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--:-- Noel King: It's Today Explained. I'm Noelle King. We're going to get caught up on a story that's been developing in Texas. It starts with the state's attorney general. A couple weeks ago, Ken Paxton wrote a legal opinion about transgender children and the medical care that some of them receive. Saying that gender reassignment surgeries and the use of drugs like puberty blockers can legally constitute child abuse.
--:-- Noel King: Four days later, Governor Greg Abbott directed the Texas Department of Family and Protective Services to investigate the parents of trans kids who are getting what's known as gender-affirming care. Now, the big question was, would an agency whose stated mission is to protect children from abuse follow the governor's order and investigate parents who are getting them care?
--:-- Noel King: We called Lauren McGahee. She's an investigative reporter with the Dallas Morning News. She covers government accountability, criminal justice and LGBTQ issues.
--:-- Lauren McGahee: Thanks for having me on the show.
--:-- Noel King: Our early reports are that several parents of transgender children have been visited by Child Protective Services and have been questioned. It's unclear at this time whether there's been any further action. We have not heard about a child being taken. We have not heard of that happening, but several parents have been and are being actively investigated according to those parents.
--:-- Lauren McGahee: Let's say that I'm a parent and I believe my child needs gender-affirming care. What does that term actually mean? What does it entail?
--:-- Lauren McGahee: Most people under the age of 18 who are dealing with gender dysphoria believe that they are transgender will receive only counseling. So a parent and a child will go to their doctor. They'll talk about what the appropriate kind of care might be. And most children who are dealing with this receive talk therapy, what you or I might do if we needed to talk to someone, go to a therapist.
--:-- Lauren McGahee: The next step is or can be social transition, which is starting to live in their own gender. This could look like introducing themselves by a different name, different pronoun or dressing differently. Among other treatments is receiving some kind of a medical treatment like puberty blockers or hormone therapy.
--:-- Lauren McGahee: And those create mostly reversible changes in a minor's body. This could be something like a voice might get deeper or someone might grow more hair or less hair because they're on hormone therapy.
--:-- Lauren McGahee: The misinformation around gender affirming care for trans kids that you'll hear a lot from Republican politicians is that they say that people are being castrated, that there are actual surgeries happening on children. And, you know, that that's a scare tactic.
--:-- Lauren McGahee: The WPATH, which is the World Professional Association for Transgender Health, says that surgery is not recommended until a patient has reached the legal age of maturity to give consent for something like that and has lived continuously for a year in their gender role.
--:-- Lauren McGahee: So let's talk a bit about hormone therapy. My understanding based on what you said is, let's say a child who has not yet gone through puberty says, I am transgender, I'm not a boy, I'm a girl. A doctor might give that child puberty blockers in order to prevent that child from maturing into a gender that that child believes is not their gender.
--:-- Lauren McGahee: Yes. So puberty suppressants are drugs that cause a temporary pause in someone's puberty by blocking sex hormones like testosterone or estrogen. This was created originally for kids that were having really early onset puberty, but weren't trans.
--:-- Lauren McGahee: So this was a type of treatment that was already being used for some children. Puberty suppressants are also reversible which means that when you stop taking them the puberty will restart and continue at a normal rate.
--:-- Lauren McGahee: Some adolescents in collaboration with their support team and treatment team might begin to pursue hormone therapy And hormone therapy is really, it's different for every person. You know, it's mostly reversible for many people, but it really depends on what kind of hormones they're taking and how early they take those hormones.
--:-- Lauren McGahee: So there's varying research on that. You know, there are indications that hormone therapy may have an effect on long-term fertility, especially if it started at a very young age. But again, these are conversations and research that's happening now, and we're only really starting to have a good understanding of how this affects people long-term.
--:-- Lauren McGahee: Is gender affirming care beyond just talk therapy difficult to get? Does a child walk into the doctor and say, I was born the wrong gender. I want to be a boy. I am not a girl. And then immediately get hormones or puberty blockers?
--:-- Lauren McGahee: There are not many doctors who consider this a specialty of theirs. And so if a parent is dealing specifically with this, their best case for having the full range of options open to them is to go to a doctor that considers this a specialty.
--:-- Lauren McGahee: Here in Texas, with these new threats against this care from some of the most powerful politicians in the state, there are concerns that doctors will not be willing to provide that care, provide those options if they're concerned that they may be targeted.
