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Texas health providers are suspending gender-affirming care for teens in response to GOP efforts

Hospitals across the state have already started restricting critical treatment as health care providers fear legal consequences and worry they could lose their medical licenses. Meanwhile, teenagers are already leaving the state to get care or avoiding medical care altogether.

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Psychotherapist Monrovia Van Hoose in her Austin office on March 11. Van Hoose, who began working with transgender youth in 2008, has seen an impact on transgender youth after the state’s largest providers of medical care for transgender children recently rolled back their services. (Lauren Witte/The Texas Tribune)

This article originally appeared in The Texas Tribune

Jennifer’s 15-year-old son had been on testosterone therapy for only two weeks when she got a call from his doctor. The exchange felt “very clandestine,” she said.

“He calls from his personal number, calls my personal number [and] doesn’t use my child’s name because he’s scared somebody is recording the conversation,” Jennifer said.

The doctor told her he could no longer prescribe her son’s treatment. The medical malpractice insurance carrier, he explained, had stopped covering doctors who offered hormone therapy to minors.

The doctor’s call came a week after Gov. Greg Abbott ordered investigations into parents and licensed facilities that provide standard medical care to transgender teenagers. Abbott’s order was based on a nonbinding interpretation from Attorney General Ken Paxton that classified puberty blockers, hormone therapy and surgical care as child abuse.

Jennifer asked The Texas Tribune not to disclose her last name because she fears the state could launch an investigation into her family for obtaining hormone therapy.

Leading medical organizations across the country say gender-affirming care is the best way to provide care for transgender children. It primarily involves choices around name, pronouns and clothing that align with a child’s gender identity. It can eventually include puberty blockers and hormone treatment. Surgical care is rarely, if ever, performed on teenagers.

On Monday, a state appeals court reinstated a lower court’s injunction temporarily halting the investigation of transgender kids’ parents and medical providers. The court says the injunction will remain in place while an appeal of the decision plays out.

But in response to the Texas GOP’s recent efforts to limit scientifically backed gender-affirming care, LGBTQ advocates say hospitals, insurance companies and pharmacies across the state had already started restricting critical treatment for fear of legal consequences.

Health care providers worry they could lose their medical licenses if they don’t abide by Abbott’s directive.

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U.S. Surgeon General Vivek Murthy told the Tribune that Abbott’s directive has had a chilling effect on health care practitioners, hospital systems and clinics.

“What’s happening right now is the state inserting itself between doctors, patients and families,” Murthy said. “That runs counter to the integrity of the doctor-patient relationship.”

Transgender teenagers now are grappling with narrowing access to medical care in a state where adequate, inclusive health care is already hard to come by. The lack of access has driven some to secure a substandard quality of care and others to stop seeking care altogether.

Jennifer said the doctor’s decision to stop hormone therapy was devastating for her family. She had searched for months for a pediatrician who would use her son’s correct pronouns and respect his identity. She had combed through parent Facebook groups and left voicemails with multiple health care centers before she met the doctor who started his treatment. Now she’s back at square one.

“You can’t find this care easily. Everyone is taking it off their website,” Jennifer said. “It’s like you got to know a secret handshake and then the secret knock and then the right phone number. It’s ridiculous what you have to go through to get your kid life-saving medical care.”

Providers roll back treatment

Teens who get approved for hormone therapy do so with great medical oversight. But before getting to that point, the standard approach to care for transgender youth begins with counseling and mental health evaluations.

Mental health professionals first help transgender clients navigate their gender identity. They can diagnose transgender clients with gender dysphoria by following a diagnosis tool published by the American Psychiatric Association. Therapists may later refer clients to doctors for hormone therapy and puberty blockers, and those doctors would complete a separate evaluation before prescribing medication. It’s a process that can span years.

The state’s largest providers of medical care for transgender children, however, have recently rolled back those services, bending to pressure from Republican leaders.

Texas Children’s Hospital, the largest pediatric hospital in the country, stopped providing hormone therapy to transgender children earlier this month. A spokesperson said the Houston-based hospital was assessing Abbott’s directive and that the decision to discontinue the service was made to avoid “potential criminal ramifications.”

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Legacy Community Center, another major provider in Houston for transgender children, also paused hormone therapy for minors after the directive was announced, according to advocates for transgender Texans who work closely with the clinic. Legacy did not respond to multiple requests for comment.

