On a tense conference call last November with half a dozen doctors and executives at the University of Texas Southwestern Medical Center, Dr. John Warner relayed a somber message: The only specialty clinic in the state to treat transgender adolescents was facing unrelenting political pressure to close.
State lawmakers had already sent formal inquiries about the clinic, Genecis, which was financed by the public university and housed at Children’s Medical Center in Dallas. Activists calling the clinic’s treatments “chemical castration” had shown up at the office of one of the children’s hospital’s board members.
And then there was Gov. Greg Abbott.
“We received a reach from the governor also requesting information about the clinic,” said Dr. Warner, an executive vice president at the medical center, according to a recording of the call obtained by The New York Times. “And with that came an expectation that something different would occur.”
“Time is not on our side,” he added. “The conversation is intensifying — not the reverse.”
The next week, hospital executives closed the clinic, taking down its website before staff members or patients were informed of the change.
The demise of the clinic, which saw around 500 patients in 2021, shows how treatments for transgender minors have become a highly contentious issue in Republican-controlled states across the nation, with elected officials challenging widely accepted medical practices in an echo of the debate over abortion.
That fight has reached a fever pitch in Texas.
Days before he won a contentious Republican primary last week, Mr. Abbott and the Texas attorney general directed the state’s child welfare agency to investigate “‘sex change’ procedures and treatments” as child abuse, arguing that even hormone therapy should be considered an “abusive procedure.” The directive drew sharp criticism from medical groups and a swift lawsuit from civil rights groups, which said the directive violated the rights of transgender adolescents and their parents.
But months ago, before these moves were making national headlines, executives at U.T. Southwestern were discussing closing down Genecis because of what they described as direct outreach from the governor’s office, according to recordings of several phone discussions among hospital executives obtained by The Times.
What the governor’s office purportedly said to pressure the hospital’s leadership is unclear.
When asked about these interactions, U.T. Southwestern said in an emailed statement that the governor was not personally involved. But the hospital did not answer questions about whether Mr. Abbott’s office had contacted hospital executives. “Inquiries regarding actions by the Governor’s Office should be directed to the Governor’s Office,” the statement said.
Mr. Abbott’s office did not answer questions about the substance of these conversations or whether they took place, but it denied involvement in U.T.’s decision to close Genecis.
“The Governor’s Office was not involved in any decision on this issue,” Nan Tolson, a spokeswoman, said in an email.
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 healthof 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.
On the campaign trail in Texas, transgender health care has often come to the forefront. Last summer, after legislation that would have banned such treatments for minors failed in the state legislature, Mr. Abbott’s primary opponent, Don Huffines, attacked the governor for not taking a bolder stance in favor of the bills.
Weeks later, Mr. Abbott said on a conservative radio program that although the bills had not passed, he could “game the odds” and had “another way of achieving the same exact thing.”
On a call with other hospital leaders around the same time, Dr. Warner said that hospital executives had been responding to “some questions from the governor’s office” as well as from state lawmakers, according to a recording obtained by The Times. The executives discussed how they would try to keep the clinic open in some capacity despite political pressure to close it.
“There is the possibility that we as a state agency cannot provide this care,” Dr. Warner told the group on the July call. “So the question we’re going to be asking of ourselves is what should U.T. Southwestern do as a state agency that provides the most benefit to the kids but also protects the institution.”
But in another call several months later that was also recorded, any possibility of the clinic staying open seemed gone.
“I do not think that in our current circumstances that — without some modification of the clinic — that it would be allowed to continue,” Dr. Warner said on the November call. “People will come after it until it’s gone.”
U.T. Southwestern and Children’s Health took down the Genecis website on Nov. 11. A week later, staff members were told that existing patients could still be treated at the hospital, but no new patients could be accepted. The decision was made without consulting the medical center’s ethics boards.
Texas’s Push Against Gender-Affirming Treatments
Limiting trans care. Republicans in Texas are seeking to criminalize medical treatments that help align trans teens’ bodies with their gender identities. Here is what to know about the efforts:
Failed bills. Texas has repeatedly considered bills that would have banned gender-affirming treatment for teenagers, yet all have so far failed. One proposal sought to redefine child abuse to include gender-affirming treatment for transgender children.
