Explaining the Latest Texas Anti-Transgender Directive
Three BU experts on whether the Texas move is legal and its impact on the trans community
Explaining the Latest Texas Anti-Transgender Directive
Three BU experts on whether the Texas move is legal and its impact on the trans community
The Texas Department of Family and Protective Services (DFPS) this week opened its first investigation into the family of a transgender teenager who received gender-affirming medical treatment under a new directive from Texas Governor Greg Abbott that has sparked a nationwide outcry and condemnation from President Biden.
It’s only the newest anti-transgender measure from Texas, which saw a record number of anti-trans bills introduced to the state’s House and Senate last year. And in January of this year, Senate Bill 29 went into effect, requiring transgender student-athletes to compete on sports teams that match their sex assigned at birth.
The latest directive comes in the form of a letter issued in late February to DFPS directing the agency to classify medical treatments for transgender adolescents—such as puberty blockers and hormone injections—as “child abuse” under existing state law. The letter calls for DFPS to investigate parents who help their children access such treatments, as well as licensed facilities that administer them. The letter also imposes penalties on any “mandatory reporters” like doctors, nurses, and teachers who don’t report instances of treatment to the agency, as well as on members of the general public.
The letter is the follow-up to a legal opinion Texas Attorney General Ken Paxton released a few days prior, defining such procedures as child abuse and labeling gender-reassignment surgeries as “forced sterilization,” among other claims.
If you’re wondering, is that all legal? you’re not alone. The American Academy of Pediatrics and the American Medical Association, among many other groups, have released statements condemning states like Texas for attempting to block transgender youth from accessing medical treatment. Following Abbott’s letter, multiple district attorneys throughout Texas stated that they would not be investigating parents or medical providers and the US Department of Health and Human Services announced it would work to protect the rights of transgender children in Texas.
Biden mentioned the Texas effort in his State of the Union speech Tuesday, and in a statement Wednesday, said: “Transgender children bring fulfillment to their parents, joy to their friends, and are made in the image of God. Affirming a transgender child’s identity is one of the best things a parent, teacher, or doctor can do to help keep children from harm, and parents who love and affirm their children should be applauded and supported, not threatened, investigated, or stigmatized.”
Once the first Texas investigation into a family was announced, the ACLU immediately filed a lawsuit on behalf of the teenager and their parents, as well as Texas physician Megan Mooney, arguing that Abbott’s directive has no legal basis and is instead an attempt to “endanger the health and wellbeing of transgender youth in Texas by depriving them of medically necessary care.” On Thursday, a Texas judge blocked the particular DFPS investigation from taking place, but not investigations in general. On March 11, a court will decide whether or not to block Abbott’s directive statewide.
To shed some light on the situation—and what directives like the Texas one could mean for the transgender community—BU Today tapped three Boston University experts. Linda McClain, School of Law Robert Kent Professor of Law, is an expert on civil rights and gender law. Melissa K. Holt, a Wheelock College of Education & Human Development associate professor and associate dean for faculty affairs, has spent years researching gender and sexual identity in adolescents, and is currently coleading a study focused on transgender and nonbinary youth. Finally, Debbie Bazarsky, inaugural director of the LGBTQIA+ Center for Faculty & Staff, is a nationally recognized leader and lecturer on LGBTQIA+ topics and the field of diversity, equity, and inclusion.
The interviews have been condensed and edited for clarity.
with Linda McClain, Melissa K. Holt, and Debbie Bazarsky
BU Today: First of all, does Governor Abbott’s directive appear to be legal?
McClain: As the ACLU complaint says, last year, the Texas legislature declined to pass [SB 1646, a bill that would have legally designated gender-affirming medical treatment for minors as child abuse]. Abbott, not happy with that result, decided that there was another way around this. So, he basically asked the Attorney General to write an opinion about what, under Texas law, is child abuse and whether gender-affirming treatment would count as child abuse. The Attorney General wrote it. Abbott then wrote his letter announcing that DFPS should regard this range of gender-affirming treatments for children as child abuse, [and the agency’s commissioner directed staff to follow the governor’s wishes].
It does not seem to be legal. As the complaint explains, the governor doesn’t get to declare what child abuse is in Texas—that has to come from the state legislature, who then may delegate a body or individual to write regulations. Therefore, the complaint says that Abbott’s directive violates the Administrative Procedure Act, because it didn’t go through the proper channels of lawmaking. The complaint uses the phrase ultra vires [to classify Abbott’s actions], which in legal terms means acting outside of one’s scope of authority.
BU Today: When do children develop an awareness of their gender identity, and what is gender dysphoria?
