes puberty blockers as reversible. The organization also describes puberty blockers as a medication that has been used to treat precocious puberty with “few side effects identified,” though concerns exist about bone development. The U.S. Food and Drug Administration approved the first puberty blocker medication in 1993.

Precocious puberty, also known as early puberty, occurs when a child begins sexually maturing at a young age, before 8 for girls and before 9 for boys. Along with rapid growth, girls may start experiencing menstruation and breast development, while boys may start experiencing deepened voices and testicular enlargement.

Puberty blockers are meant to be temporary, delaying puberty until a youth is ready, but are not a one-off medication. Granados said he typically sees patients for precocious puberty at a young age and follows them into their teenage years to make sure they’re developing correctly.

The state’s lawsuit cites Granados’ medical records in its claims. Mark Bracken, the El Paso attorney representing Granados, said the Texas Attorney General’s Office never requested the doctor turn over his medical records prior to the lawsuit.

Bracken said he is working with the Attorney General’s Office to try to obtain a protective order from the court that will allow the state to identify the alleged patients with provisions to protect their personal information from the public.

Attorney files motion to move case to El Paso County

In a response filed Nov. 25, Bracken filed a motion to move the case from Kaufman to El Paso, and a motion to dismiss the case.

All of the prescriptions cited in the lawsuit were filled in El Paso, according to the state’s court filing. Granados resides and works in El Paso, splitting his time between his three clinics, as well as El Paso Children’s Hospital and the Hospitals of Providence.

Scheduling out-of-town court appearances would be difficult when Granados is on call three weeks every month for neonatal, emergency and pediatric intensive care, Bracken said. Granados would have to make multiple two-day trips to Kaufman to appear in court, taking time away from the patients who depend on him, he said.

On a recent late afternoon in his Downtown office, Granados pulled out his cellphone to scan his number of patients. The doctor began making his hospital rounds at 6:30 a.m. that day. He sees anywhere from 22 to 28 patients a day and the practice receives an estimated average of 200 referrals for new patients every month.

Granados sometimes opens the clinic on Saturdays to get through the backlog of new referrals, he said.

Obesity is becoming more prevalent among children in El Paso, which can lead to metabolic issues, he said. After the start of the pandemic he began seeing more new patients with Type 2 diabetes, as well as Type 1, which is an autoimmune condition.

Granados began working and teaching at Texas Tech University Health Sciences Center El Paso in 2014, where he opened El Paso’s first transgender health clinic, before leaving in 2017 to go into private practice.

After him and Sandhu, the next closest pediatric endocrinologist is in Ciudad Juárez, a four-drive to Albuquerque, New Mexico, or farther to Tucson, Arizona. Over the years, Granados has seen children and adolescents from Las Cruces, New Mexico, to Fort Hancock in West Texas, as well as families from Juárez seeking a second opinion.

Any of Granados’ patients, their parents and staff called to be witnesses would have to take time off to make the journey to Kaufman and pay for their own travel expenses just to testify, Bracken said.

“The law is clear with these types of claims, if it’s filed, it has to be where the health care was provided and all the health care was provided here,” Bracken said.

This article first appeared on El Paso Matters and is republished here under a Creative Commons license.

Disclosure: Texas Tech University, Texas Tech University Health Sciences Center, Texas Tech University Health Sciences Center El Paso and Hospitals of Providence have been financial supporters 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.