Medical experts pushed back against Texas lawmakers’ assertions that puberty blockers and hormone therapies are experimental and put young transgender patients at risk as they testified Tuesday in a hearing that seeks to block a new law banning such medical treatment for kids.
Dr. Johanna Olson-Kennedy, a doctor who treats adolescents and has been providing gender-affirming care for 17 years, said the body of medical research demonstrates these treatments have a high success rate in improving mental health outcomes of trans youth. But in her clinical work, the evidence is more obvious.
“Recently, I had one of my patients tell me, ‘If you had not allowed me, and helped shepherd me through these interventions, I don’t think I would be here,’” said Olson-Kennedy, the medical director of the Center for Transyouth Health and Development at Children’s Hospital Los Angeles.
She added that hundreds of her patients have expressed the same sentiment in her nearly two decades treating roughly 1,100 young patients.
Texas families and doctors are suing the state to block Senate Bill 14 from going into effect Sept. 1. That new law would ban transgender youth from taking puberty blockers, receiving hormone therapies and having surgery, the latter of which is rarely performed on minors. Such medical interventions are used to treat gender dysphoria, a medical term for the distress someone experiences when their gender identity doesn’t match their body. The plaintiffs assert that the new law violates their parental rights and interferes with their ability to practice medicine.
Legal groups including the American Civil Liberties Union of Texas, Lambda Legal and the Transgender Law Center requested that Travis County District Court Judge Maria Cantú Hexsel issue an injunction against the law.
In her opening statement of the two-day hearing, Assistant Attorney General Heather Dyer rejected the plaintiffs’ claim that SB 14 discriminates based on sex because, she said, people with gender dysphoria are not a protected class.
A central argument of lawmakers supporting SB 14 during the legislative session was that puberty blockers and hormone therapies put young patients at risk for fertility loss and a reduction of bone density. On Tuesday, defense attorneys for the state repeated these claims.
“SB 14 was designed to protect minors from scientifically unsound treatments,” Dyer said.
The medical experts called on by the plaintiffs rejected those claims Tuesday, arguing that the scientific literature supports the use of hormones or puberty blockers as a means to improve the mental health of transgender youth and reduces the dysphoria these young people feel.
“I would not consider estrogen or testosterone the end of the story for fertility,” said Dr. Daniel Shumer, a pediatric endocrinologist at the C.S. Mott Children’s Hospital in Ann Arbor.
Pediatric endocrinology is the field of medicine that specializes in transgender adolescent health care.
Representing the state, Assistant Attorney General Johnathan Stone asked Shumer about the number of his patients who stopped receiving gender-affirming treatment. A group of people who refer to themselves as detransitioners have been vocal opponents of gender-affirming care for youth in legislative hearings throughout the country. During this year’s regular Texas legislative session, Republican lawmakers called on several people who had detransitioned to testify in support of SB 14.
Shumer said of his roughly 400 patients, 10 had stopped taking puberty blockers, a reversible treatment that delays the onset of puberty, and two had stopped taking hormones.
Olson-Kennedy noted that there are a variety of reasons people detransition — including a lack of acceptance of their new identity or a loss of health care access — but overall, the number of people who do take this step is very small.
The state’s only witness on Tuesday was evolutionary biologist Colin Wright, who has a Ph.D. in evolutionary biology and ecology from the University of California Santa Barbara. Wright testified that humans can only be “observed and recorded” as either the male or female sex. While individuals can modify their secondary sex characteristics, like body hair and breast development, Wright said people cannot change their sex.
Lawyers for the plaintiffs noted that Wright was not an expert in gender dysphoria and had not published original research on the topic of biological sex. Wright, who is vocal on his social media platforms about his opposition to gender-affirming care for minors, was asked if he thought transgender individuals were delusional. Of the idea that people can change their sex from what was assigned at birth, he said, “that specific belief is a delusional belief.”
Dr. Aron Janssen, a psychiatrist at the Ann & Robert H. Lurie Children’s Hospital of Chicago, testified to the evidence that psychotherapy alone cannot alleviate gender dysphoria, asserting that puberty blockers or hormone therapy is medically necessary. By restricting access to these treatments, young patients will have worse outcomes, Janssen said.
“There’s an intense improvement we see amongst these kids,” Janssen said of his clinical experience.
Parents of trans youth and Texas health care workers testified about the impact SB 14 would have on their families and patients. One of the plaintiffs in the lawsuit, Dr. David Paul, a pediatric endocrinologist who works at Texas Children’s Hospital in Houston, said SB 14 would strip him of the ability to provide the standard of care for his transgender patients.
“They are probably the most positive outcomes of all the patients I see,” Paul said of patients who receive gender-affirming care. If his patients couldn’t access this type of care, Paul said he worries their physical and mental health will deteriorate. He added he has already lost one of his patients to suicide.
One parent of a transgender child, identified by the pseudonym Mary Moe, said she and her daughter have moved out of the state in the wake of SB 14.
“I would like to return to Texas, but Texas has become very ugly to me and my family,” Moe said.
Texas lawmakers’ efforts to restrict gender-affirming care in Texas followed nearly identical campaigns from other Republican-led state legislatures. Across the country, 19 other states have passed similar legislation. Prohibiting doctors from providing gender-affirming care to trans youth is widely popular among Republican voters — over 85% of registered GOP voters in Texas supported these restrictions to some degree, according to an April poll by the Texas Politics Project.
But the wave of new legislation invited a series of lawsuits across the country seeking to block the laws from going into effect. Those suits have largely proved successful in federal courts.
In June, a federal judge ruled that Arkansas’ ban on gender-affirming care for minors is unconstitutional because it violates the due-process and equal-protection rights of transgender children and their families. Federal judges in Florida, Kentucky and Tennessee have also blocked those states’ laws from going into effect. An appeals court intervened to allow Tennessee to implement its ban, and the Kentucky federal judge lifted the injunction he issued, allowing the law to go into effect.
This lawsuit is filed in state court and claims SB 14 violates parental-right protections laid out in the Texas Constitution.
Disclosure: The ACLU of Texas has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
"Medical experts assert transgender health care for youth is safe as LGBTQ+ Texans sue over new prohibition" was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
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This article originally appeared in The Texas Tribune at https://www.texastribune.org/2023/08/15/texas-sb-14-lawsuit-gender-affirming-care/.
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