The Texas Supreme Court has allowed a new state law banning gender-affirming care for minors to take effect, making Texas the most populous state with such restrictions on transgender children. Legal advocates, including the American Civil Liberties Union, who sued on behalf of families and doctors, described the law and the court’s decision as “cruel.” They emphasized that transgender youth and their families now face the start of the school year with fear and uncertainty, but vowed to continue their fight.
Last week, a state district judge ruled that the pending law violated the rights of transgender children and their families to seek appropriate medical care and infringed on doctors’ ability to follow established medical guidelines without risking their licenses. The judge issued a temporary injunction to block the law, but state officials immediately appealed to the Texas Supreme Court. The all-Republican Supreme Court lifted the injunction without explaining its decision, and a full hearing is expected to address the lower court’s ruling on the law’s constitutionality.
More than 20 states have adopted laws to ban some gender-affirming care for minors, although some are not yet in effect or have been put on hold by courts. The Texas law prevents transgender minors from accessing hormone therapies, puberty blockers, and transition surgeries, despite medical experts noting that such surgical procedures are rarely performed on children. The law also mandates that children already on these medications must be weaned off in a “medically appropriate” manner.
Jonathan Covey, policy director of Texas Values, a conservative group that supported the law, stated, “Texas kids are safer today because of the Supreme Court ruling. Protecting children from harmful and dangerous gender transition surgeries and puberty blockers is in the best interests of the child and something we all agree on.”
The lawsuit argued that the Texas law would have devastating consequences for transgender teens if they are unable to obtain critical treatment recommended by their physicians and parents. Several doctors who treat transgender children expressed concern that their patients’ mental health could deteriorate, potentially leading to suicide, if they are denied safe and effective treatment.
The Texas ban was signed into law in June by Republican Governor Greg Abbott, who was the first governor to order the investigation of families of transgender minors receiving gender-affirming care. This move reflects a broader trend across the United States, where numerous states have implemented or considered actions aimed at limiting LGBTQ+ youth access to gender-affirming health care.
In Alabama, a law signed in April 2022 prevents transgender minors from receiving gender-affirming care, including puberty blockers, hormone therapy, and surgical intervention. The law makes it a felony for any person to facilitate such treatments for transgender minors, punishable by up to 10 years in prison or a fine up to $15,000. A federal lawsuit challenging the law was filed, and a preliminary injunction was granted, blocking enforcement of several sections of the law while litigation is pending.
Arkansas lawmakers passed legislation in 2021 prohibiting gender-affirming treatment for minors, including puberty blockers, hormone therapy, and gender-affirming surgery. The law also prohibits medical providers from making referrals for such care. A federal court granted a preliminary injunction, temporarily blocking the state from enforcing the law while the case is pending.
In February 2022, Texas Governor Abbott issued a directive defining certain gender-affirming services for youth as child abuse, calling for investigations and penalties for parents who support their children in accessing these services. Health care professionals facilitating access to these services could also face penalties. A state court entered a temporary injunction preventing the state from enforcing the directive while the case is pending, but the Texas Supreme Court modified the injunction, allowing enforcement against plaintiffs not involved in the lawsuit.
Arizona Governor Ducey signed legislation in March 2022 banning physicians from providing gender-affirming surgical treatment to minors, though the law does not address hormone therapy or puberty blockers.
Since January 2022, 15 states have introduced a total of 25 bills that would restrict access to gender-affirming care for youth. These bills vary in provisions, including criminalizing or imposing professional disciplinary action on health professionals providing such care, penalizing parents aiding in access, and limiting insurance coverage for gender-affirming services.
While some states have adopted broad nondiscrimination health protections based on gender identity and sexual orientation, the Biden administration has been working to eliminate barriers and expand access to health care for LGBTQ+ people. The administration has taken multiple steps to promote access to health care for LGBTQ+ people and to prohibit discrimination based on sexual orientation and gender identity.
Most major U.S. medical associations, including those in pediatrics, endocrinology, psychiatry, and psychology, recognize the medical necessity and appropriateness of gender-affirming care for youth. They note the harmful effects of denying access to these services, emphasizing that such care is associated with improved mental health outcomes for transgender youth.
State policies restricting youth access to gender-affirming care could have significant health and other implications for LGBTQ+ youth, their parents, health care providers, and other community members. LGBTQ+ youth experience higher rates of depression, anxiety, and suicidality than their non-LGBTQ+ peers. Inability to access gender-affirming care has been linked to worse mental health outcomes, potentially exacerbating existing disparities.
Parents who facilitate access to gender-affirming services for their children could face penalties, including losing custody of their children. Providers may be torn between providing the highest standard of care and facing potential sanctions. Teachers and other mandated reporters could also face penalties for failing to report youth accessing gender-affirming care.
The legal and policy landscape regarding youth access to gender-affirming care is shifting across the country, with an increasing number of states seeking to limit such access.
Source: Associated Press, American Civil Liberties Union
