Republican Texas politicians and medical groups are arguing whether puberty blockers and hormone therapy harm transgender children. Some legislators want to restrict or ban gay adolescents from receiving transition-related treatments that many medical associations favor.
Sen. Donna Campbell, R-New Braunfels, wants to ban such therapies for gender-transitioning children. Campbell and opponents of transition-related care painted doctors who provide such supervision as opportunists profiting on a “social contagion” with treatments lacking scientific data to assess safety and efficacy during a last week’s discussion on her Senate Bill 14.
“I got into the Senate, or government, because I wanted government out of our lives,” Campbell said during the Senate State Affairs Committee hearing. “But if there comes a time when a profession, such as the medical profession, cannot regulate itself to protect patients, protect children, then the government needs to step in.”
Medical groups, doctors, and transgender Texas say the scores of lawmakers supporting such restrictions either miss how transition-related health care aids trans people or willfully misinterpret information to target an already stigmatized minority.
They suggest puberty blockers and hormone therapies—transition-related surgery involving sex organs is nearly never performed on children—improve the mental health of trans kids, who are much more likely to be depressed and attempt suicide than their cisgender classmates. 40% of 27,000 transgender people surveyed by the National Center for Transgender Equality attempted suicide in 2015, almost nine times the national average.
Dr. Jessica Zwiener, a Houston endocrinologist who treats trans youth and adults, told senators this month that her patients’ mental health improves drastically after taking hormones like estrogen and testosterone.
“They become more outgoing, take better care of themselves, work more in school. “They’re happier; they can see a future,” Zwiener stated. Nobody discusses that.”
SB 14’s Senate counterpart died in the Texas House in 2021. This year, most House members have co-authored House Bill 1686, similar to Campbell’s Senate version. Monday is Bill 1686’s House Public Health Committee hearing.
SB 14 moved quickly during this legislative session. On March 16, hundreds debated the bill for hours. It passed the Senate Affairs Committee 8-3 on March 20. Lt. Gov. Dan Patrick prioritized the topic for the Senate this year. The entire chamber could vote on SB 14 next week.
Political division abounds. SB 14 and other GOP proposals could upend Gay Texans’ lives. At this month’s SB 14 hearing, GOP activist Steven Hotze called trans health care providers pedophiles. Sen. José Menéndez, D-San Antonio, encouraged Hotze to refrain from inflammatory remarks. Menéndez said trans people “live their true selves.”
Care Aimed At Mental Health
Transition-related care addresses gender dysphoria’s mental health difficulties. Transgender people encounter discrimination and stigma, aggravating depression, and suicidal thoughts.
Parents choose transgender children’s best practices and therapies. Most doctors follow a medical association-recommended care timeline. Hormone therapy should wait until a trans child can give informed permission, usually around 16. Medical professionals should not pressure teens to identify as transgender, socially transition, or start treatment.
Although multiple studies show that transgender youth who receive medical care for transitioning have fewer melancholy and anxiety symptoms, Campbell claimed transition-related care does not help youngsters with gender dysphoria.
A January National Institutes of Health-funded study monitored over 300 young trans people undergoing hormone therapy for two years and reported lower despair and anxiety and increased life satisfaction. Many studies show that transition-related care improves transgender kids’ and adults’ mental health. The Washington Post and Kaiser Family Foundation found 78% of transgender respondents were happier living as their gender.
Campbell did not respond to several requests for comment, but her statements in last Thursday’s session and her written support of SB 14 contradicted influential medical groups and peer-reviewed studies. Dr. Campbell. Texas Tech University granted her a medical degree. Campbell completed their ophthalmology residency. Her campaign website states she is board-certified in emergency medicine.
Campbell and others argue that puberty blockers and hormone therapy do not treat gender dysphoria. Houston psychologist Megan Mooney, who testified against Bill 14 for the Texas Psychological Association, said puberty blockers and hormone therapy for transgender adolescents improve mental health. Mooney also noted that delayed transition-related care increases the risk of suicide and self-harm.
“I ask you to examine what science tells us consistently: Gender-affirming medical care is the preferred, evidence-based way to treat gender dysphoria in youth, Mooney said in this month’s hearing. “This law hurts children.”
Zwiener stated no long-term studies on puberty blockers and hormone therapy for transgender youth. This care was rare until recently, she noted. Given the stigma and lack of financing, she said academic organizations haven’t traditionally studied this topic.
“The remedy to ‘lack of data’ is more studies, not outlawing care—especially when the smaller studies and anecdotal evidence are largely positive,” Zwiener added.
