As Texas GOP leaders continue targeting transgender children, state’s protective services agency takes aim at surgeries rarely used on kids

Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news.

The Texas Department of Family and Protective Services has responded to Gov. Greg Abbott’s request for an interpretation of state law sent last Friday, agreeing that some gender confirmation surgeries for transgender children constitute child abuse.

According to the letter, signed by DFPS commissioner Jaime Masters, allegations of such surgeries “will be promptly and thoroughly investigated and any appropriate actions will be taken,” though it’s unclear what impact the ruling will have.

Medical experts said gender-affirming care for transgender children rarely, if ever, includes use of the surgeries — orchiectomies, hysterectomies and mastectomies — that Abbott cited in his letter Friday to Masters. Most care for transgender children includes social transitioning and puberty blockers, which are reversible.

Abbott vowed last month to take action to restrict transition-related medical care for transgender minors in Texas. The move comes after a bill that sought to define several types of gender-affirming health care as child abuse was passed by Texas Senate during the regular session before gaining little traction in the House.

Brian Klosterboer, an attorney with the Texas division of the American Civil Liberties Union, said the letter seems to carry little weight or merit.

“It seems to us that this is mainly a political attack and political stunt as a way to attack transgender kids,” Klosterboer said. “… This letter, it is official in the sense that what the commissioner says might influence how DFPS does their work, but it doesn't change the law in this area.”

Rep. Erin Zwiener, D-Driftwood, a founding member of the Texas House LGBTQ Caucus, said legislation would have to be passed to change the Texas Family Code for there to really be any major change. However, the letters could present detrimental effects to transgender children seeking gender-affirming care.

“This opens the door to any parent of a trans kid being accused of child abuse,” Zwiener said.

For years, Texas Republicans have introduced legislation targeting transgender people, with little success. In 2019, Attorney General Ken Paxton urged state agencies to investigate whether a mother supporting her 7-year-old child’s gender transition was committing “child abuse.”

Earlier this week, former state Sen. Don Huffines, who will challenge Abbott in next year’s Republican primary, criticized the governor for not doing enough to protect Texas children from “mutilation” while touting an endorsement from the father of the transgender child that garnered Paxton’s attention in 2019.

Evidence-based standards of care adopted by medical professionals and associations, especially concerning transgender health care, do not include providing genital surgery for minors and specify that it should be a consideration only if someone is of legal age.

Aliza Norwood, medical director at Vivent Health, said decisions like the one made by DFHS distracted from all the benefits of gender-affirming care for children and adolescents.

"And when you read these statements and these laws, it's very clear that there's just no thought and no nuance to how somebody's life might be affected by things," Norwood said. "And that's just heartbreaking, because there seems to be a total lack of empathy or understanding."

Ricardo Martínez, CEO of Equality Texas, said rhetoric within the letters from Abbott and DFHS, which include the term “genital mutilation,” are an attempt to institute fearmongering and do not reflect actual gender-affirming care. The group put out a joint statement with the Transgender Education Network of Texas criticizing both Abbott’s letter and DFPS' response.

“I think that it's important to address that current best practice, health care approach for transgender children is a social transition which requires no medical intervention,” Martinez said. “I think that the letters that have been exchanged between Governor Abbott and the state agency are really not taking that into account. For older adolescents and teens the prevailing standards of care best practices and guidelines, look nothing like the contents of those letters.”

Disclosure: Equality Texas has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

Join us Sept. 20-25 at the 2021 Texas Tribune Festival. Tickets are on sale now for this multi-day celebration of big, bold ideas about politics, public policy and the day’s news, curated by The Texas Tribune’s award-winning journalists. Learn more.