As Texas prepares to ban gender-affirming care for minors, a leader in the field is closing her practice and leaving the state.
Dallas-based pediatric endocrinologist Dr. Ximena Lopez started GENECIS, a clinic for trans youth, in 2014. At the time, she expected some backlash from the community. The first pediatric gender clinic in the United States had only been around for seven years, at .
鈥淭here was some questioning out there, but the program was still able to grow successfully,鈥� Lopez said.
GENECIS 鈥� which stood for GENder Education and Care, Interdisciplinary Support 鈥� was one of the only programs in the Southwest that offered holistic care for gender dysphoria, bringing together psychologists, pediatricians and endocrinologists. It was a partnership between UT Southwestern Medical Center and Children鈥檚 Medical Center Dallas. Lopez directed medical interventions like puberty blockers and hormone therapy for patients in the clinic.
鈥淚t becomes such a joy to treat these patients and see them blossom, because you observe patients going from a very sad, hopeless state to being comfortable with themselves,鈥� she said.
But the work, and her ability to support her Texas patients, has been changing.
鈥淚t鈥檚 really been the last four or five years that the threat to care has been growing exponentially, to the point where it鈥檚 just too much for everybody,鈥� Lopez said. 鈥淚t鈥檚 really heartbreaking.鈥�
Lopez said 2017 was when she first noticed this threat to care. That鈥檚 when Texas lawmakers introduced Senate Bill 6, the 鈥渂athroom bill鈥� that would have restricted trans people from using bathrooms that matched their gender identity. Despite a special legislative session, the bill didn鈥檛 get enough support from politicians and did not become Texas law.
In this current legislative session, Senate Bill 14 seeks to ban gender-affirming medical care for trans minors and revoke the medical licenses of any doctors who offer this care. It鈥檚 passed both the Senate and the House, and is now on its way to the governor's desk.
If Gov. Greg Abbott signs it into law 鈥� as he has indicated he will 鈥� the ACLU of Texas and other stakeholders , as they have in other states with gender-affirming care bans, like .
Lopez said the No. 1 question patients and their families have asked her is, 鈥渁m I going to be able to continue my treatment?鈥�
鈥淭he sad part is that I don鈥檛 have a good answer for that,鈥� she said. 鈥淚 try to reassure them, that鈥檚 part of my job as a doctor, but I can鈥檛.
鈥淚t's very much up in the air.鈥�
Multiple medical associations, , endorse medical treatments like puberty blockers and hormone therapy as the standard of care for treating patients with gender dysphoria. Lopez said the impact of SB 14 鈥渨ill be devastating.鈥�
鈥淭his is lifesaving care,鈥� she said. 鈥淚t鈥檚 like denying care to somebody who has cancer. You can save their life with chemotherapy, but you鈥檙e going to tell them, 鈥業鈥檓 sorry, I can鈥檛 do this.鈥� That鈥檚 how it will feel.鈥�
Political pressure to close trans clinic in Texas
The most recent bills in the Texas Legislature are not the only thing trans kids, their families and doctors have had to navigate. State lawmakers, including Gov. Greg Abbott and Attorney General Ken Paxton, have targeted gender-affirming medical care since 2021. In phone calls obtained , UT Southwestern leaders said they were under 鈥渦nrelenting political pressure to close鈥� GENECIS from Gov. Abbott and other Texas lawmakers back in November of that year.
They were successful to some degree, said Lopez: UT Southwestern and Children's Health temporarily shut down the clinic the following month, leaving .
In February 2022, Gov. Abbott and Paxton publicly questioned the medical legitimacy of gender-affirming medical care, and directed the Department of Family and Protective Services to investigate families for providing this care to their kids. Families, kids and trans adults worried about the impact these directives, which were not laws, would have on their ability to live in Texas.
Lopez filed a lawsuit against UT Southwestern and Children鈥檚 Health in , arguing that closing the clinic infringed on her abilities as a medical professional to treat her patients. Paxton petitioned to intervene in the case on behalf of the state, but was . Lopez won an injunction to restart treatment, and has been seeing patients since May 2022.
The medical center 鈥渄id cause significant harm to our program by removing a lot of resources,鈥� she said. 鈥淚t has made us feel like we can鈥檛 trust our own institution, which is supposed to fight for our patients, for what鈥檚 right, for science. We were abandoned by our own hospital, and they succumbed to the pressure of politics.鈥�
Even with the clinic reopened, families of trans youth were still being investigated by the state, and some to make sure their .
鈥淚 not only worry about the lack of care they're going to get, but I also worry a lot about how they feel seeing this happening around them,鈥� Lopez said. 鈥淭hey don't feel safe. They don't feel safe going to school, going to the doctor's office. It鈥檚 all very scary.
鈥淚 would say 99% of our families are trying to flee the state if they can.鈥�
"Doctors have lost their voice鈥� in Texas
Lopez is worried for her safety, too. It鈥檚 one of the reasons she鈥檚 closing her practice at the end of July and moving to California. She said the political climate in Texas has put her and other physicians in 鈥渁n impossible situation.鈥�
鈥淲e feel negligent, because we will not be able to provide what we know is best for the patient,鈥� she said. 鈥淎nd if we do, then we鈥檒l be doing something that鈥檚 illegal. It feels cruel, it feels unethical, and it feels like we鈥檙e torturing our patients and ourselves. That鈥檚 the reason why I鈥檓 leaving. I don鈥檛 think I can mentally be able to do that for a long time.鈥�
Lopez said 鈥渄octors have lost their voice.鈥� She feels frustrated that she can鈥檛 speak out about the scientific and medical proof that gender-affirming medical care .
鈥淚t鈥檚 that frustration and impotence that鈥檚 really tearing me apart,鈥� Lopez said. 鈥淎nd then going back to [the] clinic and seeing all these families suffering and asking us to help them, it鈥檚 just putting us in a very difficult position.鈥�
Dr. Louis Appel, , was one of the few medical professionals who spoke out during hearings on anti-trans legislation this year. He testified in opposition to SB 14 when it was first heard in a Senate committee in March, but as a primary care pediatrician he hadn鈥檛 treated any trans patients.
鈥淚 do wish that the environment was such that the folks that were more expert in this care, and directly provide it did not feel that their safety and the safety of their patients was threatened by being able to come forward and speak on legislation such as this,鈥� he said.
Attorney General Ken Paxton has also begun investigations into gender-affirming care clinics, like Dell Children鈥檚 Medical Center in Austin. According to reporting from KUT, doctors staffing the clinic left their jobs in May, . It left patients
But Lopez knows even though her decision to leave is hard, it鈥檚 the right one for her. She still wants to continue her work, even if it won鈥檛 be in Texas.
鈥淚 will do better for patients if I can be in a safe place where I can keep my sanity,鈥� she said.
Her favorite memories are ones where her patients graduated from the clinic, starting their life as young adults.
鈥淭hey literally thank me for being there,鈥� Lopez said. 鈥淭hey are now happy with their life, they鈥檙e moving on, maybe going to college or working. A few years ago, they thought they would never be there. For me, that鈥檚 what makes it all worthwhile.鈥�
Got a tip? Email Elena Rivera at erivera@kera.org. You can follow Elena on Twitter .
四虎影院 is made possible through the generosity of our members. If you find this reporting valuable, consider Thank you.
