The governor of Texas told state health agencies on Tuesday that medical treatments for trans adolescents should be classified as child abuse.
His statements, made in a letter to the Texas Department of Family and Protective Services, followed an opinion on Friday by Attorney General Ken Paxton that said providing medical treatments like puberty-suppressing drugs and hormones to trans teenagers should be investigated as child abuse.
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, are required to report it.
It is not clear how the orders would be enforced. Some county and district attorneys have stated that they will not enforce the opinion, despite the state's child welfare agency saying that it will investigate such claims.
Christian Menefee, the Harris County attorney, said in an interview that this is a complete misrepresentation of the definition of abuse in the family code. Mr. Menefee said that Harris County, the state's most populous county, won't be prosecuting anyone for allowing someone to take puberty suppressants.
A broadening political drive to deny treatments that help align the adolescents' bodies with their gender identities has been endorsed by major medical groups. According to the Williams Institute at the University of California, Los Angeles, School of Law, twenty-one states introduced such bills last year. Arkansas passed a law that made it illegal for clinicians to give puberty blockers and hormones to adolescents. The law was temporarily blocked by a federal judge in July after the American Civil Liberties Union sued on behalf of four families and two doctors.
In Texas, several such bills were introduced. None of them passed. The University of Texas Southwestern Medical Center and Children's Medical Center Dallas closed the state's only multidisciplinary clinic for trans youth because of political pressure.
Early voting has begun in the primary elections in Texas. March 1 is election day. Mr. Abbott and Mr. Paxton are facing challengers who are questioning whether they have been conservative enough. Mr. Paxton, a two-term incumbent who has been indicted on securities fraud charges, is seen as particularly vulnerable. He is likely to get less than 50 percent of the vote and will have to go to a second round.
Legal attempts to limit gender-affirming care and harm young trans people have been condemned by medical groups and experts.
The assistant secretary for health for the Department of Health and Human Services and the Biden administration's highest-ranking pediatrician said that gender-affirming care for trans youth is essential.
A growing number of adolescents are seeking medical treatments. According to the Centers for Disease Control and Prevention, there is a high risk of suicide for trans teens. Preliminary research shows that adolescents who receive medical treatments have better mental health. There are ongoing studies.
There were no pending investigations of child abuse involving the procedures described, but the agency would investigate cases that were reported, according to a spokeswoman for the Texas Department of Family and Protective Services.
The courts will have the final say on whether children can be taken from their parents.
Kate Murphy is a senior policy associate for child protection at Texans Care for Children.
Mr. Menefee said that the position taken by the governor and the attorney general could have a chilling effect.
There are medical risks associated with some treatments used in gender-related care. Evidence shows that puberty-blocking drugs can weaken bone development, though it recovers once puberty starts. Drugs can lead to fertility loss if they are used at an early stage of puberty. If having children is important to patients, they should be counseled on how to preserve fertility by delaying the use of blockers. Doctors and families should wait until the teenager has reached the age of majority, which is 18 in Texas, before performing irreversible genital surgeries.
The stakes are too high for some political groups who oppose gender-related treatments for young people.
Jonathan Covey, director of policy for the group Texas Values, said in an email thatMinors are not allowed to purchase paint, cigarettes, alcohol, or even get a tattoo.
The director of the Psychiatry Gender Identity Program at Massachusetts General Hospital, Alex Keuroghlian, says that decisions about treatments for young people should only be made by a patient, their parents and their physicians. Governor Abbott's letter is completely divorced from medical evidence, consensus and mainstream practice.
Medical groups agree that puberty suppression and hormones benefit trans teens, even though some doctors have debated how much time should be spent on psychological assessments for adolescents.
The former president of the United States Professional Association of Transgender Health has advocated for more assessment for such teenagers before they start medical treatments. She said that forcing teenagers to go through puberty for a gender they don't identify with was inhumane.
Legislators or politicians should not be involved in medicine for which they have no experience.
A policy and advocacy strategist at the A.C.L.U. of Texas who uses gender-neutral pronouns called the governor and attorney general's stance politically motivated and said it could prevent young trans people from getting the medical.
They said in a statement that gender-affirming care saved their life.
David gave reporting.
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