The Biden administration on Wednesday said it was needless and dangerous for Texas elected officials to label gender-affirming medical care for transgender youth as “child abuse.”

In exclusive statements provided to The Dallas Morning News, a White House spokesperson said families should have the right to seek the appropriate health care for their children and blasted state GOP officials for targeting LGBTQ youth.

“Conservative officials in Texas and other states across the country should stop inserting themselves into health care decisions that create needless tension between pediatricians and their patients,” White House Principal Deputy Press Secretary Karine Jean-Pierre said. “No parent should face the agony of a politician standing in the way of accessing life-saving care for their child.”

On Monday, Texas Attorney General Ken Paxton issued a new interpretation of state law that said certain types of medical care for transgender youth are “child abuse.” Gov. Greg Abbott responded the next day by directing state agencies to investigate allegations of abuse, warning that doctors, teachers and parents who fail to report could face consequences.

Attorney general opinions do not have the force of law, but agency leaders are mostly expected to follow them. Since agency heads are often appointed by the governor himself, Abbott’s support for Paxton’s opinion makes their choice in heeding the warning more clear.

But how these statewide decisions trickle down to the actions of — and consequences for — transgender children and the adults in their lives is unclear at this time.

On Wednesday, five district attorneys from across the state, including Dallas County District Attorney John Creuzot, condemned Paxton’s opinion and Abbott’s directive, describing them as a politically motivated “onslaught on personal freedoms.” Houston and Travis county top prosecutorial attorneys have vowed not to pursue cases based on the Paxton opinion.

Republican politicians in Texas have recently begun to put health care for transgender children under the spotlight. Abbott and Paxton are facing their most competitive GOP primary election in years. Former state Sen. Don Huffines, who is challenging the governor, has repeatedly pressured Abbott to take a more aggressive stance against gender-affirming care for children.

But Abbott and Paxton’s directive on “child abuse” and trans care flies in the face of best practices backed by state and national medical groups.

The American Medical Association, American Psychiatric Association and American Academy of Pediatrics all support age appropriate, individualized care for children experiencing gender dysphoria, which 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.

In recent months, The Texas Pediatric Society and Texas Medical Association urged Paxton not to target transgender children’s access to these treatments.

Paxton’s opinion says the definition of child abuse under state law extends to non-surgical treatments including hormone therapy and puberty blockers.

This type of care should be explored only for youth who have experienced the onset of puberty and after undergoing mental health evaluation, according to the World Professional Association for Transgender Health, or WPATH, which authors standards of health care for gender-diverse people.

Surgery 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 WPATH standards.

Adm. Rachel L. Levine, a transgender woman and assistant secretary for health for the Biden administration, said Wednesday that gender-affirming care can save lives.

“Our nation’s leading pediatricians support evidence-based, gender affirming care for transgender young people. HHS stands with transgender youth and their medical providers,” she said in a statement to The News.

Progress Texas, a progressive political group, went a step further than the White House on Wednesday by accusing Abbott and Paxton of the “immoral” behavior of “terrorizing trans kids and their families.”

“Inventing problems to rally voters around is the Texas Republican way, and it seems even children are not immune to their assaults. To any trans kids out there, please know you are loved and you deserve so much better,” communications director Wesley Story said.

Texans react

The biggest immediate concern for those who may be affected are Abbott’s warning of consequences facing transgender children and the adults in their lives. Texas groups representing doctors, teachers and parental rights said nothing needs to change right now as a result of these new directives.

On Wednesday, the ACLU of Texas sought to allay the fears of caregivers with transgender kids seeking gender-affirming care.

CPS cannot remove a child from their parent or guardian without a court order, the civil rights legal group said, and no court in the country has found that gender-affirming care is child abuse.

While the directives from Abbott and Paxton are not law, ACLU of Texas staff attorney Brian Klosterboer said “they spread fear and misinformation and could spur false reporting of child abuse at a time when DFPS is already facing a crisis in our state’s foster care system.”

The current law, he added, allows doctors to provide transgender youth with age appropriate, individualized care: “Any parent or guardian who loves and supports their child and is taking them to a licensed health care provider is not engaging in child abuse.”

The state’s social workers union also reminded its members that Paxton’s opinion was non-binding and they “still have professional discretion on mandatory reporting.”

“No rules on reporting were changed through this opinion, not through the Governor’s letter,” the Texas chapter of the National Association of Social Workers said in a statement.

The group also took a clear stance against the directives.

“Redefining child abuse to include gender affirming care would endanger how mental health professionals serve people in the LGBTQ community,” the group added, asking CPS to reject Paxton’s opinion and Abbott’s order.

Monty Exter, a lobbyist for the Association of Texas Professional Educators, said teachers have a duty under state law to report child abuse or suspected abuse. Failure to report abuse could result in a class B misdemeanor, punishable by up to 180 days in jail and fines, or sanctions to a teacher’s professional certification.

But Exter added: “It is up to the Texas Legislature and the courts to determine what constitutes abuse.”

The Texas Legislature next meets in January 2023. The issue could end up in the courts before then, however, if someone affected by the new guidance decides to sue the state.

Renee Baker, a licensed social worker in Dallas who treats transgender children, advised that clients stay calm and follow the medical advice of doctors to stay healthy. Health care professionals are held to standards of care that conflict with these directives, she said.

“We can’t be sure what will happen, but I am optimistic in time that this will be overturned,” she said.