By: Gillian Grant

Following the trends of recent years, 2022 is shaping up to be another busy year for anti-LGBTQ legislation. Over 200 anti-LGBTQ bills have been introduced this year, many of which specifically limit the rights of trans youth. South Dakota and Iowa have both already passed laws prohibiting trans students from participating in single-sex sports teams that align with their gender. A similar Texas law took effect earlier this year. Additionally, legislators in several states have introduced bills that would prevent trans youth from accessing gender-affirming healthcare. In 2021, the Texas legislature considered SB 1646, which would have made allowing a child to receive gender-affirming healthcare, such as hormone replacement therapy (“HRT”), child abuse. While the bill was ultimately defeated, its sentiments have been revived recently through a series of opinions and directives issued by Texas state officials.  

In a February 2022 opinion letter, Texas Attorney General Ken Paxton concluded that providing trans youth gender-affirming healthcare, including HRT and GnRH analogues (“puberty blockers”), could constitute child abuse because it “deprive[s] minor children of their constitutional right to procreate.” To support his ludicrous claims, Paxton cites a study on the forced sterilization of disabled people and people of color; the author of the study stated that she is “adamantly opposed” to her research being used to support anti-trans healthcare policies. Subsequently, Governor Greg Abbott directed the Texas Department of Family and Protective Services (DFPS) to investigate the parents of trans children receiving “abusive gender-transitioning procedures” and reiterated that medical professionals and teachers must report children who have received such care.

Several Texas families have already been the subjects of investigation by DFPS pursuant to the new policy. The ACLU and Lambda Legal have challenged the directive on behalf of one such couple, their trans daughter, and a clinical psychologist, arguing that the new policy puts trans youth and their families, educators, and health care providers at significant risk. The petition notes that trans children will experience negative mental and physical health effects if they are unable to access affirming healthcare. Meanwhile, their parents will face the difficult choice of risking criminal prosecution when supporting their child or denying medically-necessary care to their child at the risk of harming their mental and physical health. Furthermore, health care providers are put in a lose-lose scenario: either they comply with the policy and violate their professional standards of ethics, or they adhere to the medically-accepted standard of care and risk prosecution and the loss of their license. In the ACLU case, a Travis County judge enjoined enforcement of the directive against the named plaintiffs, finding that “[p]laintiffs will suffer irreparable injury” if the directive is enforced. The following week, the court issued an injunction preventing Texas officials from investigating any allegations of child abuse based solely on the provision of gender-affirming care to trans youth. A trial on the merits is scheduled for July 11, 2022.

SB 1646 and the February 2022 directive issued by Governor Abbott are not the first times Texas Republicans have described gender-affirming healthcare for trans kids as abuse. In 2019, Governor Abbott announced that officials would be launching an investigation into a Texas mother after her ex-husband accused her of abuse when she allowed their seven-year-old trans daughter to socially transition. In a letter to DFPS, then First Assistant Attorney General Jeff Mateer[1] (working under current Texas Attorney General Paxton) expressed concern that DFPS was not already investigating the mother and claimed that she was causing her daughter “permanent and potentially irreversible harm” by allowing her to socially transition. The child’s father, Jeff Younger, is currently running for the Texas House of Representatives. His campaign website repeatedly misgenders his daughter, claims that his daughter was misdiagnosed, and refers to gender-affirming healthcare as “transgender sexual abuse.” During a recent appearance at the University of North Texas, Younger was greeted with a heartwarming display of pushback against his transphobic views as students chanted “f–k these fascists” and “trans rights.”

Despite Texas officials’ claims, gender-affirming care is safe and contributes to the mental and physical wellbeing of trans youth. For prepubescent trans children, transitioning is purely social – the child may choose a new name and pronouns and wear clothes congruent with their gender identity. As the child approaches puberty, they may be prescribed puberty blockers to suppress estrogen or testosterone production. Puberty blockers are fully reversible and are commonly prescribed to cisgender youth who begin experiencing puberty too young. In later adolescence, trans youth may be prescribed HRT so that they can undergo puberty in alignment with their gender. Surgical interventions, except chest surgery, are not recommended for youth under the age of 18. The American Medical Association, American Academy of Pediatrics, American Psychological Association, and other major medical associations support gender-affirming care for trans children, including the use of HRT and puberty blockers.

On March 2nd, President Biden issued a statement regarding Texas’s most recent attack on trans youth, stating that Governor Abbott’s directive “callously threaten[s] to harm children and their families just to score political points.” That same day, the HHS Secretary announced several steps the HHS is taking to protect trans youth from discriminatory practices, including: issuing guidance to child welfare agencies that LGBTQ children should be affirmed and supported; reminding health care providers that they are not obligated to release trans patients’ medical information; and reaffirming that denying medical treatment on the basis of gender identity is illegal.

[1] In 2017, Mateer’s nomination to the District Court for the Eastern District of Texas was withdrawn after two speeches in which he made anti-LGBT comments were uncovered. In these speeches, he referred to trans children as evidence of “Satan’s plan,” defended conversion therapy, and suggested that marriage equality would lead to bestiality.

Gillian is a 2L at Arizona State University’s Sandra Day O’Connor College of Law. Her social justice interests include juvenile justice, education, and issues impacting the LGBTQ+ community. In her free time, she enjoys playing video games, cooking, and volunteering with animal rescue groups.