AUSTIN — Attorney General Ken Paxton has issued a new interpretation of state law that says certain types of medical care for transgender children are abuse, a dramatic change contrary to medical standards that if implemented could make Texas one of the most aggressive states in targeting trans youth access to health care.
On Monday, Paxton issued an opinion stating his office believes gender-affirming health care for transgender youth — including treatments like hormone therapy and puberty blockers — is a form of child abuse. The move comes despite opposition from the top medical and child welfare groups, who oppose blanket bans to care.
“There is no doubt that these procedures are ‘abuse’ under Texas law, and thus must be halted,” Paxton said in a news release. “The Texas Department of Family and Protective Services has a responsibility to act accordingly. I’ll do everything I can to protect those who take advantage of and harm young Texans.”
It’s unclear what Paxton’s opinion could mean for transgender children. Attorney general opinions do not have the force of law and are meant as written interpretations of current statute. Paxton issued his opinion after state Rep. Matt Krause, R-Fort Worth, asked him to weigh in on the issue.
Sex-change operations and puberty blockers prescribed to kids is “child abuse” under Texas law.
— Attorney General Ken Paxton (@KenPaxtonTX) February 21, 2022
These procedures are monstrous and tragic. “I’ll do everything I can to protect against those who take advantage of and harm young Texans. https://t.co/AOoO5NNmyC
Spokespeople for the Department of Family and Protective Services and Texas Health and Human Services said the agencies would be reviewing the opinion.
In arguing his point, Paxton likened transgender youth health care to the opioid crisis. State have an interest in “routinely” regulating the medical profession and health care guidelines, he said, to protect the public.
“There is always the potential for novel medical determinations to promote purported remedies that may not improve patient outcomes and can even result in tragic harms. The same potential for harm exists for minors who have engaged in the type of procedures or treatments above,” Paxton wrote.
He added: “The State’s power is arguably at its zenith when it comes to protecting children.”
Paxton also addressed parental rights to access health care for this child, saying there are limits.
“This general right to consent to certain medically necessary procedures does not extend to elective (not medically necessary) procedures and treatments that infringe upon a minor child’s constitutional right to procreate,” he said, referencing surgical interventions that medical experts say is not recommended for young patients.
Gender dysphoria is the feeling of discomfort or distress that can occur in people who identify as a gender that is different from the gender or sex assigned at birth, according to the Mayo Clinic.
For children who have not reached puberty, mental health care is the primary form of treatment for gender dysphoria. Best standards dictate that medical interventions like hormones should be explored only for youth who have experienced the onset of puberty and after undergoing mental health evaluation.
Surgery to treat gender dysphoria is not recommended until a patient has reached the legal age of maturity and lived continuously for at least a year in the gender role consistent with their gender identity, according to best practices set out by the World Professional Association for Transgender Health, or WPATH, the group that authors the standards of care for the health of gender-diverse people.
Paxton’s opinion comes as Republican politicians, jockeying for power ahead of one of the most competitive reelection seasons in years, increasingly put transgender children under the spotlight.
Last year, GOP lawmakers tried and failed to change state law to ban gender-affirming care for transgender minors. In August, after pressure from Gov. Greg Abbott, the child protective services agency changed its definition of abuse to include transgender “reassignment surgery” for minors and promised to investigate any allegations after Abbott directed them to look into the issue.
In November 2021, a prominent Dallas-based clinic treating trans kids called Genecis stopped taking new patients.
Limiting access to gender dysphoria treatment options such as puberty blockers would place Texas among a small number of states that have taken steps to cut transgender youth access to certain medical services. Last year, Tennessee passed a law banning hormone treatment for prepubescent minors.
Arkansas also passed a law to ban doctors from providing or referring minors to receive medical treatment for gender dysphoria. A federal judge put the law on hold last year while it is being challenged in the courts. Paxton and several other attorneys general recently filed an amicus brief supporting the Arkansas law and calling trans care “experimentation” on kids.
By contrast, major state and national medical groups have opposed limiting transgender kids’ access to care.
The American Medical Association, American Psychiatric Association and American Academy of Pediatrics all support providing age appropriate, individualized care for children experiencing gender dysphoria. Just days after child protective services issued its new guidance in August, the Texas Pediatric Society sent the agency a letter urging it to make its decision based on science.
“Medical care for transgender children and adolescents is evidence-based and has proven effectiveness,” Dr. Seth Kaplan, the society’s then-president, wrote to DFPS Commissioner Jaime Masters Aug. 16 on behalf of its 4,600 pediatrician, pediatric subspecialist and medical student members.
The Dallas Morning News obtained the Aug. 16 letter through a public records request.
“As physicians, we must be able to practice medicine that is informed by our years of medical education, training, experience, and available evidence, freely and without threat of punishment. Providing patient care that helps rather than harms is our duty according to the oaths we took as doctors. Gender-affirming care is part of the comprehensive primary care we provide to our patients and should not be criminalized or stigmatized,” Kaplan added.
