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As Texas moves to treat gender-affirming care for trans kids as ‘child abuse,’ families and advocates worry about the future

Families of transgender kids and LGBTQ advocates have raised concerns about the well-being of children after Texas Attorney General Ken Paxton and Gov. Greg Abbott’s decision to treat gender-affirming care as child abuse.

Protesters rally against the criminalization of medical treatment for trans kids in front of the state Capitol on Sunday, Feb. 27, 2022.

Pilar Hernandez was hoping the nightmare for her family was over.

For months last year, transgender advocates in Texas fought a group of bills in the legislature seeking to ban transition care by arresting parents and delicensing doctors who provide transition care to children. Several of those bills died, but the ordeal scarred Hernandez, the mother of a 17-year-old transgender boy in Houston.

Last week, those fears resurfaced: Attorney General Ken Paxton issued an opinion that defined providing access to certain gender-affirming treatment as child abuse, leaving some parents worried about the safety of their families and some advocates concerned about the well-being of trans kids in Texas.

"I had this fantasy that this year we’ll be able to at least rest a little," Hernandez said while fighting back tears. "I think we all have post traumatic stress syndrome from last year, so this brings everything back."

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The AG's definition is opposed by major medical organizations, such as the American Academy of Pediatrics, the Pediatric Endocrine Society and the American Medical Association, which say these treatments are within the standards of care and often life saving.

Pilar Hernandez is the mother of a 17-year-old transgender boy in Houston.

They're also opposed by families who have reaped the benefits of these medications. Hernandez said her family has considered moving out of state for her son's sake, though it's not an option they want to resort to.

Her son Alexander began taking testosterone a few years ago and said the treatment has significantly improved his gender dysphoria and anxiety.

"I feel great about it," Alexander said. "It’s one of the best things I’ve done for my health just all around."

In the nonbinding opinion, Paxton classified gender reassignment surgery — which is rare for kids — as abuse under Texas law. He also did the same for puberty blockers, testosterone and estrogen treatments, which are more common, less invasive and often reversible.

"There is no doubt that these procedures are ‘abuse' under Texas law, and thus must be halted," Paxton wrote in a statement accompanying the opinion. "The Texas Department of Family and Protective Services (DFPS) has a responsibility to act accordingly. I'll do everything I can to protect against those who take advantage of and harm young Texans."

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Three days later, Abbott issued his directive to DFPS, noting a requirement to report abuse among all licensed professionals in Texas.

A spokesperson told the Texas Newsroom that the Department will follow the law “as explained by the Attorney General opinion” but there were no pending cases on the matter as of last Monday.

Several district and county attorneys in Texas' Democratic regions have openly opposed Paxton's opinion and said they refuse to investigate such cases as abuse.

"I will not prosecute any parent, any facility, or anyone else for providing medically appropriate care to transgender children," said Harris County DA Kim Ogg. "I will continue to enforce the Constitution and the state's criminal laws to assure the greatest degree of freedom and order that we can achieve."

There's also an open question of whether schools will be a safe space for trans kids. In the letter, Abbott said licensed professionals like teachers are mandatory reporters of child abuse.

Jackie Anderson – the president of Houston Federation of Teachers, the union representing Houston ISD teachers – said this interpretation of child abuse is disruptive to the education of students.

"We are supposed to snitch on parents who are seeking medical and emotional assistance for their kids?" Anderson said in an email. "Really?"

Houston ISD did not respond to questions about whether the district is expecting teachers to report transgender students and their families to the authorities. However, in a statement, Superintendent Millard House II said, "it's the responsibility of our district to protect all its students, including our transgender students."

Some school districts contacted by Houston Public Media said they were waiting for guidance from their legal council or the Texas Association of School Boards. Others did not respond to requests for comment.

Organizations like the Transgender Education Network of Texas (TENT) say they aren't surprised by such statements from Texas leaders.

"Time after time, it's no longer a shock but it's a disappointment," said Andrea Segovia, senior field and policy advisor for TENT. "You're talking about kids that are just trying to figure out who they are."

She's concerned about the mental health impact these statements have on trans youth.

"If you keep seeing how much your state leadership hates you, do you ever feel like it's gonna get better?" Segovia said. "We say the state of Texas would rather see dead kids than trans kids thrive. And it's absolutely true, because we keep seeing these attacks on kids."

That's a concern shared by other trans care providers. Cece Cox, CEO of the Dallas-based community organization Resource Center, said statements like the ones issued by Abbott and Paxton have the effect of publicly challenging the humanity of trans Texans.

But Cox also stressed that challenges to transgender rights are happening all across the nation, making it all the more important to support families targeted by such actions.

"Texas is not this crazy outlier," Cox said. "There's negative bills and positive bills being filed all across the United States. We all have to stick together in this along the way."

Providers like Dallas-based therapist Diana Diduck aren't sure how the statements on mandated reporting will affect her work with patients, many of whom she helps navigate through gender dysphoria, depression and anxiety.

She said it's an important and vulnerable step to seek care, which now feels threatened.

Screenshot of a Discord chat among members of a Gay Straight Alliance club at a Houston ISD school.

"Am I supposed to not provide care?" Diduck said. "Am I supposed to not refer the family to a pediatrician or an endocrinologist or to a psychologist for further evaluation? I'm very confused as to what this could mean."

Meanwhile, some transgender kids are doing their best to keep optimistic, both for themselves and their community.

Student Hayden Cohen is a non-binary 17-year-old and co-president of their schools' Gay Straight Alliance at Houston ISD. Last Wednesday, they received a rush of panicked messages from members of the club.

Cohen told everyone to keep calm, and noted it wasn't even clear yet whether such guidance from the AG would stand up under legal scrutiny.

"If anything comes up, there are resources," Cohen said. "This isn't something we need to worry too much about just yet."

"Take a deep breath," they said. "It’ll be okay."

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