Gov. Greg Abbott and state lawmakers have used variations of the phrase “parental rights” this year to push a litany of legislation, with varying degrees of success.
But Kari, a Georgetown mother of a transgender 17-year-old, says she feels like she has “no choices at all” as she and her family stare down a ban on puberty blockers and hormone treatments for trans minors that goes into effect Sept. 1.
“My rights as a parent have not only been infringed upon, but they’ve been stripped. I’ve been removed from making a decision about my child’s health care with my child and for my child,” said Kari, who agreed to talk to The Texas Tribune if her full name wasn’t used because she fears her family could be targeted by hate groups.
Senate Bill 14’s passage leaves families with trans kids in a myriad of challenging situations. Some are weighing the stress of uprooting their lives against the psychological damage their children could experience once access to gender-affirming care is cut off. Others are unable to leave the state and are preparing to watch their children go through what they call government-forced detransitioning. And one low-income family with a trans kid wants to move but is struggling to raise money to do so.
The law will allow trans minors already receiving transition-related care to be “weaned off” puberty blockers and hormone treatments in a “medically appropriate” manner. But parents and medical experts say the law doesn’t provide clarity on how that should happen — and that can be unsafe to wean people off of such treatment at all.
Texans whose kids are transgender say the law is an affront to the notion that Abbott and the Legislature are champions of parental rights since each of the choices it leaves them could have dire outcomes. And a new lawsuit that aims to block the ban on gender-affirming care argues that the law violates parental rights already enshrined in the state constitution.
The American Civil Liberties Union of Texas and Lambda Legal are representing several doctors and parents of trans kids, who argue in the lawsuit that SB 14 violates those constitutional rights by stopping parents from providing medical care for their children. It also says the law discriminates against transgender kids because the ban applies only to them and allows cisgender children to access the same treatments for care that isn’t aimed at transitioning.
The state constitution says Texans can’t be “deprived of life, liberty, property, privileges or immunities, or in any manner disfranchised.” The suits argues that means Texas parents with transgender children should not be blocked from accessing the recommended treatment that doctors and medical groups say lessens trans kids’ higher rates of depression, anxiety and suicide.
“The Texas Constitution provides stronger rights for parents, stronger rights in the guarantees of equality … and much stronger rights with respect to the individual rights of autonomy,” Lambda Legal senior counsel Paul Castillo said. “Those decisions that rest with parents are at their apex when they are made in consultation with physicians who recommend this medically necessary care.”
Kari said she put in hours of research and had several discussions with her child’s therapist and doctor before deciding that testosterone treatments were the best way to avoid the “personal anguish” her son would feel as his body developed the physical characteristics of a gender with which he didn’t identify.
Lawmakers supporting the bill said children are too young to decide whether to undergo gender-affirming care, even though the treatments they will soon be banned from accessing are available to cisgender kids of the same age for other medical purposes.
“A lot of politicians throw around the term ‘informed decision,’ but that’s exactly what we’ve done,” Kari said.
Emily Witt, a spokesperson for the Texas Freedom Network, a left-leaning state watchdog organization that supports public education and religious freedom, said state leaders, in order to limit the rights of trans people, are using the term “parental rights” to tap into a groundswell of fears from Texans who think the government is going too far in determining what their kids learn.
“It’s been co-opted to tap into this cultural fear of not having control over your kids’ lives,” Witt said, “when really their agenda is erasing trans people.”
See here for more on the lawsuit, then go read the rest and try to put yourself in Kari’s shoes. I have multiple friends and one family member (that I know of at this time) who are parents of trans kids. I know how hard this enmity of the state has been for them (the family member lives in another state, one that isn’t hostile to them). I’m not an anxious person, I’m fortunate to not have to deal with pervasive negative thoughts, just normal parental worry. The thought that I could be criminalized by the state for giving my kid the love and care they need makes me hyperventilate. It also makes me very, very angry.
The people who are being targeted by this pernicious bigotry are facing some very dark times. I don’t know how long that may last or how bad it may get – Lord knows, it can very easily and very quickly get worse. I do know that our society as a whole will be the lesser for it, and in ways that are entirely predictable yet mostly invisible at this time.
