I'm a primary care internist in Austin, Texas and have provided gender-affirming care for adults as part of my practice for eight years. I'm also the sister of a transgender man who suffered greatly before he transitioned. Growing up, I witnessed first-hand how gender-affirming care can save lives. But in Texas and other states, those lives are now being threatened by the very institutions that are supposed to protect them.
On March 11, instead of seeing patients in clinic, I sat in the back of a large auditorium at the Texas Department of Family and Protective Services (DFPS) and listened to stories of trauma for hours. Each story started with the same phrase: "My name is —, and I'm here to read a statement from the family of a transgender child who is too terrified to be here." One by one, community members stepped up to read statements to DFPS council members from transgender kids and their families submitted from across the state. Brave family members and transgender youth also stood up to speak themselves, despite the extremely personal nature of their testimony and the great personal risk.
One mother spoke of how she did not initially support her transgender son's transition when he came out. She choked back tears as she described coming home one day to find her son unconscious on the floor of his room. I watched a council member blot away tears as this mother poured out her soul, explaining that his suicide attempt convinced her to listen to him and how, with treatment, he is now thriving and happy. Another family pleaded with the council, "Don't make me read my child's obituary." These parents described making difficult decisions driven by an unconditional love for their children, and an intense fear that the unthinkable could happen — that a state agency could take their children from them for loving and supporting them.
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I too was there on behalf of others. I am trained as an adult physician, but I went to represent my colleagues in pediatrics who can't risk putting their patients and themselves in danger by speaking up. Due to political and financial pressure from Gov. Greg Abbott, clinics that care for transgender youth have been shutting down to avoid persecution.
Texas legislators say they are protecting youth by banning gender-affirming care, but the data shows the opposite. In 2020, a staggering 52% of transgender youth reported considering suicide. More than a dozen studies have shown that gender-affirming care for youth improves anxiety, depression and thoughts of suicide. Yet instead of following the guidance of every major medical organization, legislators have shown a disdain for the lives of transgender youth, going so far as to remove LGBTQ suicide prevention information from state websites.
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These politicians are targeting extremely vulnerable children and pushing disinformation to gain political support. Despite fear-mongering, gender-affirming care for youth follows well-established, age-appropriate standards of care. This means that for young children, that care includes just supporting them socially, by using the name and pronouns they prefer. Adolescents with gender dysphoria are much more likely to identify as transgender when they are in adulthood; for them, temporary puberty blockers can be considered while they undergo counseling with trained mental health professionals and physicians before moving to less reversible treatments such as hormones. Genital surgeries, often referenced by legislators and even DFPS leadership, are in fact not recommended for minors by current guidelines.
The real danger here is denying high-risk youth medically indicated, life-saving care while ripping them from supportive families. Family rejection is extremely common when transgender people come out to their family, something I hear about from most of the adult transgender patients I see. Transgender adults who are rejected by their parents are twice as likely to attempt suicide and have higher odds of alcohol or drug abuse. That's why it's so shocking that Texas is trying to find the few families that are supportive of their transgender children and teens and actively tear them apart.
As local and national businesses take a public stand against this immoral order, so must our neighbors and friends. If everyone could hear the stories I've heard, many more would be moved to speak up. No parent should have to decide between going to prison and withholding necessary care from their child — care that could literally save their lives.
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