An opinion and an order. Attorney General Ken Paxton recently issued an opinion stating that providing treatments like puberty-suppressing drugs to transgender teenagers should be investigated as child abuse. Shortly after, Gov. Abbott reaffirmed the notion in a letter to state health agencies.
The political stakes. The moves by Mr. Abbott and Mr. Paxton, both two-term Republican incumbents, came days before Texas’s primary election on March 1, in which each faced challenges from far-right opponents who have questioned whether they have been sufficiently conservative.
Investigations begin. While Gov. Abbott’s order doesn’t change Texas law, the state’s child welfare agency has begun investigating child abuse claims related to trans care. On March 2, a state court temporarily halted the investigation of one family, but allowed others to continue.
The pushback. Professional medical groups and transgender health experts have condemned attempts to limit trans care. Some county and district attorneys in Texas have said they would not prosecute families of transgender children for child abuse under the new definition.
“Neither the U.T. Southwestern ethics program nor the Children’s Medical Center ethics committee were informed about the decision over the Genecis program,” said Dr. John Z. Sadler, a psychiatrist and the director of the U.T. Southwestern Program in Ethics in Science and Medicine.
In an emailed statement, U.T. Southwestern said that new patients could visit the medical center for consultations and counseling, but they would be referred to other providers for puberty blockers or hormones.
“Genecis was never a stand-alone clinic and was not ‘closed’ as has been misreported in the media,” the statement said. “The decision to remove the Genecis program branding was made to provide a more private experience for patients and families.”
Dr. Warner did not respond to a request for comment.
In late November, Children’s Medical Center sent patients’ families a letter, obtained by The Times, stating that the clinic was closed in order to offer “a more private, insulated care experience for patients and their families seeking gender affirming care.”
Some parents were angered by that explanation.
“That doesn’t explain an awful lot of what they’ve done,” said one mother of a transgender teenager in Dallas, who requested that only her first name, Holly, be used to protect her family’s privacy. Holly’s son had received counseling and testosterone treatments from the clinic since 2018, she said, and she hopes he will continue to be seen by his existing providers at Children’s Medical Center.
“He has been seen. We’ll see if that continues,” she said. “I’m concerned that it won’t.”
Andy Hackett, a 19-year-old college student who started going to Genecis three years ago, said the clinic’s expert providers not only gave him testosterone treatments and emotional support, but also helped to reassure his parents, who were worried about the medications.
Restricting medical support for trans adolescents won’t make their needs go away, he said. “The mind-set almost feels like, if you take away the resources then kids will stop being queer,” he said. “But that doesn’t mean there’s going to stop being trans kids.”
Genecis’ closing was the beginning of a wave of changes related to transgender adolescent care in Texas. Last week, in response to the attorney general’s determination that hormone therapies for transgender adolescents could constitute child abuse, Texas Children’s Hospital in Houston, a private nonprofit institution, stopped providing the treatments.
And in recent weeks, the U.T. administration has also tried to excise transgender health from its medical school’s curriculum.
In February, university leaders asked the instructors of a two-week elective course on transgender health to remove all mentions of the words “transgender” or “gender dysphoria” from the syllabus and course description, according to emails reviewed by The Times. The class title was changed from “Adolescent and Young Adult Transgender Care”to“Multidisciplinary Care of Diverse Youth.”
Then last week, after the governor’s order to investigate transgender medical care for adolescents as child abuse, the university decided to stop offering the medical school elective course altogether, according to two people involved in the class. The course was reinstated on Monday, after inquiries from The Times, and reverted to its original title.
In an emailed statement, U.T. Southwestern said that the elective had been paused in December “without review or approval by senior institutional leaders,” but that lectures on related topics had been incorporated into a different class on endocrinology and reproductive health that is required for all medical students.
The university did not respond to questions about why the terms “transgender” and “gender dysphoria” were removed from the course information or why the class was reinstated.