While forcing a pregnant child to risk their life to have a rapist’s baby, promoting deadly non-consensual circumcision, and non-consensual intersex genital mutilations are positions Texas Governor Greg Abbott supports, he wants to pretend that allowing a trans kid time to figure things out by putting puberty on pause, is now abuse akin to beating a child unconscious.
This is a political hoax.
Under political pressure for being too liberal from several far-right candidates, Abbott issued what is an effectively fake directive that all schools and licensed mental, medical, and social service providers must aid him in reporting trans children to the Texas Department of Family and Protective Services (DFPS) and that such reports be viewed by DFPS as child abuse.
Again, this is a political hoax.
Abbott’s “directive” is based on Paxton’s newly minted “legal opinion.” In fact, Abbott included Paxton’s opinion in his “directive.” While Paxton’s “opinion” is full of red meat that Paxton’s voters will love, on Page 2, Paxton’s “opinion” states:
“This opinion does not address or apply to medically necessary procedures.”– Texas Attorney General and Indicted Felon, Ken Paxton
Citing Paxton, Abbott asserts the following:
“As OAG Opinion No. KP-0401 makes clear, it is already against the law to subject Texas children to a wide variety of elective procedures for gender transitioning…”– Texas Governor Greg “Don’t Google ERCOT today” Abbott
While Abbott’s voters might believe that trans care is medically unnecessary, every actual medical and psychological organization disagrees. Moreover, the medical necessity of trans care is backed up by decades of case law at every level and decades of peer-reviewed scholarship. Trans care is medically necessary, no matter how much that fact upsets Abbott’s voting base.
Let me repeat this demonstrable medical fact: trans care is medically necessary.
No matter how loudly Abbott bangs his political spoon on his highchair, his “directive” isn’t legally binding and does not, in any way, require anyone to report anyone else to DFPS because a kid is receiving medically necessary trans care.
In his directive, Abbott asserts, “Texas law imposes reporting requirements upon all licensed professionals who have direct contact with children who may be subject to such abuse, including doctors, nurses, and teachers, and provides criminal penalties for failure to report such child abuse.” In fact, the scholarship is clear: it is abusive to withhold trans care from those who medically need it.
Beginning with the first Nazi book-burning, fascists have a long and painful history of sacrificing the existence of trans people on the altar of their political soapbox. Abbott and Paxton are no different.
Abbott is being primaried by far-right politicians. Instead of standing up to the fascist rot growing in the Texas GOP, Abbott and Paxton decided that wasting taxpayer money, wasting the time and resources of DFPS, and terrorizing children would make their voting base happy.
And it did exactly that. In fact, their base was near giddy at the suffering Abbott and Paxton caused. Paxton and Abbott know that the suffering their political cruelty inspires makes them relevant to those who likewise enjoy harming trans children and the families who love them. The waste, stress, and trauma caused by Paxton and Abbott’s abuse of public services are entirely acceptable to people like them.
The reality is that there are a lot of very sad and very ignorant people who are far too credulous to understand that they’re being duped into targeting children. These people will call DFPS and report trans children and their families for the medically necessary trans care their children are receiving. Time and resources will be diverted from DFPS investigating actual child abuse and will instead be wasted on performing perfunctory reviews so that DFPS can note that the child was receiving medically necessary care before closing their file. As trans children and their families endure harassment and material harm from Paxton and Abbott’s political stunt, it is a near certainty that both civil and criminal cases will be brought against those acting on Paxton and Abbott’s hoax.
The families of Texas trans kids will have to deal with the fallout of this hoax for years to come. In the coming days, several organizations, including the TransAdvocate’s parent nonprofit, the Transgender Foundation of America, will be collaborating to develop resources for families who have to deal with the material consequences of Paxton and Abbott’s political hoax.
A Reality Check from the American Medical Association
On behalf of the American Medical Association (AMA) and our physician and medical student members, I write to urge the National Governors Association (NGA) and its member governors to oppose state legislation that would prohibit the provision of medically necessary gender transition-related care to minor patients. We believe this legislation represents a dangerous governmental intrusion into the practice of medicine and will be detrimental to the health of transgender children across the country.
Empirical evidence has demonstrated that trans and non-binary gender identities are normal variations of human identity and expression. For gender diverse individuals, standards of care and accepted medically necessary services that affirm gender or treat gender dysphoria may include mental health counseling, non-medical social transition, gender-affirming hormone therapy, and/or gender-affirming surgeries. Clinical guidelines established by professional medical organizations for the care of minors promote these supportive interventions based on the current evidence and that enable young people to explore and live the gender that they choose.
Every major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people. Decisions about medical care belong within the sanctity of the patient-physician relationship. As with all medical interventions, physicians are guided by their ethical duty to act in the best interest of their patients and must tailor recommendations about specific interventions and the timing of those interventions to each patient’s unique circumstances. Such decisions must be sensitive to the child’s clinical situation, nurture the child’s short and long-term development, and balance the need to preserve the child’s opportunity to make important life choices autonomously in the future.
We believe it is inappropriate and harmful for any state to legislatively dictate that certain transition-related services are never appropriate and limit the range of options physicians and families may consider when making decisions for pediatric patients. In addition, evidence has demonstrated that forgoing gender-affirming care can have tragic consequences. Transgender individuals are up to three times more likely than the general population to report or be diagnosed with mental health disorders, with as many as 41.5 percent reporting at least one diagnosis of a mental health or substance use disorder. The increased prevalence of these mental health conditions is widely thought to be a consequence of minority stress, the chronic stress from coping with societal stigma, and discrimination because of one’s gender identity and expression. Because of this stress, transgender minors also face a significantly heightened risk of suicide.
Transgender children, like all children, have the best chance to thrive when they are supported and can obtain the health care they need. Studies suggest that improved body satisfaction and self-esteem following the receipt of gender-affirming care is protective against poorer mental health and supports healthy relationships with parents and peers. Studies also demonstrate dramatic reductions in suicide attempts, as well as decreased rates of depression and anxiety. Other studies show that a majority of patients report improved mental health and function after receipt of gender-affirming care. It is imperative that transgender minors be given the opportunity to explore their gender identity under the safe and supportive care of a physician.
James L. Madara, MD
CEO and EVP, American Medical Association