AUSTIN — Attorney General Ken Paxton has issued a new interpretation of state law that says medical care for transgender children is abuse, a dramatic change contrary to medical standards that 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 common 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 for months have urged Paxton not to take this step.
“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.
Spokespeople for the Department of Family and Protective Services and Texas Health and Human Services said the agencies would be reviewing the opinion.
Paxton’s opinion comes as Republican politicians, jockeying for power ahead of one of the most competitive re-election 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 Gov. Greg 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.
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.
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.
Many of the state’s largest health care and child advocacy groups have also repeatedly begged state agencies and elected officials to consider scientific evidence that age appropriate, individualized care for transgender children helps save lives, The Dallas Morning News has learned.
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.
“Gender-affirming care is part of the comprehensive primary care we provide to our patients and should not be criminalized or stigmatized,” 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 News obtained the Aug. 16 letter through a public records request.
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