On February 22, in the final days before crowded Republican primaries, Texas Attorney General Ken Paxton and Governor Greg Abbott announced that affirming a transgender young person’s gender identity could be considered “child abuse” under Texas law. In essence, they are trying to criminalize the love of devoted parents and eradicate the survival opportunities of Texas young people.

In response to an inquiry from House Representative Matt Krause, Paxton issued a nonbinding opinion from the Office of the Attorney General that gender-affirming medical treatment, “when performed on children, can legally constitute child abuse.” Abbott then issued a directive to the commissioner of the Texas Department of Family and Protective Services (DFPS) to launch investigations into any instances of what he refers to as “these abusive procedures.” Under threat of criminal prosecution, he called on any licensed professionals—including doctors, nurses, and teachers—to report families who affirm their transgender children for potential investigation.

These opinions from Abbott and Paxton set off a wave of panic among transgender youth, their families, their medical providers, and allied communities across the country. Even though neither document is binding on either the DFPS or the courts, the Texas political leadership has made parents terrified to send their children to school, to take them to the doctor, and to remain in the state. And even if no legitimate investigation can be born of these political acts by Abbott and Paxton, they have already transformed life for transgender Texans and their families. There is a precariousness that comes with knowing you are being surveilled and that your care and love for your child can be the very thing that leads to government efforts to remove them from your home.

On a Zoom call hosted by the ACLU of Texas and other local groups with hundreds of families on Wednesday evening, Texas parents, educators, and medical providers filled the chat with questions about their safety and the safety of the children in their custody and care. For most parents of transgender adolescents, the road to medical treatment is a long and painful one. No parent wants to watch their child suffer, and every parent fears for their child’s future health and well-being. gender dysphoria, the diagnosis that many transgender people have, can be serious when untreated. It results in clinically significant depression and other negative impacts flowing from the experience of having a gender that does not align with one’s sex assigned at birth. But this condition and its treatments are not new.

Treatment for gender dysphoria in adolescents involves almost exclusively nonsurgical interventions that don’t begin until puberty and only where medically necessary and with informed consent from both parents and the minor patient. The conversation over this care would suggest that thousands of prepubertal children are being rushed into surgery—but no prepubertal children get medical treatment for gender dysphoria at all. And this care is not new, experimental, or unsafe. It is supported by every major medical association in the United States including the American Academy of Pediatricsthe American Medical Associationthe American Psychological Associationand the Endocrine Society. Access to this care can be transformative for young people with gender dysphoria. Many families describe the experience of watching their child come alive and bloom. Many young people explain how the care saved their lives—an experience echoed by most trans adults. Though those like Abbott and Paxton distort the underlying science and play on people’s fears about transgender experiences and bodies, the data is clear: When young people are affirmed in their identity, they thrive.

In December 2021, the Trevor Project released a peer reviewed study finding that “gender-affirming hormone therapy is significantly related to lower rates of depression, suicidal thoughts, and suicide attempts among transgender and nonbinary youth.” Using this data—the best available—doctors, parents, and young people work together to develop treatment plans, and now that work of keeping young people well and alive could be criminalized in Texas and around the country.

This latest escalation from Texas’s leading lawmakers comes in the middle of a national crisis of legislative attacks on transgender young people. So far in 2022, over 100 bills have been introduced across the country, many of them similarly targeting health care for transgender minors. Just 24 hours after Paxton and Abbott’s announcements in Texas, the Alabama House passed a bill that would make treating a transgender adolescent with gender-affirming medical care a felony. Similar bills are pending in Ohio, Oklahoma, Idaho, Wisconsin, Arizona, and Tennessee. Last year, the Arkansas General Assembly passed a ban on gender-affirming health care for minors, overriding Governor Asa Hutchinson’s veto within 24 hours. Thankfully, a US District Court judge blocked the law before it could go into effect, but the case is on appeal, and young people and their families are worried about their futures in their home state.

When Hutchinson, a Republican who signed many other pieces of anti-trans legislation that year, vetoed the bill that would ultimately become law, he explained in a subsequent Washington Post Editorial:

It is undisputed that the number of minors who struggle with gender incongruity or gender dysphoria is extremely small. But they, too, deserve the guiding hand of their parents and the counseling of medical specialists in making the best decisions for their individual needs.

HB 1570 puts the state as the definitive oracle of medical care, overriding parents, patients and health-care experts. While in some instances the state must act to protect life, the state should not presume to jump into the middle of every medical, human and ethical issue. This would be—and is—a vast government overreach.

The same politicians touting small government and parental rights are now advancing severe intrusions into the family. Because ultimately this is not about small government or parental rights, but about control—control over people’s bodies, autonomy, families, and survival. there is a long history in this country of separating families. It was not an aberrant policy of the Trump administration but a central legacy of this country that continues in multiple forms today. From deliberately ripping apart enslaved families to forcibly removing Indigenous children to separating immigrant families at the border to removing transgender children from their homes, this is a long, interconnected, and enduring practice. It is incumbent upon us not to be swayed by rhetoric of safety, care, and protection and to instead rise up in solidarity with those feeling the cruel physical and emotional impacts of being terrorized by the state.

Those in power who want to eliminate us are not going to make things better, but we can get better organized and build our own networks of care. Families are afraid. We are at war at home and abroad amid a pandemic and a collapsing climate. The situation can seem desperate, but we have the tools to survive. For generations, we have shown up in solidarity, shared information and resources, and called upon those in power to loosen their grip over people’s lives. When the state doesn’t listen, we can create those opportunities the state has tried to deny us for one another. This fight is life or death. I am all in—are you?

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