Texas’s gender affirming care ban worries parents, transgender adults

HOUSTON – Lisa Stanton is preparing her 12-year-old transgender daughter Maya and their family for fleeing the state due to a ban on gender-affirming treatment that was newly approved by Texas lawmakers this week and is expected to go into effect in September.

“We have a safe folder. We have folders ready to go with all our documents and passports and we have cash on hand. We have an escape route if we need it,” Stanton said. “The alternative is we pick up and move and we are officially political refugees. Or we stay and fight for our home. We shouldn’t have to leave. This is wrong.”

But like Stanton and her family, many other families said they are considering moving or seeking care out of state after the Texas legislature’s vote on Wednesday to approve a bill banning hormone and puberty blocking treatments as well as surgeries for transgender minors. The bill would force the Texas Medical Board to revoke physician licenses for those who violate the ban, and would prohibit taxpayer funds from being used for transgender health care or from going to any person or entity that “provides or facilitates” the treatment.

With the signature of Gov. Greg Abbott, a Republican, Texas will become the largest state to ban such medical care for minors. Abbott left no question about his intentions during a Thursday appearance on Fox News.

“I’ll be signing it,” he said.

To parents of transgender children, however, the move was yet another in a host of actions targeting their health care, which have come in the form of executive orders and bills dating back several years.

Last year, Abbott ordered state child abuse investigations into transgender youth receiving gender-affirming care. The order – the first of its kind, according to transgender advocates – put medical providers and families of transgender children at risk of criminal penalties for providing treatment endorsed by the nation’s largest medical groups, including the American Medical Association.

Abbott’s letter to state agencies came the same week Attorney General Ken Paxton, also a Republican, released a nonbinding legal opinion that labeled certain gender-confirming treatments as “child abuse.”

When impacted families sued Abbott, the Texas Supreme Court initially allowed the state to continue investigating them for child abuse while also ruling in favor of one family who challenged the order. Another Texas judge later issued a restraining order blocking investigations of families who sued and those in the LGBTQ advocacy group PFLAG, which claims more than 600 members statewide.

On Thursday, Abbott called gender-affirming treatments “outrageous.”

“In Texas, we believe that cutting off a child’s sex organs is child abuse and it’s going to be treated that way by law,” he said. Transgender advocates noted such surgeries are not generally performed on children. Nationally recognized medical guidelines recommend patients be at least 15 years old to undergo surgery, and then only in special circumstances.

Efforts to clamp down on transgender health care have dominated in Republican-held state legislatures in recent months; at least 14 other states have enacted restrictions on medical treatments for transgender children. Florida Gov. Ron DeSantis (R) signed a bill this week that bans hormone treatments and gender-transition care for minors, and would penalize doctors who violate the law with up to five years in prison.

But no state affected so far is home to as many transgender children as Texas, with nearly 30,000 people ages 13 to 17 identifying as transgender, or about 1% of Texans in that age group, according to estimates from the Williams Institute, a research center that reports on LGBTQ community demographics.

The new Texas bill – which would take effect Sept. 1 – prohibits doctors from prescribing drugs to induce infertility and from performing certain surgeries, including mastectomies. It includes a limited exemption for transgender children receiving medical treatment before the bill’s passage, though it also required those patients to “wean” themselves off medications.

Karen Loewy, senior counsel for Lambda Legal, represents families in two lawsuits against Abbott seeking to block the state from investigating parents of transgender children for child abuse. She said the new law would not affect those cases.

“Were the state to start investigating those who were getting medically necessary treatment for their children, were they to investigate them for child abuse, we will raise it with the courts that have issued the injunctions,” Loewy said.

Lambda Legal, the American Civil Liberties Union and several other groups announced Thursday that they plan to sue to block the new Texas law.

Supporters of the Texas legislation have condemned the treatments as “mutilation.”

“Let’s send a message to millions of Texans that in this building, we will protect Texas children,” state Rep. Tony Tinderholt (R) said before the Texas House passed the measure last week.

