Texas once again took the national spotlight as a leader in anti-transgender attacks, as Governor Greg Abbott took the unprecedented move of directing Texas’s Department of Family and Protective Services to consider best-practice, age-appropriate, medically-necessary, gender-affirming care for transgender children as child abuse. This follows the release of a legal opinion by Attorney General Paxton - which is not legally binding - that opined the same. These unprecedented efforts are a craven, politically motivated attempt to criminalize healthcare decisions made between parents, medical experts, and transgender youth. Every major medical and mental health organization in the country supports gender-affirming care for transgender and non-binary people, and Prevent Child Abuse America has condemned the Attorney General’s opinion.

While the Attorney General’s opinion is not legally binding, and any action against families for providing children with best-practice, age-appropriate, medically necessary care would likely face swift legal challenges, these actions are nevertheless deeply alarming to transgender youth and their families. As we saw just last week, there are real consequences to the discrimination perpetrated upon LGBTQ+ people. Politicians are culpable for the harm they cause by subjecting vulnerable youth to continued legislative attacks.

“Governor Abbott’s actions are unconscionable. The Paxton opinion is poorly researched, poorly reasoned – and entirely political. While it is not legally binding, it is discriminatory and dangerous, and will have real-life consequences for trans kids and their families,” said Texas State Director Rebecca Marques. “Abbott’s order is a shameful attempt to score political points by attacking Texas’s transgender youth – who are, again and again, the Governor’s target – in an attempt to one-up and outdo other radical anti-equality politicians by attacking best practice, age-appropriate, medically-necessary care that in many cases is lifesaving. ”

Every credible medical organization calls for affirming care for transgender and non-binary people.

Sexual orientation and gender identity are real concepts recognized by major medical and mental health associations -- including the American Medical Association, the American Academy of Pediatrics, the American Psychological Association and the American Academy of Child and Adolescent Psychiatry -- as part of the normal spectrum of human experience. Health care providers who work with transgender and non-binary people -- including young people -- are providing life-saving care, with many patients driving hundreds of miles just to get to their doctor’s office.

Transgender children are not undergoing irreversible medical changes.

This is a fundamental misunderstanding about what transition looks like for young people, which is primarily about providing social support, using the right name and pronouns, and allowing them to present in a way that is consistent with their gender identity. Therapists, parents and health care providers work together to determine which changes to make at a given time that are in the best interest of the child.

“Transition-related” or “gender-affirming” care looks different for every transgender and non-binary person.

Some transgender and non-binary people may choose to only socially transition, such as using a new name and pronouns, and dressing in a way that is consistent with their gender identity. Others may choose to socially and medically transition, including undergoing hormone therapy and/or gender affirmation surgery. Each person’s journey is unique to them. At the same time, many transgender and non-binary people cannot afford gender-affirming medical treatment, nor can they access it.

Not all transgender and non-binary people who transition have surgery.

Many transgender and non-binary people choose to transition without surgery. Some have no desire to pursue surgeries or medical intervention. Transgender children do not undergo gender-affirming surgeries, but may receive fully reversible medications that put puberty on hold under the care of a licensed medical provider.

Gender-affirming health care is lifesaving.

For transgender people, being denied critically necessary transition-related care can extend and exacerbate the stress and discomfort caused by gender dysphoria, leading to increased incidences of depression and substance abuse, as well as health complications caused by delaying care. Ensuring that transgender and non-binary people have access to trans-affirming health care is lifesaving. A recent study from the Trevor Project provides data supporting this - transgender youth with access to gender-affirming hormone therapy have lower rates of depression and are at a lower risk for suicide. Additionally, this study shows that parental support is vital in ensuring transgender youth’s mental and physical health.

Detransitioning is very rare. Medical regret is rarer.

According to the National Center for Transgender Equality’s 2015 U.S. Transgender Survey, only 3% of respondents have detransitioned permanently at some point. The vast majority of respondents who detransition only do so temporarily. Detransitioning is often conflated with medical regret, however; detransitioning can include nonmedical parts of someone’s transition such as changes in their gender expression or legal changes to their identity. One study found that less than one-half of one percent of trans patients who have received gonadectomy report surgical regret. Also, there is no scientific evidence showing that surgical regret would cause trans people to forego surgery in hindsight. Surgical regret could include trans patients who do not regret receiving surgery, but may be disappointed with one or more minor details relating to the outcome of their surgery. Trans people who also regret one or more parts of their surgery do not always detransition. When respondents detransition, it could include reasons beyond surgical regret. According to that same survey by the National Center for Transgender Equality, respondents who detransitioned cited a number of reasons for doing so, including facing too much harassment or discrimination after they began transitioning (31%), having trouble getting a job (29%), or pressure from a parent (36%), spouse (18%), or other family members (26%).

For more information, please visit hrc.org/transgender, HRC’s Transgender and Non-Binary People FAQ and HRC’s Brief Guide to Getting Transgender Coverage Right. We would also be happy to connect you with medical experts, including Dr. Robert Garofalo, MD, MPH, Lurie Children’s Hospital, Chicago; Dr. Natalia Ramos, MD, MPH, UCLA; and Dr. Scott Leibowitz, MD, Nationwide Children’s Hospital. Dr. Garofalo is the Division Head, Adolescent and Young Adult Medicine at Lurie Children’s. Dr. Ramos is an Assistant Clinical Professor of Psychiatry, a board-certified child, adolescent, and adult psychiatrist and Medical Director - STAR Clinic, EMPWR Program & UCLA Santa Monica Pediatric Consultation-Liaison Psychiatry. Dr. Leibowitz is a child and adolescent psychiatrist at Nationwide Children’s Hospital. All are available for interviews if you would be interested in speaking with them.