Holt: Around age three kids typically have an awareness of gender and can identify their own gender. It’s also around three to five that kids may start having a sense of their assigned gender not aligning with how they perceive their gender. So, it can happen very early for some kids. At the same time, there are a lot of factors—such as familial expectations and societal norms—that can act as barriers and lead to individuals identifying as transgender or gender-diverse at an older age. There’s a lot of variability, particularly for people who identify as gender-diverse and may have many reasons why it feels more complicated for them to express their own gender identity.
Essentially, gender dysphoria is when your assigned gender identity doesn’t align with your actual gender identity. Historically, gender dysphoria has been characterized by the American Psychological Association as a mental illness, which is no longer the case. Now, it’s characterized as a “marked incongruence between one’s experienced/expressed gender” that is causing an individual distress lasting at least six months and meets certain other criteria. Experiencing gender dysphoria is a critical component when someone is considering receiving gender-affirming medical care. That’s what a treatment team will be looking out for: Is this person experiencing gender dysphoria?
BU Today: Abbott’s, and particularly Paxton’s, literature appear to liken gender-transitioning treatment for adolescents to forced “sterilization” and mutilation of “otherwise healthy body parts.” What does gender-affirming care for children and teenagers actually look like?
Holt: Prior to the onset of puberty, kids typically receive nonmedical care. Their care is focused around social transitioning [like choosing a new name and changing how they dress] and providing mental health and structural support, like schools using a child’s preferred gender pronouns and allowing them to use the bathroom that aligns with their gender identity. Later on, an adolescent can pursue the more medical aspects of gender-affirming care, such as puberty blockers and hormone injections, and so on. [And note that current medical guidelines say individuals should not undergo genital reassignment surgery until the age of 18.]
These writings are not providing all the facts around what gender-affirming care looks like for children and teenagers from a medical perspective. There are no four-year-olds going through irreversible medical procedures. [For treatments like hormone injections and chest surgeries], these are thoughtful decisions made after a long period of time when kids are well into their teenage years; often, these are kids who have socially transitioned for quite a long time, and they and their families are making additional choices to support their well-being.
There’s so much research showing that adolescents who receive gender-affirming care and have supportive families and school structures fare so much better than adolescents who don’t. The rates of psychological distress, suicidal ideation, and attempted suicide go down, as do the rates of depression. Both the American Psychological Association and the Society for Research in Child Development have released statements [saying as much]. That’s why Abbott’s directive feels very counter to scientific evidence—all indicators suggest that medically gender-affirming care is beneficial, and not having access to that care impacts the well-being of transgender children in significant ways.
BU Today: What kind of message do measures like this send to the transgender community?
Bazarsky: The very notion that trans kids and their families are at risk of facing legal ramifications and charges of child abuse for supporting their trans family members is barbaric and goes against the evidence-based, gender-affirming medical guidance from numerous national medical organizations. These parents are not being abusive; the law is abusive. Directives like this, and the anti-trans rhetoric around them, send the false and damaging message to trans people and their families that their very existence is invalid. With trans youth already experiencing stigma and discrimination and higher rates of depression, self-harm, and homelessness, among other things, directives like this have the very real potential to hurt trans kids in myriad ways and increase these rates.
BU Today: How can cisgender people be allies to the transgender and gender-diverse community?
Bazarsky: In addition to this bill, Texas and more than 20 other states have introduced legislation that would ban gender-affirming medical treatment for adolescents. This makes the passage of the Equality Act, or other federal protections, all that more essential. Advocacy, such as reaching out to elected officials, supporting organizations who are fighting these anti-trans bills in court and those who support trans and nonbinary people—these are small, yet meaningful, ways people can offer support.
If you have transgender individuals in your life, it is about showing up and offering support, validating their lived experience, honoring their lived name and pronouns by never deadnaming or misgendering them, never outing them without their explicit consent, educating oneself about trans and nonbinary identities and cissexism rather than asking trans people to educate you. Also, not asking invasive questions, being a visible and active ally, and asking trans and nonbinary family members and close friends in your life if there are things you can do to better show them safety, love, and support.
For LGBTQIA+ mental health support, call the Trevor Project’s 24/7/365 toll-free line at 1-866-488-7386. BU students can also access help through Student Health Services. Resources for BU employees include the Faculty & Staff Assistance Office and the LGBTQIA+ Center for Faculty & Staff.
To me, this is just another example of the disconnect between the government and people. There are numerous agencies, in this case DFSP, with enormous powers that can basically cripple anyone’s life. These agencies make numerous decisions pretty much by themselves or through hidden negotiations within the government. There is no accountability for these decisions not even through elections because no specific person is responsible for controlling DFSP. In this particular case, there is even a disagreement about who and how can influence DFSP’s actions.