State Rep. Shawn Thierry, a Democrat, broke with her party to vote for the measure, likening it to age limits on tanning booths, tattoos and cigarettes.

“These policies and regulations are in place because we recognize that children should be protected from actions and activities which are harmful, health risks or have lifelong consequences,” she said. “This same logic must also apply when approaching the very complex issue of treating gender dysphoria in children.”

The bill was a priority for Jonathan Saenz, president of the conservative Austin-based nonprofit Texas Values, whose colleagues testified in favor.

“More and more states are going to pass it and the courts are going to allow the states to have their role,” Saenz predicted in an interview. “There’s a lot of questions and concerns now – legitimate concerns – about these medications and procedures.”

Saenz said he was confident that lawsuits against the new measure would be unsuccessful.

“We feel very strong about it and so does our attorney general,” he said. Paxton’s office did not respond to requests for comment.

Families of transgender children described incidents that they said had curbed treatment opportunities even before the legislature’s vote Wednesday.

Paxton earlier announced an investigation into “potentially illegal” activity at an Austin clinic, Dell Children’s Medical Center, in what appeared to be a response to a video report from the conservative Project Veritas, a far-right activist group that engages in hidden camera-style investigations. The video allegedly shows a Dell Children’s social worker saying the hospital provides certain gender-affirming treatment for patients “as young as 8, 9” and sometimes after only one consultation.

In response to the video, Dell Children’s released a statement on April 28 that said it does not provide hormone therapy or gender-affirming surgery to children, and the hospital system was looking into the allegations.

After that report, Christopher Rufo, a senior fellow at the conservative Manhattan Institute, posted records that he said showed doctors at Texas Children’s Hospital in Houston providing gender-affirming care. Hospital spokeswoman Kelley Carville said its staff “have always and will continue to” treat patients “within the bounds of the law.”

On Friday, Paxton announced that his office also is investigating Texas Children’s, demanded the medical records of minors to whom the hospital had provided gender-affirming care, and affirmed his nonbinding opinion that gender-affirming care constituted “child abuse.” Harris County Attorney Christian D. Menefee called the investigation “legally baseless.” The hospital declined to comment on the investigation.

Adult transgender patients said they, too, have been affected by cutbacks in care. Andrea Seger said neither she nor her 19-year-old transgender son were notified by Dell Children’s that they had stopped treatments. They learned it Thursday from their attorney.

“We have been emailing and calling, leaving messages and … nothing,” she said of the clinic where her son Logan has been treated for the past two years. “No heads up to find a new doctor.”

“What happens to these kids who have been taking hormones if they don’t have refills?”

Ian Pittman, an Austin attorney representing families of transgender children, said that his clients were seeking other options.

“Many of my clients are finding care out of state now because they’re concerned,” he said, citing efforts in California, Colorado, Minnesota and Oregon. But, he said, “There’s huge wait times.”

Kay, an Austin mother who asked to be identified by her middle name due to concerns about privacy for her 9-year-old transgender daughter, said the legislative action was not unexpected, but added another layer of difficulty for families.

“The bill passing we knew was going to happen and we all had been preparing,” she said. “Paxton’s investigation (of Dell Children’s) was what really ripped the rug out from under us.”

“Now we’re dealing with people running out of medications and people who were supposed to have surgeries done. Patients have been abandoned and they haven’t even been notified. It’s mass chaos. I’ve had to personally notify families.”

Kay said she can’t move because of a custody agreement, and many others can’t afford to leave their jobs or relocate. Seeking out-of-state treatment has been complicated by a dearth of clinics, or clinics with 18-month waiting lists. And it wasn’t clear, she said, if clinics elsewhere would accept out-of-state insurance.

“We are going to have to go out of state to a clinic and pray nothing else happens here that calls that child abuse,” she said. “I’m afraid of what’s coming next.”

“The alternative is we pick up and move and we are officially political refugees. Or we stay and fight for our home. We shouldn’t have to leave. This is wrong.” Lisa Stanton Mother of transgender child