And in Dallas, GENECIS — Gender Education and Care, Interdisciplinary Support — the state’s largest gender-affirming program, formally dissolved in November. The closure was in response to pressure from the governor’s office and a Texas House investigative committee, according to recordings of internal meetings obtained by The 19th. Existing patients can continue hormone therapy, but new patients at GENECIS can only access psychiatric evaluations and counseling, and be evaluated for gender dysphoria.

A doctor who headed the GENECIS program recently filed a petition against her employer, UT Southwestern Medical Center, to find out why the hospital cut care.

Gender-affirming medical and mental health care has always been in short supply in Texas, even before the GOP started targeting transgender children. So when the three major providers of gender-affirming care decided to halt their services, it was a huge blow for transgender Texans already struggling to find treatment, said Austin-based psychotherapist Monrovia Van Hoose, who often works with transgender youth.

The recent anti-trans efforts are “a backlash against what I would call pretty modest gains in access to care for minors in Texas,” she said. “I was very saddened to hear that GENECIS closed down. That was a big deal when that facility opened.”

Van Hoose said few doctors were willing to offer gender-affirming care in the state when she started working with transgender teenagers in 2008. More began to offer treatment after the GENECIS clinic opened in 2014.

But beyond GENECIS, Texas Children’s and Legacy, doctors who offer gender-affirming are still few and far between. Lou Weaver, a 51-year-old transgender man who works with health care providers to secure culturally competent care for LGBTQ communities, said Texas medical schools are not offering enough training on how to treat transgender patients, which means most local pediatricians are unable to provide appropriate care for transgender children.

Families often have to make hourslong drives to get medically backed gender-affirming care for their children. One family in the Rio Grande Valley told the Tribune they drive eight hours to Dallas to get care for their child.

But now even those long drives might not be enough to access care as doctors weigh new legal liabilities. When Paxton said gender-affirming care can be considered child abuse, it put health care professionals in a tight spot because they are mandated to report child abuse.

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Therapists, pediatricians and doctors could now lose their licenses if they don’t report the families of their transgender clients. Making such reports, however, would violate standards of care from health organizations such as the World Professional Association of Trans Health and the American Medical Association.

Areana Quiñones, executive director of Texas-based Doctors for Change, said health care providers are disappointed legal and political issues are getting in the way of providing science-based medical treatments.

“We’re put in a no-win situation no matter what we do,” said Renee Baker, a Dallas-based therapist. “We don’t want to lose our licenses and ability to practice.”

Weaver said the hospitals could have used their teams of lawyers to advocate for scientifically backed medical treatments, “​​and yet they’re caving.” Health care providers are failing to protect their patients when they pull back treatment in response to political pressure, he said.

Few good choices left 

Weaver said many transgender teenagers in Texas, facing diminishing options for care, will turn to informal channels to get the puberty blockers and hormone prescriptions they need. Some could try to buy prescriptions off of friends or look to the state’s unregulated black market, he said.

“What are you going to do to get what they need? You find a way to get it,” he said. “Our leaders have made this a desperate time for people who need access to health care.”

One teacher said in a written testimony at a Texas Department of Family and Protective Services meeting this month that some of her transgender students have rationed their hormone prescriptions over weeks because of inadequate access to medical care.

Some parents are traveling beyond Texas to get access to gender-affirming medical treatment. Some may also travel out of state to get any kind of medical care out of fear that going to a Texas health provider may require disclosing gender-affirming therapy and lead to a child abuse investigation.

Carrie Jackson drove her 17-year-old transgender son to Oklahoma to get emergency mental health care one week after Abbott issued his directive. Her son woke her up in the middle of the night because he was preparing to attempt suicide. Her son told her Abbott’s directive had made him feel like his existence was creating a threat for his family, she said.

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Carrie Jackson stayed up with him through the night and scheduled multiple virtual assessments the following morning. Medical providers told her he needed to be admitted to a hospital.

She wanted to get him help as soon as possible, but she held back from taking him to a local hospital because she was afraid that DFPS, the state child welfare agency, would learn about the gender-affirming care her son has received and open an investigation.

“I don’t want my child in a hospital being interrogated by [DFPS] and without me being able to have any access to him to be there as a support for him,” she said.

