Genecis

For Dr. Ximena Lopez's patients, halting puberty can be lifesaving. She's the only pediatric endocrinologist in the only transgender youth clinic in the Southwest, which makes her something of a Godsend for trans children, teens, and their parents who have nowhere else to go for help.

Since the first transgender youth clinic opened at Boston Children's Hospital in 2007, more than 40 clinics have opened around the country. Most are clustered on the East Coast and in California — but one clinic stands out a bit. Under the supervision of Dr. Lopez, 41, Children's Health in Dallas launched its Genecis Program in one of the most socially conservative cities in America in fall 2014.

Cosmopolitan.com spoke with Dr. Lopez about why it's so vital to offer treatment to young, transgender Texans.

It all started with a patient I had about three years ago. His name is Evan, he was born a girl but identified as male from early on. When his family came to see me, Evan was 9 years old and was starting puberty and starting to develop breasts. He was very depressed — he'd been wanting to die and commit suicide, and his mom had taken him to different psychologists. He'd been on anti-depression medication, and it seem liked nothing was working. She wanted to support him as a boy so she let him do a social transition to male, change his name, his clothing, his haircut, and he started to do really well and came out of his depression.

Evan's mom was very well-educated and knew there was an option to get treatment to block or suppress puberty, which at that point was very distressing for Evan. So she came to see me and said, "Can you give the endocrine treatment to block puberty?" Normally this treatment is used to suppress puberty for children who start it too early, like if a 5- or 6-year-old starts puberty, this is the treatment we'd do. At that time, I'd never really treated a patient for this reason, and neither had any of my colleagues. But I did have some history that kind of let me be open to this.

When I was training to be a pediatric endocrinologist in Boston, there was this other pediatric endocrinologist, Dr. Norman Spack, who had founded the first transgender program for adolescents in Boston. He came to Massachusetts General Hospital, where I was training, to give a talk about his program, and brought a patient with him. The patient was a 21-year-old MIT student who looked like a male in every way that you can imagine, and he told us his story of how he transitioned from female to male, and for me that was eye-opening. It really helped me understand that this is real, and that some individuals need to transition, and they need medical intervention.

The main concern is the high risk of suicide — up to about 40 percent of these patients have attempted suicide as adolescents.

This particular patient had grown up in Saudi Arabia, and his parents had taken him to Amsterdam when he was a teenager to have what we now call the Dutch Protocol, which is blocking puberty in early adolescents, followed by sex hormones. So this patient had undergone Dutch Protocol and looked like a male in every way; there's no way you could tell he had ever been a female. That was my experience when Evan came to my clinic in Dallas. I kind of had an idea of what could be done, but I didn't have the experience.

At first I tried to send Evan to Boston — that's what we do when we don't have experience as a physician, we send our patient to another experienced physician. I told his parents, "I know about this procedure, but I don't really have experience with it." The mom said, "Well, I have four other kids and I can't afford to go back and forth between Texas and Boston." So I found a psychiatrist in Galveston, Texas, who actually had a lot of experience with these patients. I sent Evan to Galveston and the psychiatrist told me he had clear gender dysphoria, and it would be recommended to give Evan treatment to suppress or block puberty. So I went ahead and started treatment.

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A few months after I saw Evan, I got another patient off a recommendation from his mother. Through social networks, Evan's mother had met other mothers locally who had children in similar situations, and she said I would treat them. They started coming in, and within the next few months, I had something like three or four patients, and I was still sending them all to Galveston first at this point. At some point I thought, I don't know how common this is, but we need a center here — there's a need for these patients to be seen where everything can be addressed.

We needed not only me to provide medical intervention, but we needed someone to treat, understand, and diagnose other mental health issues. Not just gender dysphoria, but most of these patients also have a lot of psychiatric problems, mostly deriving from the gender dysphoria, like depression, anxiety, and suicide attempts. This is a high-risk population.

The main concern is the high risk of suicide — up to about 40 percent of these patients have attempted suicide as adolescents. There's a sincere need. Before Genecis, the only transgender patients that had been seen in the hospital were seen as inpatients in the psychiatry unit. They were all patients who had attempted suicide. So it made sense for us to create a program where we can care for them early on, before they get to the point of attempting suicide.

I went to the director of our division and told him, "This is what's going on, why don't we build a multi-disciplinary team of psychology, social work, and myself, and we can assess these patients and give them the mental health care they need, and they can help me guide the treatment instead of sending them out to Galveston."

