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Texas AG says transition care for minors is child abuse under state law

Advocates say Ken Paxton’s opinion is politically motivated, but that it could have grave consequences for trans youth and their families.
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Texas Attorney General Ken Paxton said in an opinion Monday that providing gender-affirming medical care to minors is considered child abuse under state law. 

Medical care such as puberty blockers, which temporarily pause puberty, hormone therapy and gender-affirming surgeries “must be halted,” he said in a statement Monday. He added that the Texas Department of Family and Protective Services “has a responsibility to act accordingly.” 

“I’ll do everything I can to protect against those who take advantage of and harm young Texans,” Paxton said. He released the opinion in response to an inquiry from state Rep. Matt Krause, a Republican, who asked whether treatments for transgender youth could be considered child abuse. 

An opinion from an attorney general is an interpretation of existing law that doesn’t change the law itself. 

The issue has been part of a monthslong back-and-forth between Paxton, Gov. Greg Abbott and the Department of Family and Protective Services after the state Legislature last year failed to pass a bill that would’ve made providing gender-affirming care to minors a felony alongside physical and sexual abuse and sex trafficking. 

Paxton and supporters of restrictions argue that gender-affirming care is “experimental,” and that minors are too young to consent to such care. Advocates note that the efforts fly in the face of guidance from all relevant major medical organizations — including the American Medical Association, the American Academy of Pediatrics and the American Psychological Association — which say that gender-affirming care is medically necessary for transgender youth and is backed by decades of research. 

Adri Pèrez, policy and advocacy strategist for LGBTQ equality at the American Civil Liberties Union of Texas, said Paxton’s opinion is politically motivated. Pèrez, who uses gender-neutral pronouns, noted that the attorney general released the opinion just ahead of the state’s March 1 Republican primary election — one of the most competitive primaries that Paxton has faced in years. 

Paxton's opponents have been highlighting his recent legal troubles: He is awaiting trial for a 2015 indictment on charges of securities fraud, and he is under investigation by the FBI over allegations of bribery and abuse of office. Paxton’s office has not returned a request for comment.

Pèrez added that attorney general opinions are not legally binding. 

“Ken Paxton’s thoughts on this, no matter what they are, do not affect how a court would or should analyze these issues,” they said. “And as of today, there’s no court in Texas or the entire country that has ever found that gender-affirming care can constitute child abuse.”

However, Pèrez said the opinion could have scary consequences for transgender youth. 

“The opinion has a section that says that it is mandatory for teachers, social workers and others of their duty to report child abuse,” they said. “So even though the opinion is not binding, some people could point to this opinion as a reason to report, and that could increase the amount of false reports that we see being done on parents, it could increase bullying and harassment in schools directed toward trans youth, and bullying and harassment directed to their parents and guardians.”

Pèrez said that several parents of trans kids in Texas have already faced false reports that have led to investigations, and that investigators have consistently trusted parents and medical professionals, who support gender-affirming care. 

Still, they said the rhetoric in the letter and in the bill that the Legislature considered last year have created a persistent fear within the community. 

Annaliese Cothron, whose 9-year-old child is trans, said that she’s created a supportive environment for her child, but that she still lives “in a lot of fear.” 

“I think that’s exactly the intention here — the intention is to create harm, is to embolden people to report loving Texas families who are following evidence-based medically necessary care for their children,” she said. “It’s emboldening them to be attacked and harmed and ultimately abused and traumatized by the Texas system. I do live in fear that that could happen to me.”

She said that she transferred her two children, both of whom are LGBTQ, to a private school last fall after hearing stories from other families of trans kids in Texas public schools who were outed or not allowed to use the bathroom of their gender identity. In October, Abbott also signed a bill that bans trans student-athletes from playing on public school sports teams that align with their gender identity.

“It’s really unfortunate that we kind of had to put them into a different setting away from sports and things like that, because who wants to tell their kid you’re not going to be allowed to do something so basic as playing a school sport?” she said, adding that their new school is an hour away from their home in San Antonio. “But that’s the choice we’ve had to make now to keep our children safe.”

Linzy Foster, another parent in Austin, said reading Paxton’s opinion filled her with an “old feeling of anxiety and rage” that she felt throughout last year, when she visited the Capitol about a dozen times to advocate on behalf of her 8-year-old trans daughter when Texas considered more than 50 anti-trans bills.  

“He wants to get re-elected and they’re using trans kids as prey, as pawns to get re-elected,” Foster said of Paxton. “It feels like harassment and abuse, and it feels like it’s all being done at the expense of our kids and it doesn’t make sense.” 

She added that Paxton’s opinion and the rhetoric it uses — for example, by referring to gender-affirming care as “forced sterilization” —  spreads misinformation and adds fuel to the hate that trans youth and their families already face. She noted that medical guidance doesn’t recommend gender confirmation surgery for transgender people until the age of legal consent, which in most states is 18. 

The World Professional Association for Transgender Health, a nonprofit group, also condemned Paxton’s opinion in a statement Tuesday. 

“Targeting trans youth, their parents, and their health care providers for political gain is unconscionable,” the group said. “We strongly denounce this alarmist and misguided opinion which could obstruct access to medically necessary care. It is yet another example of the profound misunderstanding of the conditions under which transgender people live, and a profound lack of compassion for the need for responsible medical care that helps trans people, including trans youth, to thrive and contribute to society.”

Should the Department of Family and Protective Services implement Paxton’s opinion, it could face legal challenges. Only two states — Arkansas and Tennessee — have enacted restrictions on gender-affirming medical care for transgender minors, and a federal judge blocked Arkansas’ law from taking effect in July. 

Cothron said that though Texas is repeatedly attacking families like hers, she wants to send a clear message: “My family exists and we deserve to be here, and trans people deserve to exist and thrive in Texas,” she said. “I should not have to move just to live peacefully in my community. My children deserve peace, they deserve dignity, they deserve autonomy, and they deserve the government not attacking them as people.” 

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