Earlier this year, Gov. Greg Abbott signed SB 14, a measure which bans transgender youth from accessing gender-affirming medical care, like puberty blockers and hormone therapy. Under the law, doctors who defy it would have their licenses revoked.
The ACLU of Texas, along with other organizations, filed a lawsuit to stop SB 14 from going into effect Sept. 1. A Texas judge granted a temporary injunction, blocking the law from moving forward, but the state appealed, overturning the injunction for now.
As debates play out in court, providers in Texas are concerned. Doctors who treat trans minors say the law interferes with their ability to do their jobs—and hurts their patients.
Beck Munsey, a clinical mental health counselor in North Texas who treats youth and adult LGBTQ+ clients, said he's been fielding questions from clients all year.
"Even with the anti-trans youth laws, it impacts adults as well," he said. "[They're] worried about, ‘Okay, they’re attacking youth now? What about in two years? Are they going to start coming after me?'"
Munsey has heard these questions come up more frequently due to the state's recent actions. Last year, the Department of Family and Protective Services investigated families of trans youth accessing gender-affirming medical care. Bills in this year's legislative session sought to ban multiple aspects of LGBTQ+ life, including health care access, drag performances and trans athletes' participation in school sports.
Munsey said all of this has created a sense of spiraling anxiety, for him and his patients.
"As a trans person that who also is a mental health practitioner, it’s very difficult for me," he said. "My clients’ worries and concerns are the same worries and concerns that I have."
What does gender-affirming care look like?
Texas lawmakers who supported SB 14 said it protected kids by shielding them from treatments and procedures that may harm them. That's despite years of research outlining the importance of gender-affirming health care and transition-related care in supporting the health and well-being of trans and gender non-conforming people.
Under SB 14, Medicaid and other state health programs will also be prohibited from paying for these services and reimbursing doctors. If children are currently receiving medical interventions, the law states they need to be weaned off over a period of time "and in a manner that is safe and medically appropriate."
From discussions he's heard and the text of the law, Munsey doesn't think Texas lawmakers understand what gender-affirming care is or its impact on patients' lives.
Gender-affirming care can involve medical interventions down the line, but Munsey said it often starts with a conversation. It's something he practices with his cis and trans patients.
"It’s actively listening to a client, validating and affirming their experiences, advocating for them, and then helping find their authenticity," he said. "And those are things we do with every client that comes into the counseling office."
Gender-affirming care practices are often different depending on the age range of the patient, and the patient's needs, according to the standards of care in the International Journal of Transgender Health. That might look like social transition and support at home and school, or, as patients become teenagers, puberty blockers and hormone therapy which give them "more time in which to explore the possibility of medical transition."
"It’s a long process," Munsey said. "There’s medical professionals, mental health professionals, doing assessments who are trained in this."
He wishes that trans people's voices were included in policy decisions that impact their lives.
"I don’t think I’m going to change anybody’s mind by just having a single conversation, but I really would love to have a seat at the table instead of being on the menu," said Munsey.
But the confusing language of the law, and the harsh penalties for doctors who provide this care, have left him and others wondering what the future of their work will be. Bhavik Kumar, the medical director for primary and trans care at Planned Parenthood Gulf Coast, said these practices are the best standards of care for patients.
"When I think about gender care, it’s health care," Kumar said. "That’s the first thing that should be stated. It's access to acute care for colds. It's access to chronic care for high blood pressure and thyroid conditions. It’s also access to puberty suppression and hormone interventions if that’s what somebody chooses."
Gender-affirming care bans mirror abortion bans
Kumar thinks bans on gender-affirming care parallel abortion bans, where "politicians who are not healthcare providers, have not had the training" spread misinformation that is "completely not in line with what we do."
He said the threats to doctor's abilities to provide services to their patients is also something that came out of abortion legislation.
"When it comes to penalties, loss of your medical license, and really just blatant attacks on health care providers, this is not new," Kumar said. "It’s still unfortunate. It is still ruthless and hostile."
Since abortion is almost entirely banned in Texas, Kumar said doctors at Planned Parenthood try to give their patients the next best option. He said regardless of what happens with gender-affirming care access, they'll continue to serve their patients in the ways they can.
"This moment is very, very dark and grim," he said. "But we ground ourselves in our truth and the truth that I’ve heard from my patients, and we keep moving forward."
Lawsuit to stop trans youth medical care ban
The ACLU of Texas, along with Lambda Legal, the Transgender Law Center and other advocacy groups, filed a lawsuit to block the ban going into effect Sept. 1. On Aug. 25, a Texas judge granted the groups a temporary injunction, blocking the law, but the state appealed, which undid the judge’s decision at this point in time.
Another group involved in the lawsuit with the ACLU of Texas is GLMA, which represents LGBTQ+ and allied health professionals across the country. Executive Director Alex Sheldon said it's important for the organization to oppose policies that contradict best medical practice.
"These bans are, ‘solving an issue,' but that issue does not exist," Sheldon said. "They purport to be protecting people from intrusive care. But we do not need protection from care that is medically necessary and lifesaving. That would be like protecting a drowning person from a life vest or from CPR."
Sheldon says these laws aren't just an issue in Texas—more than twenty Republican-led states have passed legislation banning gender-affirming care, with lawsuits in places like Arkansas, Missouri, Indiana and Oklahoma.
"We are actively witnessing the continued erosion of trust in science and the continued erosion of the connection between science and policy," said Sheldon.
"When decisions about the nation’s health care are based on political ideology, rather than scientific evidence, the consequences will be far reaching and catastrophic. Health professionals know better than anyone else that this is something that we need to interrupt right away."
Regardless of whether the lawsuit moving through Travis County District Court blocks the ban from taking effect for good, Sheldon said GLMA isn't giving up anytime soon.
"This is not the time to be silent," they said. "It’s not the time to wait. This is the time to speak up. It is a time to use your expertise, use whatever platform you have, and advocate for change."
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