A Huge Shift
Campbell told the Senate State Affairs Committee this month that puberty blockers, hormone therapy, and surgery are irreversible. Many medical groups agree puberty blockers and hormone therapy are reversible after use. Doctors may perform breast and chest procedures on minors around 16 or 17, provided they have family support. “Bottom surgery”—genital procedures—is unusual in children.
Campbell said most kids would outgrow gender dysphoria with counseling. Texas transition-related care opponents cite research that found 80% of gender dysphoric youngsters “detransition.” Working groups discovered insufficient study sizes and inaccurate sampling in studies supporting that statistic.
The American Academy of Pediatrics observed that just 3% of 300 trans kids detransitioned five years following social transitioning.
“A lot of it just sort of boils down to the whole alternative facts thing, like what is true and what is not,” Zwiener added.
Transition-related care critics label transgender identity a “social virus.” Campbell and others have also questioned the sharp rise in youngsters seeking transition-related care.
The Senate Research Center’s review of Campbell’s measure suggests a profit motive for individuals who conduct these purely elective and costly operations. Transgender youth are becoming more visible and accepted, according to doctors.
Lauren McGaughy tweeted that More than 100 transgender Texans and their allies are at the Capitol today to advocate for bills that would strengthen. You can see below:
More than 100 transgender Texans and their allies are at the Capitol today to advocate for bills that would strength #LGBTQ rights.
Here are some scenes from their gathering in the Capitol rotunda. #txlege pic.twitter.com/5Lwr3MyLXJ
— 🌟 Lauren McGaughy (@lmcgaughy) March 8, 2023
Zwiener said mature patients in their 50s and 60s came to her after discovering the trans community online and finding others who shared their identity. While providing transition-related care, doctors told The Texas Tribune they follow the American Academy of Pediatrics, World Professional Association for Transgender Health, and Endocrine Society recommendations.
Like many medical treatments, puberty blockers and hormone therapy have adverse effects, including bone mineralization and fertility loss. Doctors think transition-related therapy improves mental health more than those side effects.
Even if they haven’t met transgender people, Zwiener’s families know the side effects. Zwiener said parents want the best for their children, so they heed medical advice and their children’s requests.
“We’re talking about these when it’s simply such a major impact in these kids’ lives,” Zwiener added.
Walking A Political Tightrope
Campbell said Texas medical associations supported transition-related treatment, which hurt children. Texas Pediatric Society and Texas Psychiatric Association oppose Bill 14.
Nonetheless, the Texas Medical Association remains neutral. That group opposed similar measures. Dr. John Carlo, a trustee of the association, said the group is staying neutral to continue negotiations with lawmakers and shape the legislation.
Carlo said TMA wants to continue medically-approved transition-related therapy for youngsters. The association aims to protect doctors’ licenses. Carlo said TMA’s Council on Legislative evaluates each bill to benefit Texas patients.
“Because this is such a highly politicized topic, we’re not essentially closing the door on any one argument,” Carlo added. “We’re trying to preserve a basis of scientific evidence, look at it from how we best take care of patients.”
Andrea Segovia, senior field and policy adviser with the Transgender Education Network of Texas, said patients and doctors should decide on health care. Segovia said transition-related care is unique to each trans individual.
“This blanket approach that we see with this health care [ban], but also in general when talking about trans issues, undermines people’s freedoms and liberties in Texas, where we believe freedom and liberty matters most to us,” Segovia added.
In recent years, Republican Texas lawmakers, officials, and far-right groups have politicized Homosexual lives. GOP lawmakers also propose severely restricting classroom lessons, school activities, and instructor guidance about sexual orientation and gender identity in this legislative session. They’re also pushing laws prohibiting kids’ drag show attendance and trans student athletes’ college sports teams.
The Tribune reported earlier this year that many activists and extremists have fanned anti-drag fear by portraying all drag as sexual. These reasons have been used to support LGBTQ-targeted legislation, frequently in the name of child protection.
After GOP lawmakers failed to ban puberty blockers and hormone therapies for trans kids in 2021, Republican Attorney General Ken Paxton issued a nonbinding legal opinion equating transition-related care with child abuse. Gov. Greg Abbott ordered the Department of Family and Protective Services to investigate parents caring for transgender children. LGBTQ groups are contesting the instruction, which a Travis County judge mostly rejected last year. Paxton requested the injunction be lifted earlier this month.
Despite critics, Zwiener said the fear of prohibiting transition-related care has helped doctors follow best practices and monitor their patient’s progress and outcomes.
“People who support gender-affirming care are constantly extremely anxious that it’s going to be taken away or made illegal, and so people tend to do things very conservatively, very by the book,” she added.
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