Children are way too young to be having irreversible genital mutilation surgery performed on their bodies. This madness has to be stopped, if you’re an adult and want to do this then fine, but leave the kids out of it.
It doesn’t sound like you actually read the article. The third bolded section titled “Abbott’s and particularly Paxton’s literature appear to liken gender-transitioning treatment for adolescents to forced “sterilization” and mutilation of ‘otherwise healthy body parts.’ What does gender-affirming care for children and teenagers actually look like?” explains what gender-affirming care actually means, and that it specifically doesn’t mean that young children undergo irreversible treatments.
Did you even read the article?? Maybe you should take a second and read a little more closely:
“Abbott’s and particularly Paxton’s literature appear to liken gender-transitioning treatment for adolescents to forced “sterilization” and mutilation of “otherwise healthy body parts.” What does gender-affirming care for children and teenagers actually look like?
Holt: Prior to the onset of puberty, kids typically receive non-medical care. Their care is focused around social transitioning [like choosing a new name and changing how they dress] and providing mental health and structural support, like schools using a child’s preferred gender pronouns and allowing them to use the bathroom that aligns with their gender identity. Later on, an adolescent can pursue the more medical aspects of gender-affirming care, such as puberty blockers and hormone injections, and so on. [And note that current medical guidelines say individuals should not undergo genital reassignment surgery until the age of 18.]
These writings are not providing all the facts around what gender-affirming care looks like for children and teenagers from a medical perspective. There are no four-year-olds going through irreversible medical procedures. [For treatments like hormone injections and chest surgeries], these are thoughtful decisions made after a long period of time when kids are well into their teenage years; often, these are kids who have socially transitioned for quite a long time and they and their families are making additional choices to support their well-being.
There’s so much research showing that adolescents who receive gender-affirming care and have supportive families and school structures fare so much better than adolescents who don’t. The rates of psychological distress, suicidal ideation, and attempted suicide go down, as do the rates of depression. Both the American Psychological Association and the Society for Research in Child Development have released statements [saying as much]. That’s why Abbott’s directive feels very counter to scientific evidence—all indicators suggest that medically gender-affirming care is beneficial, and not having access to that care impacts the well-being of transgender children in significant ways.”
Before placing blame, learn the facts.
I think you should do more research on this subject as your comment makes no sense. Any sort of gender transition surgery can’t be performed until after many years of doctor consultation, therapy, etc. This isn’t something you can just get on a Wednesday after deciding on a Tuesday. Instead, your take here is damaging to children who are trans and exploring their gender identity.
Hormone blockers or hormone replacement therapy during puberty is irreversible as well. Do you not understand that a child’s mind is very plastic, they can be convinced of just about anything. I’m sorry but this view of using irreversible medical treatment on minors who “feel” they are the opposite gender is a minority opinion.
Do you do any research before you comment? Literally a 30 second google search invalidates this whole comment…
Which part is not accurate?
As a physician, I can assure you that hormones have permanent effects no matter when they are given. If given during puberty, certain processes in muscle, lung, cardiac, even brain development are affected, and we still don’t know all the areas of the brain that are affected by the “sex” hormones! Effects are cascading: one causes another, forever changing relationships between cells and systems. I certainly don’t agree that treatment is child abuse, but hormone blockers and hormone treatment is not innocuous. Parents of minors, and psychologists, psychiatrists should all be in agreement that a defined course is the best for the child. Isn’t questioning everything about our “self” a part of adolescence?
As I recall, a persons brain does not fully mature until 21 or so. And the therapy seems to be more like grooming, the kid receives lots of attention, which is affirming in itself and may produce a “false positive “. And it tears many families up. The far greater # of FTM need to be explored. Girls notoriously have more body image dissatisfaction, and the male gender is considered superior. Those born male have different, and more erotic reasons for wanting change, as I see it. I don’t think minors should have plastic surgery, or hormone therapy. What was once gender fluid is not that at all, it was a ploy.
As is noted above “current medical guidelines say individuals should not undergo genital reassignment surgery until the age of 18.”
Ironically, the irreversible genital surgery performed on minors in the US is circumcision, which is not being discussed as problematic in this context.
Conflating gender reassignment surgery (and calling it genital mutilation) and the recommended gender affirming care of minors– which includes social transition, supportive home and learning environments, counseling, and potentially (where deemed appropriate after careful consideration) puberty blockers and potentially eventually (after even more careful consideration) hormone therapy– is uninformed and inflammatory. Regardless of intent, it is not protecting children.
Kids under the age of 18 typically do not undergo surgery. What is normally done is people take hormone blockers, and then after a while take the hormone that corresponds with their gender. Both of these in fact, are reversible and do not cause long term damage to a child’s body. What it does do, however, is allow kids with dysphoria to feel more comfortable.
