Vanderbilt University Medical Center has agreed to pause gender-affirming surgeries performed by its pediatric transgender health clinic, which has been under fire from Republican lawmakers. Vanderbilt has now responded to a letter signed by 62 GOP members of the Tennessee House of Representatives who demanded the clinic stop surgeries on minors.

Since its founding in 2018, the clinic was doing about five surgeries a year and never on genitals, according to the one-page letter signed by deputy CEO Wright Pinson.

“None of these surgeries have been paid for by state or federal funds,” Pinson says, adding a response to video clips in which a Vanderbilt doctor says there is money to be made in gender-affirming care. “The revenues from this limited number of surgeries represent an immaterial percentage of VUMC’s net operating revenue.”

The clinical guidelines set internationally do allow for breast removal after age 16. Vanderbilt says everyone who has had surgery was at least that old. Clinical guidelines recommend waiting for adulthood on genital surgery, and Vanderbilt says it follows those guidelines.

Vanderbilt’s pause, even on the few surgeries a year, is not permanent. The clinic’s leaders say they will review new clinical guidelines with national experts for several months. But Vanderbilt also agrees to follow whatever laws the state legislature decides to pass.

The concerns expressed by Republicans were first raised by anti-trans activist Matt Walsh. The medical center is also commenting on video clips Walsh posted in which a physician says she has a problem with employees backing out of gender affirming care because of moral objections.

“Comments from videos posted on social media that are obtained at these kind of events should not be construed as statements of VUMC policy,” Pinson says.

Those who want to be excused from care they find morally objectionable are allowed to opt out, according to medical center policy.