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How Medical Care for Transgender Youth Became ‘Child Abuse’ in Texas – The New York Times

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A custody battle in the Dallas suburbs amplified a growing conservative cause and helped fuel a move to treat transgender medicine as abuse.

HOUSTON — Jeffrey Younger fought for years with his ex-wife, a pediatrician, over the gender identity of one of their twins. While she followed the advice of their children’s doctor to affirm the child’s desire to dress as a girl, grow long hair and be known as Luna, Mr. Younger steadfastly objected.
He resisted the new name, insisting instead on boys’ clothes, short haircuts and the name the couple had chosen at birth.
What began in a single household in a small community outside Dallas became a very public custody battle between Mr. Younger and Dr. Anne Georgulas, transforming him into a folk hero among conservatives and amplifying a growing effort to roll back transgender protections in state houses across America.
It paved the way, too, for an order late last month by Gov. Greg Abbott of Texas to investigate parents for child abuse if they provide certain medical treatments to their transgender children.
The abuse investigations ordered by Mr. Abbott, the first of their kind, represent the peak of a new round of action in state capitals aimed at transgender Americans, the most significant push by groups opposed to transgender rights since the national campaign to limit bathroom access foundered in 2017 and 2018. On Tuesday, a bill passed the Idaho House that would make medical treatments for transgender youth a felony, punishable by life in prison.
But few predicted that it would go as far as it has in Texas. The directive by Mr. Abbott very quickly resulted in investigations by the Department of Family and Protective Services, prompted a major Houston hospital to restrict its care for transgender children and raised fears among civil rights advocates of copycat efforts in other states. President Biden has condemned the action and asked federal authorities to step in if cases of discrimination arise.
“This is actually the first time that they’ve succeeded in getting something that looks like a success,” said Kasey Suffredini, the chief executive of Freedom for All Americans, a national gay and transgender rights group. “It’s incredibly painful. It is devastating.”
A court battle is underway to stop the investigations across Texas, with a hearing scheduled for Friday.
The fight over transgender issues, waged on several fronts in recent years, has increasingly focused on medical treatments for children.
Major medical groups — along with transgender advocates — back what is known as gender-affirming care, which involves supporting a child’s gender identity and social transition, often through clothes or a name. Such care can also eventually include puberty-blockers or hormone treatments, though genital surgery is not typically recommended for children. While acknowledging some uncertainty and risk, they cite evidence that the approach can improve children’s mental health and reduce suicide.
Opponents — including some large conservative organizations — argue that children are too young to decide for themselves and must be shielded from potentially life-altering treatments that have only recently gained broader acceptance among the medical community.
Those at the center of the conservative push for new state laws include a coalition of familiar groups — the Heritage Foundation, Family Policy Alliance and Alliance Defending Freedom — that came together in the last two years.
Then last month, a newer player on the right, American Principles Project, took up the cause in Texas, spending more than $600,000 to run a series of highly produced ads on cable television featuring the case of Mr. Younger, who has become an outspoken supporter of restrictive legislation on transgender issues. The ads directly targeted Mr. Abbott during a hard-fought Republican primary, accusing the governor of not taking steps to “protect our children.”
By that point, Mr. Younger, 57, had testified repeatedly at the Capitol in Austin on measures to restrict transgender medical treatments. After the bills failed, he entered the Republican primary for an open seat in the Texas House of Representatives.
Last week, Mr. Younger came in second place, qualifying for the May runoff.
For conservative activists, the legislative push has been part of a broader national struggle over social issues, including legislation in Florida to ban teaching about gender identity in schools. Some of the same activists who defend the rights of parents in battles over school curriculum argue that, on the question of transgender treatment, children need protection from their own parents.
“Parents make all sorts of decisions with their kids,” said Craig DeRoche, the chief executive of the Family Policy Alliance, part of the coalition helping legislators draft new transgender laws. “And as a community, we chime in as to which decisions should or shouldn’t be available to parents.”
But for many families in Texas, the threat of an investigation by the state has introduced new fears into an already challenging set of medical decisions. Children now worry that classmates or teachers could report their parents for possible abuse. Some families have taken steps to leave the state.
“We’re kind of looking over our shoulder a little bit,” said Autumn Tupper, 43, of Frisco, Texas, a Dallas suburb. Because of the governor’s directive, her son, Orion, 17, who came out as transgender over the last year, decided to delay gender-affirming hormone treatment until he turns 18 this summer.
The deeper roots of the current fight over transgender rights in Texas can be traced to a 2015 battle in Houston over a local anti-discrimination ordinance, which would have applied to a range of protected classes, including race, age and gender identity.
Opponents rallied around the notion that the bill would put women in danger by allowing men to enter women’s bathrooms, dubbing it the “bathroom ordinance.” Its defeat helped clear the way for a national conservative push to enact so-called bathroom bills aimed at transgender people.
But the bathroom effort stumbled. The one measure that passed, in North Carolina, was later repealed. In Texas, many social conservatives were angered at the state’s failure to pass such a law.