At least once a day Dr. Ximena Lopez sees a parent crying in her clinic. They’re crying because Lopez just told them they need to find a new way to get transition-related care for their children — by leaving Texas or sourcing treatments outside the state — because the state outlawed these treatments for trans youth.
After a yearslong barrage by activists and lawmakers, the state has won the battle against the use of transition-related care, like puberty blockers and hormone therapies, for transgender youth. While the war over this health care remains in question — and a legal fight to block the new law begins in Texas — clinics have closed and some doctors have stopped providing this care.
“The reason why I’m leaving Texas is that it’s unbearable for me,” Lopez said. “It’s so devastating that I just can’t bear living in a state where I feel oppressed and where I’m just seeing my patients suffer.”
Lopez formerly provided gender-affirming care to trans youth as the director of the GENder Education and Care, Interdisciplinary Support (GENECIS) program, which was jointly run by the Children’s Medical Center and the University of Texas Southwestern Medical Center in Dallas. By the end of July, she’ll no longer practice at the Dallas hospital and plans to move out of Texas.
In light of the state’s ban on gender-affirming care for kids, The Texas Tribune spoke with over half a dozen doctors who practice this type of medicine about the fear of losing their jobs, scaring away medical providers from working in Texas and — most importantly — revoking this critical health care for transgender children.
From state-launched investigations into the families of trans youth, to threats of actual violence, doctors are fearful to speak out against the attacks on transgender health care. Physicians raised concerns that the state is driving physicians away from Texas and inadequately training the next generation of medical professionals.
In recent months, many patients — including adults — have lost access to care as providers have left the state, a spokesperson for Texas Health Action, a nonprofit health care provider with clinics in Dallas, San Antonio and Austin, told the Tribune.
Dr. Anita Vasudevan, a primary care physician from Texas who chose to continue practicing in California instead of returning to her home state because of the ban on gender-affirming care and abortion, said the loss of Lopez and the GENECIS program highlights the issue of specialized providers leaving the state. This translates to missed learning opportunities for medical professionals in training, which will result in worse care for patients, she said.
“We’re building a generation of providers that just, unfortunately, won’t receive the level of training that they need in order to take care of patients in the ways that they need to be taken care of,” Vasudevan told the Tribune. “That’s a hard pill to swallow.”
One area of particular concern, doctors said, is the worsening of an existing pediatric specialists shortage. In Texas, an estimated 17.4% of children have special health care needs that require attention from specialized pediatricians, according to the American Academy of Pediatrics. These shortages mean patients have to travel longer distances and wait for weeks or months to see subspecialists, which can result in delaying or forgoing treatment.
Lauren Wilson, a pediatric hospitalist and the president of the AAP Montana chapter, partially attributes this shortage of doctors for children to the disparity in pay between adult and pediatric specialists. According to a 2023 compensation report from the healthcare-related companies Doximity and Curative, endocrinologists make nearly $60,000 more annually than their pediatric specialist peers, who undergo commensurate levels of training.
Shortages in this speciality — pediatric endocrinology — is of particular concern to Wilson because these doctors treat a wide range of children. This area of medicine deals with hormones and associated issues and mostly treats children with diabetes or growth problems. But these physicians also often specialize in gender-affirming care treatments like puberty blockers and hormone therapies for trans children (less specialized physicians can also administer gender-affirming care.)
It’s not clear how many doctors have left or will leave Texas in response to restrictions on gender-affirming treatments, but states that have enacted other health care restrictions offer some clues.
States with abortion bans saw a 10.5% decrease in applications for obstetrics and gynecology residencies in 2023 compared to the previous year, according to data from the Association of American Medical Colleges.
Doctors, including Lopez, said they have already seen the effects with candidates deciding after the interview process not to accept positions in Texas “because of the politics.”
See here for previous blogging on Dr. Lopez and the GENECIS program, with a more recent update from Ginger. The “future doctor shortage” caused by our draconian anti-abortion laws is a regular beat around here. It may take awhile for these effects to be noticed, perhaps well past the time when the likes of Greg Abbott and Dan Patrick have swanned off to retirement communities. Plenty of us will still be around to feel them. Until then, the solution, or at least the mitigation, remains the same, and that’s at the ballot box. Say it with me one more time: Nothing will change until our government changes.