[The clinic opened] in fall 2014, so a little more than a year ago. We had no opposition from the hospital at all. We were approved for a small program without knowing how many patients we were going to get. As soon as we opened the door, patients started coming in.

We evaluate children between ages 4 and 17 — we don't see adults. The average age in our clinic is 13, or very close to adolescence. We don't have a lot of young children. Probably the reason for that is that adolescence is a key time in the lives for children where, for many of them, that's when the feeling kicks in or when they come out. Or they get so distressed by puberty that they get depressed, or suicidal, and parents get worried and ask for help.

Right now we have more than 200 referrals. We have a few patients from border states, but they're mostly local, which tells you there's a big need. We really didn't understand how common it is, but I think being in the media these last few years has certainly helped. Figures like Caitlyn Jenner who advocate for transgender rights have really helped people in this society understand more. Three years ago, when I saw Evan, most people wouldn't have known what I was talking about. Today they know what I'm talking about. That's also helped parents feel more comfortable supporting their children and coming to seek help, instead of just denying it.

I would say 99 percent of the comments we get are very positive, actually. There are a lot of questions about the program. Faith leaders in the community, or regular pediatricians and health-care workers kind of want to understand more and why we're doing this. But I think most people are very receptive. Like when I first saw Evan, his mom didn't know any other parents with a child who was transgender, and she felt alone in the world. Now they have a support group of I think, like, 50 or 60 parents.

When someone is referred to our clinic, our social worker does a phone interview with one of the patients to get a story and assess what the needs of the family are, and then after that, we request a letter from a therapist — like a counselor or psychologist — that supports the diagnosis of gender dysphoria. That's the formal diagnosis we use. Most of these patients already have a therapist, and if they don't, we refer them to one. Then two members of our team do our own mental health assessment. We evaluate the parents — we normally ask both parents to come in. After all that, we have a multi-disciplinary discussion where we all meet as a team and discuss the patient and make a recommendation for the next steps. That includes if they need an endocrinologist to start puberty suppression, or cross examine, or maybe just wait and have more therapy, depending on the case. We try to make an individualized plan for each patient.

We're getting ready for [more and more patients]. Now that we've realized it's much more common than we thought, we're increasing the members of our team and getting more resources. I don't think there's a limit to how big we can be. We'll try to accommodate all the patients that come in and I'll try to get all the resources we need, that's the key. We're seeing patients now from all over Texas — Austin, San Antonio, and Houston. There's a big need.

The parents feel like you're saving their children, and these patients feel like you're saving them.

The no. 1 misconception about transgender youth is that parents, or the environment a child is in, caused it, or that it can be "fixed." It's similar to how homosexuality used to be treated, how before we thought that you could "fix it," and now we know you can't. The American Academy of Psychology doesn't support what they call "reparation therapy," or repairing your transgender identity.

The other misconception is that programs like ours do sex change surgery, and that's wrong. The no. 1 thing we do is provide support for families, for their emotional and social state. We don't do any medical intervention in children either. We only intervene with adolescents who have started puberty. So while hormones may create some body changes, it's not a sex change.

The third is thinking that programs like this promote children and adolescents changing their gender. What we do is evaluate where each patient is at. There are cases where a patient isn't clear, or they're not in the gender binary form. They don't identify as male or female, and might not benefit from a gender transition or medical intervention. Some of them just need time and we ask that of parents, and sometimes parents don't want to hear that. They just want a solution and to know what's going to happen, but you can't rush from one thing to another.

I feel great satisfaction when I meet with these families, how thankful they are for all we're doing, and seeing how the parents appreciate all we do — it's just an amazing feeling. That's why I became a physician, I like to feel like I'm helping people and this has been, in my entire professional life, the most rewarding experience I've ever had. The parents feel like you're saving their children, and these patients feel like you're saving them. You're helping them start a new life, and after I met with these families, I just … I feel like I'm walking in the clouds. It makes it all worth it.

Each story is just amazing and appalling, and it's amazing to see how brave these parents and kids are. And how much love the parents can give. It makes you want to help them, and hear their stories. That's the best part.

Correction: A previous version of this article said the Genecis Program started at Dallas Children's Hospital. The Genetic Program actually started at Children's Health in Dallas.

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Hannah Smothers Hannah writes about health, sex, and relationships for Cosmopolitan, and you can follow her on Twitter and Instagram

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