Carrie Jackson did some research and found a mental health facility in Oklahoma, about three and a half hours away from their Denton home. Her son was admitted for six days and is stable now.

Some families that cannot leave the state have avoided seeking care altogether.

Jackson, a 15-year-old transgender teenager in North Texas, was supposed to increase his testosterone dosage six months ago. Jackson is not related to Carrie Jackson and did not disclose his last name out of fear that his family would be reported to the state for child abuse over his medical treatment.

He has been a GENECIS patient for two years, but since the clinic formally dissolved, he’s experienced additional barriers to obtain routine medical treatment. Increasing his prescription dosage used to entail a single appointment with his doctor at GENECIS and bloodwork, but he now has to meet with three doctors at three clinics.

What’s more, he and his family are terrified to book an appointment while Abbott’s directive is still being litigated. If DFPS gets a report about his medical care, Jackson might have to stop taking testosterone until his 18th birthday.

Greater risks with delayed care

But Jackson can’t wait another three years for hormone therapy. Gender dysphoria, he said, was an intolerable sense of discomfort that pervaded every part of his life. Since he started testosterone, he has experienced an increasing sense of comfort with his body.

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“To be taken off of the one thing that has really changed my life for the better so far — it’s terrible,” Jackson said.

Waiting until adulthood to get hormone therapy may put transgender patients at greater mental health risk. A recent study found that access to gender-affirming hormone therapy in adolescence is associated with better mental health outcomes later in life.

If access to hormones like estrogen and testosterone is disrupted, transgender youth may undergo unwanted puberty changes and experience bodily functions like menstrual bleeding that can be distressing, according to Caroline Davidge-Pitts, an endocrinologist who specializes in trans health care.

When transgender youth experience unwanted changes to their bodies that do not affirm their gender identity, endocrinologists say it will likely lead to more surgeries later in life that otherwise could have been avoided. If a transgender boy, for example, experiences breast growth because he lost access to puberty blockers, he would need chest surgery later, said Joshua D. Safer, an endocrinologist and executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York.

“The point of puberty-delaying medication and hormone therapy for transgender youth when possible is to avoid permanent characteristics that will have to be addressed later,” Safer said.

Kamryn Shelton, a transgender 19-year-old, said his younger peers have attempted suicide when they have not been able to access the medical care they need.

Shelton, who supports teenagers in the Dallas-Fort Worth area through the organization Youth First, worries about youth who become disconnected from their hormone therapy or can no longer get an appointment with a gender-affirming doctor.

“Their mental health will rapidly decline. And if you stop taking your hormone shots or hormone blockers, it’s not only going to mess you up mentally, it’s going to mess with you physically as well.” Shelton said. “It’s going to kill people. If it goes any further, it will literally kill children. And that’s terrifying to me.”

Disclosure: Facebook 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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The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.

Sneha Dey is a reporting fellow at The Texas Tribune. She is a senior at Northwestern University, where she studies journalism, legal studies and creative writing. The New York native has previously worked for the Chicago Sun-Times, NPR and Chalkbeat. She has also served as editor in chief of The Daily Northwestern. When she’s not in the newsroom, she is going on runs or eating her way through Austin.

Austin

Austin Pride Rescheduled

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The Austin Pride Foundation announced that this year’s Austin Pride celebration, originally scheduled for Saturday, August 13, 2022, has been rescheduled for the following weekend. This year’s Austin Pride Festival and Parade will now be held on Saturday, August 20, 2022.

According the a post on Facebook, the change was made at the request of the City of Austin:

We will celebrate Austin Pride No! Matter! What! At the request of the City of Austin, our new date for Austin Pride is Saturday, August 20, 2022. One more week also gives us a chance to go Beyond the Rainbow for the Pride we deserve after two long years. This year the rainbow shines no matter what! See you there.

This will be the first pride celebration in Austin since 2019, after all events in 2020 were canceled as a result of the pandemic and canceled again in 2021 due to a surge of infections caused by the Delta variant of SARS-CoV-2, the virus that causes COVID-19.

