“Doctors have lost their voice”: Top trans care doctor leaves Texas as lawmakers pass ban

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For mental health support for LGBTQ youth, call the Trevor Project’s 24/7 toll-free support line at 866-488-7386. For trans peer support, call the Trans Lifeline at 877-565-8860. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988.

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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 transgender youth, in 2014. At the time, she expected some backlash from the community. The first pediatric gender clinic in the United States had been around for only seven years, at Boston Children’s Hospital.

“There was some questioning out there, but the program was still able to grow successfully,” Lopez said.

GENECIS — which stood for GENder Education and Care, Interdisciplinary Support — 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’s Medical Center Dallas. Lopez directed medical interventions like puberty blockers and hormone therapy for patients in the clinic.

“It 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,” she said.

But the work, and her ability to support her Texas patients, has been changing.

“It’s really been the last four or five years that the threat to care has been growing exponentially, to the point where it’s just too much for everybody,” Lopez said. “It’s really heartbreaking.”

Lopez said 2017 was when she first noticed this threat to care. That’s when Texas lawmakers introduced Senate Bill 6, the “bathroom bill” that would have restricted trans people from using bathrooms that matched their gender identity. Despite a special legislative session, the bill didn’t get enough support from politicians and did not become Texas law.

In the 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’s 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 — as he has indicated he will — the American Civil Liberties Union of Texas and other stakeholders have promised to sue, as they have in other states with gender-affirming care bans, like Oklahoma, Missouri and Tennessee.

Lopez said the No. 1 question patients and their families have asked her is, “Am I going to be able to continue my treatment?”

“The sad part is that I don’t have a good answer for that,” she said. “I try to reassure them, that’s part of my job as a doctor, but I can’t.

“It’s very much up in the air.”

Multiple medical associations, including the American Academy of Pediatrics, 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 “will be devastating.”

“This is lifesaving care,” she said. “It’s like denying care to somebody who has cancer. You can save their life with chemotherapy, but you’re going to tell them, ‘I’m sorry, I can’t do this.’ That’s how it will feel.”

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 officials, including Abbott and Attorney General Ken Paxton, have targeted gender-affirming medical care since 2021. In phone calls obtained by The New York Times, UT Southwestern leaders said they were under “unrelenting political pressure to close” GENECIS from Abbott and other Texas lawmakers in November of that year.

They were successful to some degree, Lopez said: UT Southwestern and Children’s Health temporarily shut down the clinic the following month, leaving around 500 patients with limited options.

In February 2022, 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’s Health in March 2022, 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 denied multiple times. Lopez won an injunction to restart treatment and has been seeing patients since May 2022.

The medical center “did cause significant harm to our program by removing a lot of resources,” she said. “It has made us feel like we can’t trust our own institution, which is supposed to fight for our patients, for what’s right, for science. We were abandoned by our own hospital, and they succumbed to the pressure of politics.”

Even with the clinic reopened, families of trans youth were still being investigated by the state, and some moved out of Texas to make sure their kids could continue treatment.

“I 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,” Lopez said. “They don’t feel safe. They don’t feel safe going to school, going to the doctor’s office. It’s all very scary.

“I would say 99% of our families are trying to flee the state if they can.”

“Doctors have lost their voice” in Texas

Lopez is worried for her safety, too. It’s one of the reasons she’s 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 “an impossible situation.”

“We feel negligent, because we will not be able to provide what we know is best for the patient,” she said. “And if we do, then we’ll be doing something that’s illegal. It feels cruel, it feels unethical, and it feels like we’re torturing our patients and ourselves. That’s the reason why I’m leaving. I don’t think I can mentally be able to do that for a long time.”

Lopez said “doctors have lost their voice.” She feels frustrated that she can’t speak out about the scientific and medical proof that gender-affirming medical care improves the lives of trans patients.

“It’s that frustration and impotence that’s really tearing me apart,” Lopez said. “And then going back to [the] clinic and seeing all these families suffering and asking us to help them, it’s just putting us in a very difficult position.”

Dr. Louis Appel, a pediatrician and the president of the Texas Pediatric Society, 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’t treated any trans patients.

“I 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,” he said.

Paxton has also begun investigations into gender-affirming care clinics, like Dell Children’s Medical Center in Austin. According to reporting from KUT, doctors staffing the clinic left their jobs in May, a few weeks after Paxton announced his investigation. It left patients “scrambling.”

But Lopez knows that although her decision to leave is hard, it’s the right one for her. She still wants to continue her work, even if it won’t be in Texas.

“I will do better for patients if I can be in a safe place where I can keep my sanity,” she said.

Her favorite memories are ones where her patients graduated from the clinic, starting their lives as young adults.

“They literally thank me for being there,” Lopez said. “They are now happy with their life, they’re moving on, maybe going to college or working. A few years ago, they thought they would never be there. For me, that’s what makes it all worthwhile.”

Disclosure: The ALCU of Texas, The New York Times and UT Southwestern Medical Center 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.

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