The Washington PostDemocracy Dies in Darkness

Texas isn’t the only state denying essential medical care to trans youths. Here’s what’s going on.

Conservatives are increasingly imposing government control over sexuality and gender

Mayor Steve Adler (D) speaks at an event at City Hall where he declared Austin a safe and inclusive city for transgender families on March 9, 2022. (Jay Janner/Austin American-Statesman/AP)

Late last month, Gov. Greg Abbott (R) issued a letter to Texas state health agencies announcing that delivering gender-affirming medical treatments to transgender youths “constitutes child abuse” under state law. It stipulated that doctors, nurses and teachers are legally now required to report parents who aid their child in receiving such care to the Texas Department of Family and Protective Services (DFPS).

The ACLU has sued Texas to prevent implementation, and a Texas judge has partially blocked enforcement. Further, the U.S. Department of Health and Human Services issued a statement indicating that denying trans youths health care is discriminatory and illegal under federal law.

But Texas is not alone. More than a dozen state legislatures are considering legislation that would ban access to medical treatments for trans youths.

Abbott’s order, and actions in other states, accelerate conservative lawmakers’ trend over the past decade of increasingly targeting LGBTQ+ youths for state surveillance and exclusion. Denying trans kids access to lifesaving health care runs counter to medical science. Targeting families with trans kids for criminal interventions and separation is likely to devastate vulnerable children. And it violates the American Medical Association’s standard that political figures should never infringe on private care decisions designed to “nurture the child’s short and long-term development, and balance the need to preserve the child’s opportunity to make important life choices autonomously in the future.”

Conservatives are increasingly making laws and policies targeting trans children

The Texas order follows a decade of politically motivated anti-trans lawmaking in the United States. Since 2020, those policies have overwhelmingly targeted trans youths. In 2021, 10 states — including Texas — passed bans on trans youths competing in school-sponsored athletics, most of which governors signed, while Arkansas enacted a now-contested ban on delivering gender-affirming medical care to adolescents. In the first two months of 2022, lawmakers have already introduced dozens of proposals to further restrict access to sports teams, health care and teachers discussing LGBTQ+ issues. Last week, Iowa passed a law banning trans girls from girls’ interscholastic sports teams; a similar bill waits on the Indiana governor’s desk.

The “save our children” rhetoric advanced in Texas has long been central to anti-LGBTQ+ conservatism. Anti-gay activists such as Anita Bryant used such language in the 1970s to demonize lesbians and gays and prevent the passage of anti-discrimination ordinances. Ultraconservative groups today use similar framings to argue that acknowledging transgender people is an “assault on the sexes.” The Republican Party platform still explicitly opposes nondiscrimination protections for LGBTQ+ people, and Republicans are behind nearly every recent anti-trans bill.

Anti-LGBTQ+ initiatives intensified after key legal victories on marriage rights and workplace nondiscrimination protections. Now a conservative coalition of anti-trans groups are trying to erase trans identities through laws and bureaucratic processes.

Conservative tactics mischaracterize medical care for and athleticism among trans kids. For example, the Texas directive wrongly suggests that surgical interventions are common among trans minors. In fact, gender transitions have diverse social and medical dimensions that doctors agree must be tailored to each child. Transition-related support often includes referring to individuals by their chosen name and pronouns. Transition also often includes medications that delay puberty.

Some lawmakers have erroneously suggested that gender-affirming care is “experimental.” However, the histories of providing transgender people with medical care in support of gender transitions stretches across the 20th century. Historians document that trans kids have found access to medical transitions for the past century.

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Lack of media coverage undermines trans dignity

Mainstream broadcast media offers only limited coverage of trans kids, of these legislative attacks or even of fictional trans characters. Yet over the past year, right-wing Fox News has devoted considerable airtime to attacking trans-inclusive policies and trans and gender-diverse people.

Such coverage fosters misunderstanding and worse. Republican Rep. Marjorie Taylor Greene (Ga.) recently promoted violence against trans people, which is already endemic; trans people are four times as likely to be violently attacked than cisgender people. The highest-profile public information about trans life is being generated by those who threaten it.

Read all TMC's LGBTQ analysis at our topic guide: LGBTQ+ politics around the world

Banning medical care policies based on gendered ideologies

Texas reveals how state legislatures are increasingly politicizing medical decisions in ways that institute government control over sexuality and gender. Texas also enforces one of the most restrictive abortion bans in the nation, a law that has been under review by the U.S. Supreme Court. Both antiabortion and anti-trans policies that seek to deny access to medical care exert state-authorized control over gender and sexual autonomy. The abortion law deputizes average citizens with enforcement, enabling them to sue any abortion provider or fellow citizen who aides a person seeking abortion-related medical care. (Thirty-one similar “copycat” laws are under consideration nationwide.)

The anti-trans directive to DFPS takes this vigilante reporting structure further, mandating reporting for doctors, educators and anyone who works with youths receiving transition-related health care. This threatens families with gender-diverse children, many of whom already fear reprisal from hostile community members and child protective services.

The Texas directive, and any potential copycat policies in other states, fit a long history of regulating gender and sexuality through government bureaucracies. Historically, regulations have controlled access to birth control, particularly for Black women. Police and vice squads were key to surveilling and incarcerating LGBTQ+ people and regulating sexuality over the past century. Presumptions about “nonnormative” gender identities have been used to deny access to U.S. immigration and welfare benefits, particularly for people of color.

The Texas policy, if enforced, will expand such practices that punish gender-diverse families by separating trans kids from loving parents, and isolating them from doctors, therapists and teachers who want to support them.

More and more states ban transgender girls from girls' school sports. But segregating sports by sex hurts all girls.

High stakes for trans youths

Research finds that gender-affirming care and family support can reduce suicidal ideation for trans and nonbinary children. While trans and nonbinary children have higher rates of depression and suicidality than their cisgender peers, studies demonstrate that when trans youths have supportive networks, their rates of depression do not differ from their peers — lowering their mental health risks.

The Texas Department of Health and Human Services has removed resources for LGBTQ+ youths from its suicide prevention website. And Texas Children’s Hospital — the largest pediatric hospital in the nation — announced Friday that it will no longer provide gender-affirming treatments in light of the policy directive. Full implementation of the Texas policy would further undermine this essential medical care by arbitrarily defining it as child abuse and requiring professionals who deal with children to separate them from those healthy supports — thus doing the opposite of what the standard of care requires.

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Elizabeth Sharrow (@e_sharrow) is an associate professor in the University of Massachusetts School of Public Policy and the Department of History.

Isaac Sederbaum (@isaacsederbaum) is a PhD student at the Evans School of Public Policy & Governance at the University of Washington.