- Texas Attorney General Ken Paxton issued a legal opinion calling gender-affirming medical care “child abuse.”
- Paxton made false claims of there being “no evidence” to support the effectiveness of gender-affirming hormone therapy for transgender youth.
- Not all gender-affirming care, including surgery, is available to those under 18 years old in the United States.
- Gender-affirming care, including puberty blockers, is accessible only under the direction of a medical professional.
- Social support and access to puberty blockers can have a positive impact on trans kids’ mental health.
The fight for transgender rights in the United States is on shaky ground in conservative majority states like Texas.
On Feb. 18, Texas Attorney General Ken Paxton released a legal opinion on pediatric gender-affirming care, comparing the treatments to “child abuse” under the Texas Family Code.
“There is no doubt that these procedures are ‘abuse’ under Texas law, and thus must be halted,” Paxton wrote in a statement. “The Texas Department of Family and Protective Services (DFPS) has a responsibility to act accordingly. I’ll do everything I can to protect against those who take advantage of and harm young Texans.”
Paxton’s remarks are an attack on transgender youth. But he also made false medical claims that there’s “no evidence” that gender-affirming hormone therapy can support trans kids’ mental health.
The year 2021 saw record-high violence, with waves of state legislation blocking transgender rights. As many as 20 states have introduced bills that prohibit or limit gender-affirming medical care. In Texas, transgender youth have been banned from participating in school sports that match their gender identity.
Paxton’s recently issued opinion garnered support from Gov. Greg Abbott, who directed the DFPS to investigate and prosecute acts of “child abuse” by parents and doctors who support kids’ transitioning.
On March 1, the DFPS initiated those investigations, filing a “child abuse” lawsuit against one of its own employees who has a transgender teen that had been receiving gender-affirming medical care.
“[Paxton’s legal opinion] shames and marginalizes parents who are doing the hard work of supporting their children amidst considerable strain and pushback,” Abbie Goldberg, PhD, a Clark University psychology professor in Massachusetts who focuses on gender diversity and sexual orientation, said in an email to Psych Central.
“It’s overly alarmist and therefore potentially destructive when it comes to the many people who really don’t know much about the effects of gender-affirming treatment,” she added.
According to Goldberg, denying trans youth the option to receive gender-affirming care and shaming their families for supporting them will only exacerbate their mental health.
Paxton’s opinion creates confusion around what child abuse actually is, which shouldn’t be conflated with gender-affirming surgery and hormones. Moreover, it contains false and potentially harmful claims about the potential mental health benefits of gender-affirming care.
Paxton’s statement reads:
“There is no evidence that long-term mental health outcomes are improved or that rates of suicide are reduced by hormonal or surgical intervention. Childhood-onset gender dysphoria has been shown to have a high rate of natural resolution, with 61-98% of children reidentifying with their biological sex during puberty. No studies to date have evaluated the natural course and rate of gender dysphoria resolution among the novel cohort presenting with adolescent-onset gender dysphoria.”
The source for Paxton’s claim is attributed to the Society for Evidence Based Gender Medicine‘s website, not scientific studies.
Yet there is considerable scientific evidence to support the mental health benefits of gender-affirming hormone therapy for trans youth.
Following the release of Paxton’s statement, The Trevor Project, a suicide prevention and crisis intervention organization for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) young people, condemned Paxton’s remarks as “unlawful.”
“Texas parents who support their trans kids should be applauded, not prosecuted,” Amit Paley, CEO and executive director of The Trevor Project, said in a statement.
“The government should not be involved in personal decisions that force doctors and families to act against the medical community’s standards of care for transgender young people.”
The Trevor Project is a leader in LGBTQ+ research. As one recent study notes, gender-affirming hormone therapy was linked to lower rates of depression and suicidality among the nearly 12,000 transgender and nonbinary youth ages 13 to 24 who were surveyed.
“Multiple studies have demonstrated that trans youth experience meaningful benefits of hormone treatment, including reduced depression and reduced risk for suicidality,” Goldberg said.
In most states, minors under the age of 18 have limited capacity to consent to healthcare, including gender-affirming care.
But neither gender-affirming hormone therapy nor gender-affirming surgeries are offered to young children, according to Elizabeth Boskey, PhD, MPH, LICSW, a researcher and social worker for the Center for Gender Surgery at Boston Children’s Hospital.
“The only type of gender-affirming medical care that is sometimes available in childhood is GnRH agonists, or puberty blockers, which are used to put a temporary halt on the changes that occur during puberty,” Boskey told Psych Central.
According to Boskey, puberty blockers generally aren’t started until after the first signs of puberty appear. She said that most individuals under the age of 18 have access to gender-affirming healthcare only when their caregivers agree that it’s appropriate.
“Other forms of gender-affirming care, including menstrual suppression and hormone therapy, aren’t prescribed until later in adolescence or adulthood,” Boskey said.
“The specific timing of gender-affirming medical care reflects the needs and concerns of transgender individuals and, for those under the age of 18, the needs and concerns of their parents.”
As with other types of medical care, Boskey explained that gender-affirming treatment is prescribed under the direction of a medical professional who has evaluated the person’s need in accordance with standards of care and professional guidelines.
Gender dysphoria is experienced when a person feels that their assigned gender doesn’t match their true gender identity, which can be distressing and anxiety-inducing.
If a child is experiencing gender dysphoria, there are a few things to keep in mind as you support them.
Boskey said a child’s request to use a name and pronouns should be honored. “The risks of not socially affirming their identity are much higher than the risks of doing so,” she explained.
Access to puberty blockers
Boskey said medical and mental health professionals try to optimize access to puberty blockers, which are reversible and provide young people and their families the opportunity to live in their gender.
Puberty blockers allow young people time to decide whether they want to take additional steps in their transition.
“It’s understandable that parents may have more worries when considering medical therapies, like hormones, which are less reversible,” Boskey said.
“If parents are unsure about their adolescent’s ability to participate in a comprehensive, medical decision-making process, then it may be helpful to discuss the adolescent’s needs and desires with a trained health professional who understands gender identity development across the lifespan.”
The Texas attorney general’s legal opinion on transgender youth does not yet have legal repercussions. Still, Paxton is sending a harmful message that only adds to the stigma around transgender and nongender conforming identities.
Social support and affirmation are crucial for reducing depression and suicidality risk among transgender and nongender conforming youth.
And when caregivers and medical and mental health professionals determine it’s appropriate to do so, specific gender-affirming therapies, such as puberty blockers, may improve the well-being of a young trans person.
Though many states still have a lot of work to do in terms of progress, others are stepping up to support affirming and accepting transgender identities, including passing laws to block conversion therapy and other harmful bills.
If you or a loved one need help or support, The Trevor Project’s trained crisis counselors are available 24/7 at 1-866-488-7386, via chat at TheTrevorProject.org/Get-Help, or by texting START to 678678. You may also seek support through the National Suicide Prevention Lifeline by calling 800-273-8255 or texting 741741 or the Crisis Text Line by texting HOME to 741741.