In Texas, the nation's largest children's hospital is halting gender-affirming care for trans youths

For A, the mother of a young transgender daughter in Houston, denying her child hormone therapy "is not an option."

Few people know that A's daughter is transgender, A said, but that could change once her child goes through puberty - something that could happen in a matter of months. Her child's doctors have recommended her daughter start taking puberty blockers at the first onset of such hormonal changes. But on Friday, Houston-based Texas Children's Hospital, the largest pediatric hospital in the country, announced it would stop prescribing gender-affirming hormone therapies.

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The hospital said the policy was decided "after assessing the Attorney General's and Governor's actions," which include a recent order from Gov. Greg Abbott, R, directing Texas's child welfare agency to investigate reports of children receiving gender-affirming care as "child abuse."

"The mission of Texas Children's Hospital is to create a healthier future for all children, including transgender children, within the bounds of the law," the hospital said in a statement. "This step was taken to safeguard our healthcare professionals and impacted families from potential legal ramifications."

The decision came as a major blow to Texas transgender communities in Houston and beyond that say they are terrified and confused about what the future holds.

This means more parents like A are now looking to get treatment out of state - or move altogether - to receive gender-affirming health care they say is crucial for their children to lead safe, healthy lives.

"If I was in an environment that didn't allow me or my child to be our authentic selves, I don't think we could live," said A, who is being identified by her first initial because of the potential legal ramifications of talking openly about her transgender daughter. "It's not like hiding a birthmark. . . . It's your whole being. You can't hide your whole being."

Last month, Texas Attorney General Ken Paxton, R, authored a nonbinding legal opinion that categorized gender-affirming treatments as "child abuse." Following the announcement from Texas Children's Hospital on Friday, Paxton tweeted that he was "glad to hear" about the hospital's decision.

Paxton has likened puberty blockers and hormone therapies to castration, which is listed as a form of "abuse" under the Texas Family Code. "When performed on children, these procedures are 'abuse' under Texas law," Paxton told the conservative outlet Townhall last week. "They're illegal. And family courts, family-law government agencies and the like must do their part to stop it."

The American Medical Association has advocated for "patient-led" gender-affirming care, calling bills denying this care to transgender minors "inappropriate and harmful." When a transgender child has met certain diagnostic criteria and after the child first shows physical changes of puberty, clinicians may recommend puberty-suppressing treatments. The medications, which pause puberty, are intended to give young people more time to decide what to do next. At any point, a transgender teenager can stop taking puberty blockers and continue to go through the puberty of the sex on their birth certificate. Hormone treatment is not recommended for pre-pubescent children.

The Texas Medical Association, in a statement from last month, said "the issues raised" by Abbott and Paxton were "complicated."

"TMA physician leaders are seeking input from the governor's office and others to determine what these orders actually mean for patients and the physicians who care for them," the organization said. "Our ultimate goal is to ensure patients can access sensitive, thoughtful, caring consultation with their physicians, regardless of the health care issue."

Families of transgender youths in Texas are already being investigated by the state's child welfare agency, prompting the American Civil Liberties Union to file a legal challenge last week asking a district court to block Abbott's order. Judge Amy Clark Meachum granted a temporary restraining order to the plaintiffs represented in the ACLU's suit, which includes a mother who works for the Texas Department of Family and Protective Services (DFPS).

While investigations in the ACLU lawsuit have been paused, DFPS can still investigate others for allegedly providing gender-affirming care to their children. This has left many parents confused and afraid to speak out against the new policies.

Some have noted that care options have dwindled for transgender youths throughout the state. Late last year, Dallas's sole clinic providing pediatric gender-affirming care, GENECIS, shuttered after conservatives called on state officials to investigate it. Houston's Legacy Community Health clinic has also reportedly moved to stop providing hormone therapy to transgender patients who are minors. (Legacy Community Health did not respond to a request for comment.)

Remington Johnson, an Austin-based transgender advocate and nursing student, said transgender people and their families had been given no notice about disruptions in care, which has put an additional burden on a community that has felt under attack by the state legislature in recent years.

"When you make it harder to access care, you are removing care," Johnson said.

The kind of gender-affirming health care Texas Children's Hospital has paused, which includes puberty blockers and hormone therapy, are ongoing medications that are taken on a set schedule, Johnson noted. Puberty blockers, for example, can be taken in increments that range from monthly to yearly, depending on the treatment. If transgender patients get off-schedule with their medication, it has immediate effects and decreases the safety and efficacy of the medication, Johnson said.

"This puts more and more burden on the families, who are already having to look for lawyers [to defend] themselves," Johnson said, adding that transgender children and their families "were driving from all over Texas" to get care in Dallas and Houston.

Abbott's recent order came after conservative legislators tried unsuccessfully to pass a bill changing the Texas Family Code last year. State Sen. Charles Perry, R, argued during floor debate that the bill was "necessary to prevent children from making irreversible decisions that they may regret later."

Legislators in Alabama are considering a similar bill, echoing much of the language Texas politicians have used: "This is just to protect children," said state Sen. Shay Shelnutt, R, one of the bill's sponsors.

A, the Houston mom, said she's considering moving or finding a provider in a neighboring state. Because her daughter will need puberty blockers and hormone therapy for years, it's important to find a state where legislators aren't considering laws that could similarly restrict her child's access to health care, she said. Otherwise, they may need to scramble to find these treatments again.

She and other parents of trans children in Texas hope that the decision to pause hormone therapy is temporary - and that hospitals and clinics will continue to provide care as the legality of Abbott's order is decided.

While puberty blockers can be reversed, puberty itself "is irreversible," said A, who worries about how her daughter's transgender identity will be exposed if she goes through puberty.

She hasn't told her child about the recent news - she doesn't "want her to be worrying about grown-up problems," she said.

"My daughter doesn't have a single doubt about who she is," A said. "It's not right for someone who doesn't know her to tell her."

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