The administrative attack on transgender youth

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A directive denying health care to transgender youth puts agencies at odds with evidence-based medicine.

In February, Texas Governor Greg Abbott ordered state health agencies to treat gender-affirming care for transgender minors as child abuse under state law. . Within days, the state furloughed an employee – the mother of a transgender teenager – and referred her to child protective services only because she allowed her daughter to receive prescribed hormone therapy. by a doctor, an investigator reportedly explained.

But trans children, their parents, and LGBTQ+ rights advocates disagree that gender-affirming care is abuse. Far from being an abuse, experts say, this care is vital and essential health care.

The number of state-level policies developed to limit the ability of transgender minors to receive medical care consistent with their gender identity is increasing. Advocates note that these laws were created to regulate the autonomy of transgender children, prevent parents from raising their children as they wish, and undermine the expertise of doctors who recommend gender-affirming health care to minors who receive it. ask.

But, unlike measures that have largely originated — and often failed — in state legislatures, Governor Abbott’s directive uses a different branch of government to limit access to gender-affirming care: health care agencies. ‘State.

Governor Abbott’s directive only targets certain types of gender-affirming care. Gender affirming care encompasses a number of medical and psychosocial health care decisions an individual may make to affirm their gender identity.

This model of care includes medical interventions, such as drugs that block puberty-related hormones or surgery. It also includes social interventions, such as accepting and encouraging children who explore the use of new names and pronouns and transferring minors to camps, sports leagues and other gender-specific activities that match their gender identity.

Experts view these medical decisions as important health care tools that can improve the well-being of transgender people who choose to undertake them.

In fact, studies show that transgender youth who have access to a range of gender-affirming care options have better overall health outcomes than their peers who want but cannot access this care. As a result, professional groups, such as the American Academy of Pediatrics, broadly endorse the use of gender-affirming care for transgender youth, citing the potentially tragic consequences of leaving care for minors who need it.

Under the governor’s directive, surgeries and hormone interventions are investigated by the Texas Department of Family and Protective Services (DFPS) — and some professionals who fail to report parents of transgender children who receive these interventions may incur criminal penalties.

Although some state district attorneys said they would decline to prosecute the families in response to the directive, the DFPS confirmed they would comply with the governor’s demands.

Policies that target transgender minors target both types of care. Governor Abbott’s latest policy directs state health agencies to limit the ability of transgender minors and their parents to make medical decisions. Other bills have undermined social interventions in gender-affirming care, such as excluding transgender children from sports or banning transgender students from using restrooms that match their identity.

Other states have attempted to limit the health autonomy of transgender minors. LGBTQ+ advocacy groups noted that 2021 was a banner year for anti-transgender legislation, and many of those bills focused on restricting medical care. Last year, state legislatures introduced at least 35 bills aimed at barring trans youth from accessing gender-affirming medical care.

Of those legislatures, Arkansas became the first to successfully pass a bill to block transgender youth’s access to gender-affirming medical care. The Save Adolescents from Experimentation (SAFE) Act, whose title suggests that gender-affirming medical care amounts to “experimentation” rather than an empirically studied medical intervention, prohibits doctors from providing medical care to transgender youth .

Shortly after the SAFE Act was passed, a federal judge issued an injunction to prevent the law from taking effect in response to a lawsuit alleging the bill violated the constitutional right of transgender minors to equal protection under the law.

But Governor Abbott’s directive, unlike those efforts, uses the authority of state agencies to limit medical care options for transgender youth. Now, the American Civil Liberties Union (ACLU) has filed a lawsuit against the state of Texas, seeking to block the attempt on the grounds that it violates state administrative law. A federal judge temporarily granted their request and recently issued an injunction that bars the agencies from further investigating the parents, pending the outcome of the ACLU’s lawsuit.

The ACLU alleges in its complaint that DFPS’ compliance with the governor’s directive violates Texas administrative procedure law because the agency failed to follow mandatory procedural requirements, including “public notice, comments and a reasoned justification for the rule.

The agency exceeded its authority by agreeing to apply the governor’s interpretation of Texas law, the ACLU argues. Although agencies generally have some discretion in how they use their enforcement powers, the ACLU says this policy has expanded the agency’s scope of enforcement so much that it constitutes an entirely new rule.

Rules that do not follow proper procedures, according to the ACLU, are not valid.

Additionally, the complaint alleges that the DFPS contravenes its statutory purpose, which explicitly states that the agency must “respect the fundamental right of parents to control the upbringing and education of their children.”

Instead of helping families, the ACLU argues that investigating parents — not gender-affirming care — is hurting transgender minors. Gender-affirming care is a source of empowerment and fulfillment for many transgender youth.

As one transgender teenager would have explained, “It makes me feel who I really am, and I don’t feel singled out because I’m not like the other girls at school anymore.”

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