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Dallas

Dallas Southern Pride Announces the 2022 Juneteenth Unity Weekend

More than 20,000 people expected to attend the star-studded event featuring A-List celebrities including Moneybagg Yo, The City Girls, Saucy Santana, and Dallas’ own, Yella Beezy and Erica Banks

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DALLAS — Dallas Southern Pride will host its Juneteenth Unity Weekend celebration, June 16-19, 2022. This year’s celebration will include a myriad of events, including health and wellness screenings, COVID-19 vaccinations, concerts, their annual Juneteenth Unity Festival and Pool Party, various local club events, parties and The Emancipation Ball. Some of the biggest stars in hip-hop and entertainment are confirmed for this unforgettable four-day weekend of festivities, including the City Girls, Saucy Santana, and Moneybagg Yo, who will perform at the Juneteenth Unity Festival and Pool Party on Saturday, June 18 from 5 PM – 9 PM at Samuell-Grand Aquatic Center, 3201 Samuell Blvd., Dallas, Texas; and Dallas’ own superstars Erica Banks and Yella Beezy, who will perform at the Mega Party that Saturday at 10 PM at Amplified, 10262 Technology Blvd E, Dallas, Texas. The weekend of events will conclude with a signature brunch on Sunday, June 19, hosted by Kirk Myers-Hill, president of Dallas Southern Pride.

More than 20,000 people from across the United States and internationally are slated to attend this year’s Juneteenth Unity Weekend celebration, which was created to celebrate the brilliance and culture of Black people. An idea birthed by community leader, businessperson and activist, Kirk Myers-Hill, the Juneteenth Unity Weekend is the official annual celebration for Black Lesbian, Gay, Bi, Trans, and Queer (LGBTQ+) people to come together and celebrate their contributions to both American and Black culture, liberation and community.

“Juneteenth Unity Weekend is a celebration and representation of the many intersections and beautiful mosaics within the Black community,” said Kirk Myers-Hill, president of Dallas Southern Pride. “The Black community is only as strong as its Black Gay brothers and sisters. Juneteenth is an opportunity to showcase unity and display the belief that we are all stronger together.”

Juneteenth became a federally recognized national holiday in 2021. However, long before the nation started celebrating this holiday, Black people in Texas were celebrating this day, as it originated in Texas. The Emancipation Proclamation, which granted freedom to slaves, was signed 1863. However, it wasn’t until two years later on June 19, 1865, that slaves in Texas first learned of their freedom. Union troops entered Galveston, TX, announcing that all slaves were free. This marked the beginning of Juneteenth as it is known and recognized today. Since 2017, the Governor of Texas has submitted a proclamation recognizing the Juneteenth Unity Weekend. Additionally, Congresswoman Eddie Bernice Johnson continues to show her support by issuing welcome letters for the past five years. The Juneteenth Unity Weekend is a family-oriented celebration with events and programming for the entire community and is excited to bring the celebration of Juneteenth back home to Texas. June is also Pride Month and the Juneteenth Unity Weekend has been a staple event in the city of Dallas during Pride month for many years.

“VisitDallas is excited to support the 2022 Juneteenth Unity Weekend hosted by Dallas Southern Pride and Abounding Prosperity, Inc. Events like this continue to make Dallas a better place to live and visit,” said Craig T. Davis, president and CEO of VisitDallas.

Since its inception in 2008, the Juneteenth Unity Weekend continues to make a positive impact in the Dallas-Ft. Worth metroplex by unifying the community, celebrating freedom, providing a safe space for community gathering, and infusing millions of dollars into the local economy. The 2021 Juneteenth Unity Weekend brought thousands of visitors to the Metroplex, and sold-out all its host hotels. The event generated more than $2.2 million dollars for local business hit hard by the global COVID-19 pandemic and created hundreds of jobs for “gig” workers. The event and leadership team also created other historic moments for the city of Dallas. As a result, the HIV positivity rate dropped below 10 percent for the first time in the event’s history among more than 200 attendees tested; the Dallas Police Department held a recruitment drive targeting LGBTQ+ applicants; the Dallas skyline was lighted in the Juneteenth and Black Pride colors for the first time and The Dallas Southern Pride Official Pride flag was debuted and flown for the first time at the Sheraton Market Center.

The Juneteenth Unity Weekend is a collaborative celebration made possible by the support of the many companies and organizations that share the collective vision for this impactful event that advances the entire Black family and social justice movements and celebrates unity and peace. The 2022 presenting sponsors thus far are Gilead Sciences and Abounding Prosperity, Inc., along with Black Entertainment Television (BET) and ViiV Healthcare as diamond sponsors. Other key sponsors include the Dallas Mavericks, Radio One Dallas, Dallas TPID, AHF, Yale School of Nursing, Johns Hopkins University, HVTN, SBPAN, AIDS United, VisitDallas, Hilton, Center for Black Equity, United Black Ellument, Crawford Jewelry, and Don Morphy.