“This issue is not going to go away,” Lt. Gov. Dan Patrick, a firebrand former talk radio host, said at the time, in 2017.
By the next year, the custody case between Mr. Younger and Dr. Georgulas, in the Dallas suburb of Coppell, began to attract notice in conservative circles.
There have been other such cases of parents fighting over the gender identity of their children. But Mr. Younger sought attention with a website and a campaign that featured the birth name of his child. Among the first articles on the case appeared in The Federalist in 2018. Mr. Younger sat for many interviews, including with Infowars.
“You cannot understand the political situation in Texas without understanding my political advocacy,” Mr. Younger said in a 16-minute call with The New York Times in which he refused to answer questions. “You work for an evil and wicked organization,” he said. “I think you’ll use accuracy against my own values.”
A lawyer for Dr. Georgulas declined a request for comment, citing a gag order put in place by the judge in the case.
The couple fought bitterly in court for years. Their marriage was annulled by a court on the grounds of fraud by Mr. Younger, who had misrepresented his employment and marital history.
In court transcripts, Dr. Georgulas said she had followed the lead of her transgender child, who is now 9, and the determinations of doctors. She has denied forcing her child to identify as a girl as Mr. Younger has claimed. She has not provided any puberty-blockers or hormones, though she supports their use, if recommended. She filled out intake papers for Genecis, a Dallas clinic specializing in transgender care, but had not yet begun treatment when it shut down last year amid pressure from Mr. Abbott.
Limiting trans care. Republicans in Texas are seeking to criminalize medical treatments that help align trans teens’ bodies with their gender identities. Here is what to know about the efforts:
Failed bills. Texas has repeatedly considered bills that would have banned gender-affirming treatment for teenagers, yet all have so far failed. One proposal sought to redefine child abuse to include gender-affirming treatment for transgender children.
An opinion and an order. Attorney General Ken Paxton recently issued an opinion stating that providing treatments like puberty-suppressing drugs to transgender teenagers should be investigated as child abuse. Shortly after, Gov. Abbott reaffirmed the notion in a letter to state health agencies.
Investigations begin. While Gov. Abbott’s order doesn’t change Texas law, the state’s child welfare agency has begun investigating child abuse claims related to trans care. On March 2, a state court temporarily halted the investigation of one family, but allowed others to continue.
The pushback. Transgender health experts have condemned the attempt to limit trans care, and some attorneys have said they would not prosecute families of transgender children for child abuse under the new definition. Several major businesses signed onto an ad campaign protesting the governor’s order.
A new development. On March 11, a state court ruled that Gov. Abbott’s policy had been improperly adopted and violated the State Constitution. As a result of the ruling, investigations of parents with transgender children for possible child abuse were halted across Texas.
“Everything that she did was on the basis of professional guidance,” said Karen Hirsch, a friend of Dr. Georgulas’s.
A court in August gave Dr. Georgulas custody of the children, including control of all medical decisions and the sole right “to make decisions concerning the children’s haircuts.” But it barred her from providing any puberty-blocking drugs, hormones or surgery without a court order.
The case’s growing public profile coincided with broadening medical acceptance of gender-affirming care — and a backlash. The American Academy of Pediatrics in 2018 issued its first policy statement on the approach, which urges parents to support the identity expressed by their child and provides guidance for treatment, including medications that delay puberty.
In 2019, the Heritage Foundation, along with the Family Policy Alliance, hosted discussions in Washington on transgender athletes and transgender children, including a panel on the “medical harms” of hormonal and surgical interventions. The groups formed a coalition, known as Promise to America’s Children, and pressed for new laws.
Soon, bills were introduced on restricting transgender athletes and, in more than 20 states, legislatures considered prohibitions on gender-affirming medical care, including in Texas last year.
The bill, which passed in the Senate, failed in the House. And although a measure further restricting transgender athletes passed, some Texas conservatives were angry that the medical treatment bill had stalled.
The governor took note. Then the attorney general, Ken Paxton, facing a tough primary fight, issued an opinion that puberty-blocking drugs or hormone treatments could be considered child abuse under existing law in Texas.
Mr. Abbott, who was facing his own primary in days amid a barrage of American Principles Project ads, quickly directed the child protection agency to begin investigations. Among the first to be investigated was an employee of the agency.
The investigation was temporarily halted by a court in Austin last week.
“People don’t understand the treatment; they think it’s always surgery and it’s happening on children,” said Chase Strangio, deputy director for transgender justice at the American Civil Liberties Union, which sued to stop the investigations along with Lambda Legal. Opponents, he added, have been “weaponizing the confusion.”
Mr. Abbott’s office did not respond to a request for comment. But his top campaign strategist told reporters last week that the issue of “genital mutilation” was a political winner.
“There’s this sense, especially among conservatives, that they’re losing their country,” said Terry Schilling, president of the American Principles Project. “It was just a few years ago that we were debating gay marriage, and now we’re debating sex changes for minors. I mean, that’s exponential movement in terms of culture.”
Amanda Morris contributed reporting. Kirsten Noyes contributed research.
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