One Doc's Win for Trans Youth Healthcare in Texas

Amid the state's aggressive push to roll back rights for transgender youth, a Texas endocrinologist has had to fight to keep treating new patients at the clinic she founded.

Ximena Lopez, MD, a pediatric endocrinologist at Children's Medical Center (CMC), and an associate professor at UT Southwestern Medical Center in Dallas, will once again be able to accept pediatric patients with gender dysphoria at her GENECIS clinic, after her employer had halted services for new patients.

Advocates for LGBTQIA+ youth say even a short delay in gender-affirming care, which is already hard to come by in the state, has high stakes for transgender youth, who are at much higher risk of suicide.

"Puberty is a ticking clock," Leslie McMurray, transgender education and advocacy associate at Resource Center, a Dallas nonprofit focused on LGBTQIA+ health, told MedPage Today. "So for all these kids that are entering puberty, what do you tell them? 'Just wait another year?' Some of these kids are going to take their own lives." McMurray said she is a friend of Lopez's, and has been following the proceedings.

According to the Dallas Morning News, a December 5 court mandate finalized a September ruling that found neither the state nor Lopez's employer can interfere in her decisions as a physician, including providing treatment with hormone therapy and hormone blockers or pubertal suppression.

An earlier injunction request filed by Lopez and her attorneys stated, "CMC, by attempting to control Dr. Lopez's medical decision-making without regard to the needs of a patient, is engaged in the unlawful corporate practice of medicine."

An earlier court filing says the treatments, which adhere to the World Professional Association for Transgender Health and the Endocrine Society guidelines, are "universally medically accepted and are appropriately relied upon by Dr. Lopez in exercising her independent medical judgement on how to treat her patients."

The Dallas Morning News noted that since the court allowed Lopez to resume gender-affirming services for new patients in May, she has been able to see 72 more patients. During the suspension of services, court documents say more than 100 new patients were turned away.

In February, Texas Attorney General Ken Paxton issued an opinion arguing that gender-affirming care, including hormonal therapies, constituted child abuse. Gov. Greg Abbott (R) also directed the Department of Family and Protective Services to investigate families of children undergoing what he called "abusive procedures," including treatment with hormones.

"If you picture in your mind that 13-, 14-year-old kid that is receiving love and affirmation from both parents, which is rare enough anyway," said McMurray, "to potentially have that child taken from that household and put into the broken Texas foster care system is utterly terrifying. I just, I can't fathom that happening."

Shortly after, CMC and UT Southwestern took down the clinic's website and any "branding" of the clinic, and GENECIS stopped taking new patients who sought hormone therapy or hormone blockers.

A joint statement from the medical centers in March read: "with legal challenges to hormone therapy as a component of care for minors treated for gender dysphoria gaining momentum in Texas and elsewhere, UT Southwestern and Children's Health suspended initiating this treatment for new patients, believing that a failure to act would put the entire program in jeopardy." The statement emphasized that the centers were continuing all services for existing patients.

The earlier injunction request from Lopez, however, alleged that Abbott had exerted his political power privately to attempt to close down the GENECIS program, the first of its kind in the Southwest.

In May, Lopez applied for a temporary restraining order and injunction to prevent CMC from enforcing its new rule against GENECIS accepting new patients. Her application called the suspension an "unlawful prohibition" that would deprive her of her rights as a physician, and above all, discriminate against patients.

The Dallas County court granted her the restraining order and injunction for a month, only to have the attorney general's office file a petition that would allow it to intervene in the case. Ultimately, a judge rejected the state's petition to intervene in July because the state's interest in the case was too remote: there were no constitutional laws at stake, and no state actors involved.

While her legal struggle may now be coming to an end, more are just beginning, say advocates for LGBTQIA+ youth. McMurray said she's worried about a pending bill that could codify Paxton's opinion on gender-affirming treatment and child abuse. "Parents are terrified because they provide this care for their kids," she said.

McMurray also referenced a recent report that Paxton had requested the total number of gender marker changes on Texas driver licenses from the Texas Department of Public Safety, and may have asked for a list of names. "He doesn't say why, but there's nothing good behind it," said McMurray.

Human Rights Campaign Legal Director Sarah Warbelow called the move "chilling" in a statement on Wednesday. "Weaponizing state agencies and their public records to pinpoint and single out transgender Texans is terrifying, albeit not shocking," she said.

Some families, McMurray said, have simply opted to leave the state. "There's kids that I know that have moved out of state. Their parents have flat moved them out."

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