A portion of the proceeds from this year’s Juneteenth Unity Weekend will be used to support the free health, and wellness activities of its partner agencies, which offsets the cost of essential services to Black and Brown communities, with an emphasis on LGBTQ+ communities and their families in the DFW metroplex.

The Juneteenth Unity Weekend is still open for additional sponsors and vendors, particularly those in the arts, entertainment, health and wellness, skincare, clothing, beauty, food and beverage including food trucks, and lifestyle brands.

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For more information or to purchase tickets, visit www.dallassouthernpride.com.

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Austin

UT Austin will allow students to live together on campus regardless of gender or sexual identity

The two-year pilot program comes after at least 15 years of students asking for the change. It will allow UT-Austin students to live together in certain residence halls with students of any gender or sexual identity.

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UT-Austin is launching a two-year pilot project that allows students in certain residence halls to live with any other student, regardless of gender or sexual orientation. (Miguel Gutierrez Jr./The Texas Tribune)

This article originally appeared in The Texas Tribune

The University of Texas at Austin is starting a two-year pilot program next fall that will allow students to live together in certain campus residence halls regardless of their gender or sexual identity.

Called the “Family and Friend Expanded Roommate Option,” any UT-Austin student can select any other UT-Austin as a roommate.

Student advocates have been pushing the university to create a gender-inclusive housing option since at least 2006, according to Adrienne Hunter, a senior and transgender woman who has advocated for the change over the past few years.

“This is the result of so many students working on this issue,” she said. “It’s something in my opinion that is tangibly going to lead to so many students, trans students, feel[ing] included.”

According to a housing page on the university’s website, the university said it is allowing for this option to build better community engagement.

“This helps enhance our residents’ sense of belonging and improve our competitiveness with the Austin market and other institutions,” the university said on its website. “It also allows us to be more responsive to student needs.”

Traditionally, dorms, even co-ed ones, have been designed to separate by sex students sharing a room. The new pilot policy applies to dorms where students have private bathrooms either shared among roommates or suitemates.

Hunter said that UT housing would handle requests for more gender-inclusive housing situations on a case-by-case basis, but she said it sometimes posed problems for students who have yet to discuss their sexual identity to their parents and did not want to email about their situation for fear their parents might accidentally find out.

“To have the burden on the student to do this outreach instead of having this system was something a lot of students didn’t feel comfortable with,” she said.

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Earlier this year, the Queer Student Alliance at UT-Austin issued its first report on the state of LGBTQIA+ students since 2006. They surveyed more than 2,000 students on campus. It found while the vast majority of students who identify as cisgender felt comfortable expressing their gender identity on and off campus, transgender students in particular felt much less comfortable expressing their gender identity in on-campus housing than off-campus housing.

The report recommended instituting gender-inclusive housing with a web page that uses clear language and definitions of gender-inclusive housing policies.

Hunter said she and others used this data to make a case to UT-Austin President Jay Hartzell. The university eventually created a working group of students, faculty and staff, which provided feedback to the university as it developed a policy.

The decision to begin this pilot project comes at a politically fraught time for transgender rights in the state. In February, Gov. Greg Abbott instructed the state’s Department of Family and Protective Services to investigate families who provide gender-affirming health care to their transgender children, for child abuse.

A spokesperson for UT-Austin did not immediately respond to questions about why the university started this pilot program now or why the university did not identify the new policy as “gender inclusive housing,” as other universities across the state and country have done.

In Texas, a handful of other universities across the state already have gender-inclusive housing, including the University of Texas at Dallas and the University of Texas at San Antonio. The University of Houston has a “living learning community” that is gender-inclusive in two of its residence halls.

In fall 2020, Texas Tech University in Lubbock created a housing option that went into effect in 2021 that allows students in the West Village residence hall to allow eligible students to live together in the same apartment on-campus regardless of gender.

Disclosure: Texas Tech University, University of Texas – Dallas, University of Texas at Austin, University of Texas at San Antonio and University of Houston 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.

The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.

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