Leaders of a now-defunct health clinic — known for years as the largest program of its kind for transgender youth in Texas — came under pressure to restrict gender-affirming care from the governor’s office and a state House investigative committee, according to recordings of internal meetings among hospital leadership and staff obtained by The 19th.
Hospital administrators and doctors at GENder Education and Care, Interdisciplinary Support (GENECIS), a state-run medical institution, struggled to reconcile halting care with the knowledge that doing so could severely jeopardize the mental health of their patients, the recordings reflect.
GENECIS, which was jointly run by the University of Texas Southwestern Medical Center and Children’s Medical Center Dallas, quietly closed to new patients in November, with all references removed from the Children’s Health website. The 19th obtained nearly five hours of meetings among UT Southwestern leadership and staff, as well as staff and leadership at Children’s Medical Center and GENECIS employees, that took place during 2021 and 2022.
The shuttering of GENECIS is part of Texas officials’ efforts to restrict health care and full access to services for trans youth. Gov. Greg Abbott called three special sessions of the Texas legislature that prioritized anti-trans legislation, pledged to take action against gender-affirming care for trans youth, and has backed the state attorney general’s interpretation that giving puberty suppressing drugs and hormone therapy to trans youth is child abuse. These moves have put multiple parents seeking care for their trans children under investigation by the state. (A state court issued an injunction on Friday evening blocking these investigations.) On a March 2 call with reporters, Abbott’s campaign reportedly described the push to investigate parents of trans kids as a winning issue.
The hospital leadership and staff at GENECIS began to discuss the political pressure on the clinic as early as July, according to the recordings, as the Texas investigative committee looked into their work and the governor’s office probed for more information.
Meetings among hospital leadership and staff beginning last summer portray disarray and distress. They worried that halting care could lead to suicides and poor mental health among trans youth in a state with few options.
“How can we minimize the risk of suicidality in patients who could otherwise have come into GENECIS? I think that’s a very high priority,” Dr. Perrin White, director of pediatric endocrinology at UTSW, said at a November meeting.
“We’re taking away the life-saving medical care for the new patients,” one GENECIS employee said in response. “If we’re mitigating suicidality, let’s be clear, it’s because in large part, we’re taking away medical care.”
The GENECIS team was instructed by UT Southwestern leadership in November to stop prescribing hormone treatment and puberty blockers to new patients, several days after the website suddenly came down on November 12. Existing patients were allowed to continue all treatment, but new patients would only be able to access psychiatric evaluation and counseling, and be evaluated for gender dysphoria.
Physicians and staff debated how to maintain some semblance of care for trans youth under their new normal. Several GENECIS staff members raised concerns that the program was not designed to offer psychological care alone — and that the ultimate point of evaluating patients’ mental health is to determine whether they can receive hormone treatment or puberty blockers, considered life-saving care by families of trans kids and many of the physicians who work with them.
Access to hormone therapy and puberty-suppressing drugs, widely recommended by medical authorities, is linked to lower rates of suicidal ideation and improved mental health among trans youth. Kids who received one year of hormone therapy through GENECIS reported small to moderate improvements in symptoms of depression, per research by leaders of the program published in the American Academy of Pediatrics in March 2020.
Evan Singleton, 19, who lives outside Dallas, told The 19th that he believes the gender-affirming care he received through GENECIS — puberty blockers and hormone treatment — saved his life.
“I feel scared and sorry for these kids that can’t get the help that they need,” he said. For him, starting puberty blockers soon after he turned 10 was a relief. His mother, Mela, added that finding a way to halt her son’s puberty afforded her time to learn the best course of action for her child’s future, while halting the extreme emotional distress caused by his puberty.
Since 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.
I suppose this means we should expect more litigation, this time in the federal courts, which unfortunately will mean another opportunity for the Fifth Circuit to act like monsters. Just a reminder, that article from The 19th notes that access to this kind of care correlates with “lower rates of suicidal ideation” in these kids. If it’s really being taken away, Abbott and Paxton and the rest will have blood on their hands. Don’t ever forget that.
How long did the interviews last, and what sorts of questions did they ask you?
The whole thing felt like forever, but I guess it took about two hours. It’s humiliating. She asked me first, do I have a history of mental illness? And second, do I have a history of abuse? Like abusing my kids, my wife. Of course the answer is no. Then she asked about our social support network, like what kind of connections do we have in the community. And then she wanted to know what our daily routines are like. She wanted to see the house to see where we have food, to see if we have blankets, to see all the things you would want to see if somebody was really being a child abuser. It was surreal.
How were your kids reacting to all of this?
Well, Amber and I have been publicly raising a trans child and being a trans-inclusive family in Texas for about seven years now. And until now, we’ve been able to shield our children from the hatred that pervades our country’s politics, but I’m afraid now that it has walked through our door it’s taking a toll on them mentally and emotionally. So we’re not doing well, to put it bluntly. We get through the day, but it’s hanging over all of us.
And they’re pretty young, right? Your son is 14, and you have a 9-year-old daughter. How did you explain to them what was happening?
Well, I don’t know if we did it right. Because you never really imagine being in this situation. But I told the kids, “We’ve done nothing wrong. We never want you to lie. We’re not going to lie about anything. But we’re not going to answer questions, because the government is sending a spy into our house, and we don’t talk to spies. And we’re being interrogated for no legal or moral reasons.” It was, as you might imagine, scary for kids to hear that. But I didn’t know how to sugarcoat it. Because it’s very serious. You know, the consequences at stake for us are losing our child or uprooting our family. I’d lose my job, my health insurance. You look around the country, where could we move? There’s a guy who said he could maybe help me find a job in Arizona, but Arizona is hardly any better with this shit.
How did it feel, after inviting Paxton to dinner, to see his recent opinion on trans kids and to learn that an investigation was being opened against you?
Like the depths of betrayal, basically. And utter cynicism on his part, that this is just a way to get through a primary season for him, just using us. He knows us. He said at the end of that dinner, he looked at our son, he said, “You got a good kid there.” By the way, it’s the same thing the CPS worker said after our visit. She looked at us and over at our son, who was practicing his cello at that point, and said, “Clearly you’re doing something right because you have wonderful children.” It’s maddening that we are going through this when anybody who meets us is like, “This is just a loving family.”
Have you reached out to Paxton again since the investigation was opened?
No, we haven’t. He’s made it plain that he’s not open to learning. I think what’s going on, like historically in this moment in time, is you have trans folks who feel like they can be out as their authentic selves within circles of friends or within safe communities. And the struggle we’re in now is how to achieve that liberation more widely in public society. And frankly, people like Paxton are just acting as the oppressors preventing that from happening. And at some point, dialogue is impossible with those sorts of people. So we tried, but he’s shown us his hand, and so there’s no point with him anymore.
I would like nothing more for the Briggle family and everyone else in their position than to be left alone. But we have work to do before that can happen.