Even then, hormones aren’t normally given to children under the age of 16.
“Kids under the age of 18 *typically* do not undergo surgery.”
“hormones aren’t *normally* given to children under the age of 16.”
I’m noticing there’s a lot of this going on this thread — “normally” and “typically” — in an attempt to minimize and sweep-under-the-rug the biological intervention component. If that component happens so seldomly, why not just take it off the table ENTIRELY until the age of 18? Keep things at counselling until then, when the parties can truly & maturely consent.
Thank you for this coverage; it means a lot to the community.
An idea: Could we add a preferred pronouns field to our individual listings at bu.edu/directory?
This is 2022
Where are we headed? Not into the future
but into the past. Don’t put up with it. Our freedom is under attack.
To all voters …. GO VOTE OUR DEMOCRACY DEPENDS ON IT
One thing that is being ignored completely in this illogical stance by Abbott and the state of Texas is that genital surgery on intersex children was and still is a choice parents make without any consent of the child. Their genitalia are “otherwise healthy body parts” that don’t conform to the standard of parents and wider society, so surgery is used to align their sex with the gender identity preferred by their parents. And Texas is more than happy to allow parents to withhold life saving medical care for their children if their religious beliefs are in opposition to it, seeming to state that the way people raise their children is a private matter the government has no part in. Unless Greg Abbott really doesn’t like it, then all bets are off. And yes the circumcision of healthy penises without the child’s consent is a good point too lol.
Believe it or not, most people would say there is a major difference between circumcision and complete removal of one’s penis.
“…make without any consent of the child.”
The whole argument is that a child CAN’T rationally and maturely consent — we don’t let them vote, drink, join the military as children — and that they are pliable and easily swayed by a culture that is currently telling them being trans carries a certain cultural clout, which it undeniably does. There is a reason 84% of trans children, by the time they’re adults, settle into being gay or lesbian — they’re still *working things out* in their teens, and the encouragement of biological intervention (yes, even puberty blockers and hormone treatment) runs counter to allowing them that time to *work things out* without irreversible medical implications, as we don’t currently know the full physiological ramifications of these treatments.
The Texas legislation is needless and extreme and blinders-on — but so is denying everything stated above.
I am sorry Thelmathelp, but nobody thinks being marginalized and criminalized, with suicide rates far and away above the average, and all the other “cultural clout” that you apparently assume on trans-identifying people is somehow ‘cool.’ Transgender people do not “choose” to be transgender (!) They just are. Just like you formed your own inner conceptions of selfhood.
What, pray tell, makes your inner conceptions morally or otherwise “better” or more ‘right’ than anyone else’s?
Did you personally have to “work out” your gender as a kid? Does any cis-gender person even think for more than a second, if ever, about their gender alignment?
Think it through.
The suicide rates are not as high as is reported in the media or the numbers used by trans activists. A follow up study of one of the largest transgender clinics concluded that the actual rate of suicide is was 0.03%. It is irresponsible to exaggerate the rates, as it puts the parents into a difficult position with respect to assessing the risks of treatment and gives the transgender people themselves a wrong impression about the likely outcome of their trajectory. Finally, it should not be used to justify treatments that are scientifically speaking experimental. The study is here: https://link.springer.com/article/10.1007/s10508-022-02287-7
The difficulties with respect to informed consent procedure currently used is here: https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2046221
We shouldn’t allow infant circumcision either, tbh.
Intersex children are often infertile. It is maybe just cosmetic surgery? Surgery on otherwise healthy children and medical treatment that affects fertility or puts them into some third category is maybe something else.
Wait so is the bill/law(idk what is is at this point) still happening or has it been blocked now? I’ve heard that it has and hasn’t. And as an non-binary minor who would be affected by this I’m terrified as I’m out to my school but not family. Is this something I don’t need to worry about or do I need to go back into the closet and hide my true identity?
Even with reading the passage it still confuses me. Can someone please just tell me if I need to be worried about this or not?
I’m just a child, reading this, and it’s led me to wonder if my best friend, a transman, was pulled from school because of his medications. We are both in the orchestra, and yesterday someone came by to pick up his instrument and he hasn’t been answering my texts, and he hasn’t been to school in almost a week. I’m scared for him. I’m scared that the government has made him make the choice of going to school or being who he is. Thank you to anyone that read this.
About time people are standing up to stop this insanity. Children are in no possition to make life altering decisions. The same reason why they cannot vote, get married or drive motor vehicles. Children should be protected from predatory harm that is the root of the transgender movement.
I cannot wait till this becomes the norm worldwide and we stop this train wreck destroying the lives of people.