The Texas governor, Greg Abbott, and state attorney general, Ken Paxton, released guidance to the state's child protection services that said the provision of gender-affirming care to trans adolescents was child abuse. The guidance threatened criminal penalties for licensed professionals who fail to report suspicions of abuse to the state. If the policy is implemented, it would mean removing trans kids from supportive parents and putting them in the state's foster system.
Considered the standard of care by the major medical associations in the US, gender-affirming care can include medical interventions such as puberty blockers and hormone replacement therapies. US medical guidelines don't recommend genital surgeries for young people.
The Texas state legislature tried to ban gender-affirming care for youth. Both Abbott and Paxton are up for reelection.
The move by the Texas executive branch is not legally binding, and district attorneys in Texas's five largest counties said they would not enforce it.
According to the lawsuit, the state is investigating the parents of some children. According to the suit, an employee of Texas's department of family and protective services was suspended from her job on February 23rd, and since then has been told that she and her husband are under investigation.
The American Civil Liberties Union is involved in a lawsuit that argues that complying with Abbott's order would require Dr. Megan Mooney to violate her professional standards of ethics. When she knows child abuse isn't happening, she could face prison time for making a report.
The immediate aftermath of Abbott's announcement was the subject of a conversation with Mooney before the lawsuit was filed.
What did you think about the release of child abuse guidance?
I wish I could say I was surprised, but I wasn't. axton has been working on this opinion for a number of months and I am part of a working group here in Texas that focuses on LGBTQ youth and foster care specifically. It felt like a gut punch, but I wasn't surprised. The language is inflammatory and wrong.
axton and Abbot want to be re-elected. They are choosing to do so at the expense of children.
Legal experts say the order is not legally blind. How do you think it will change the system?
In the past 48 hours, I have seen a lot of panic among mental health groups about what to do, because those of us who work alongside physicians supporting youth and their families are mandated reporters.
Do I have to report children and families that I know are doing good work? I have spent the past 48 hours trying to get information out through social media and all of the therapist groups I am a part of. This is not legally binding. You don't have to change anything.
Children and families are panicked. Do I need to prepare to move out of state? Do I need an attorney? What should I do if they come to my door?
Texas citizens are worried about being reported for child abuse because of the inflammatory language in the notices.
What have you said to your clients?
It has been to remain calm. This doesn't mean anything. I'm not reporting you, nobody is reporting you, and there are huge groups of people who will support you and take care of you as always here in the state of Texas and elsewhere. There are many people in the Texas legislature who protect your rights.
I'm trying to have people focus on that part. It's important to have a sense of hope and optimism in times of stress.
Can you tell me what gender-affirming care looks like for different age groups?
At its core, it believes in children. That is what gender-affirming care is all about. When a child tells you who they are, you believe them, which is the same thing as any of the rest of our therapy. We believe children when they tell us they are anxious. We believe children when they tell us they have problems. If a child tells me that a doctor got it wrong when I was born, I believe them.
Supporting their journey and figuring out this particular label or identity, or outward expression means for them and for their family, and how to support them in the best way to encourage positive mental health and wellbeing, social development, but also focusing on things, is included. Sharing the guidance from their legal resources in Texas and outside Texas, so families and students know what their rights are, is how we help trans youth have a safe path forward in school.
They can get good treatment if they are connected with qualified and affirming medical professionals.
What age might medical interventions happen for adolescents?
A decision is made with children and parents. We're looking at whether that will help them to have better mental health and physical wellbeing.
My trans and non-binary kids are no different from the rest of my clients because the conversation is always about their individual goals.
I give parents lots of resources if their goal is to reduce secondary sex characteristics that their bodies naturally produce through puberty, as well as what to expect from the treatments. I send them to have consultations with physicians after that. A medical physician can tell you about the effects on your child's body. You don't have to commit to anything at a first appointment with them or me, but just get good information so you don't end up on the internet looking for HRT for kids.
What do you think about patients who have gone through pubertal suppression?
One hundred percent positive. Not a single person had a negative reaction to mental health. I can say that with all honesty. I have only seen positive impacts on children for suppression of pubertal hormones.
One thing that I've run into is people who don't want to affirm a mental illness. You affirm that if a child who was assigned male at birth feels like a girl for a year. You affirm that way if they say, "No, I thought about it and I'm actually a boy."
Is there a misconception that when people hear about a gender-affirming approach, they think it's trying to destroy a child's identity?
cis gender children know their identity, so we don't question that. We only do this with our trans and non-binary kids. cis kids know their gender and trans kids don't The questioning shows a bias in people's hearts.
The data tells us that kids know their gender at three, four, and five years old. If we assume a male and female in pointing at others and identifying themselves, research has shown children can distinguish between them.
All of a sudden these children don't understand the concept of gender or can't label their own.
Why do you think there is opposition to gender-affirming care for children?
A lack of understanding is what it is at its core. People think that therapists are turning kids trans, or that it's just a fad, or that it's just a phase because of the internet.
This isn't new. We know that trans and non-binary people have existed for thousands of years through art and literature. In many other cultures that are not bound by western Christian beliefs, people are revered and seen as better than cisgender people.
The internet has allowed children to find others like them, to give language and voice, and to know that they are not alone. That is a valuable message for them to receive.
You are telling your patients not to panic as you travel back to Texas. Is there a point where you would suggest panicking or leaving the state?
One piece of advice I heard this week was to work on safe folders, letters and testimonials from doctors, mental health professionals, neighbors and spiritual leaders, saying that the parent is not harming their child. If someone from the other side shows up at the door, that's ready to go. I am having a conversation with my clients this week about how to protect themselves if parents are looking for an action item to do.
I will be more concerned for families in Texas if a bill passes through the legislature that makes gender-affirming care a form of child abuse. I think the problem is that most families don't have the money to move. Finding ways for families to stay safe without uprooting their lives is another area we need to focus on.
I will continue to work with case workers, investigators, and the general public to make sure that people understand that gender-affirming care is medically necessary care and is life-saving care.
This interview has been edited for clarity.
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