--:-- Lauren McGahee: We've received emails from parents of transgender children who are very frightened. We've heard already reports of families with transgender children leaving the state, moving away because they are concerned about being targeted.
--:-- Lauren McGahee: Is the idea that a doctor would tell on me, the parent, a teacher would tell on me, who is reporting me in this scenario?
--:-- Lauren McGahee: So, you know, oftentimes individuals who report allegations of child abuse, their identities are not public. But individuals like teachers are required under state law to report allegations of child abuse.
--:-- Lauren McGahee: So there is a concern that certain teachers might feel pressured to tell CPS that they are aware of a transgender child that they're connected to who is receiving gender-affirming care.
--:-- Lauren McGahee: I'm not saying that that's what teachers are going to do, but they may feel some pressure given that they are statutorily required to report child abuse.
--:-- Lauren McGahee: Doctors as well. There's an interesting thing that's happened here. The doctors are the ones who prescribe puberty blockers to a child. And yet the governor is saying investigate the parents.
--:-- Lauren McGahee: Although I imagine there are plenty of people who don't think any investigation is warranted here. Why target parents and not doctors?
--:-- Lauren McGahee: Well, I think last year lawmakers tried to pass a bill that would have changed the definition of child abuse to include this care. They did not succeed.
--:-- Lauren McGahee: And so a lot of political watchers are looking at the governor's order and the attorney general's opinion as an end run around that failure.
--:-- Lauren McGahee: This is a way through more of an administrative action, through state agency actions to try to target gender affirming care for transgender kids.
--:-- Lauren McGahee: And CPS, Child Protective Services, their most direct connection is with the parent.
--:-- Lauren McGahee: What's interesting is doctors, some doctors are already pushing back and saying that as a doctor, they are also required under law to report child abuse, but they believe that gender affirming care is appropriate for trans kids and they don't think that it's child abuse.
--:-- Lauren McGahee: So reporting that actually violates their ethical obligation to do the best for their patient.
--:-- Lauren McGahee: This is not yet a law. Could it become a law? It could. It could. It could. The legislature meets again in 2023. If lawmakers wanted, they could try to change the law and put this directly into statute.
--:-- Lauren McGahee: Or if it goes into the courts and finishes up in court, the court could also come down and decide whether this is truly child abuse or not.
--:-- Lauren McGahee: So those are the only two ways that will actually have a real ending, a real outcome to this argument is through the courts or through the state legislature.
--:-- Lauren McGahee: The ACLU and Lambda Legal sued immediately. And then yesterday there was another development. A district court judge in Travis County granted a restraining order.
--:-- Lauren McGahee: So for now, the investigations will stop, although it's certainly not clear whether that's going to ease the minds of parents and kids who could be affected by this.
--:-- Lauren McGahee: But what does the lawsuit say? So Lambda Legal and the ACLU of Texas went to court in Travis County to try to stop an investigation into a Child Protective Services employee.
--:-- Lauren McGahee: So an employee who works for the Department of Family and Protective Services which is the umbrella agency over CPS has a transgender child.
--:-- Lauren McGahee: And that employee was put on administrative leave, according to the lawsuit, and is now suing because of this particular policy.
--:-- Lauren McGahee: My goodness. So one of the first people targeted by this is a person who is employed by the agency that has been directed to do the investigations?
--:-- Lauren McGahee: That's correct. Wow.
--:-- Lauren McGahee: How are people in Texas viewing this order? There are some individuals on the very conservative side that agree that gender-affirming care for trans kids should be defined as abuse.
--:-- Lauren McGahee: And then there's a lot of people who have transgender children or know a trans kid who thinks that this care is absolutely vital and life-saving.
--:-- Lauren McGahee: What I think is important to note is politics is going to be divisive. There's always going to be people on either end of an issue, especially one like this.
--:-- Lauren McGahee: But the medical community, they all support appropriate care for transgender children, including puberty blockers and hormone treatments.
--:-- Lauren McGahee: So in addition to the AMA, the APA, all of the national groups, the groups in Texas whose job is to determine what care is appropriate for people all support age-appropriate gender-affirming care for trans children.
--:-- Noel King: Thank you.
--:-- Noel King: Email, and calendars synced. You'll see all your relationships in a fully-fledged platform, they say, all enriched with that actionable data. And they say you can build AI-powered automations and use its research agent to tackle some of your most complex processes to seize so that you can focus on what matters, building your company.
--:-- Noel King: You can join industry leaders such as Flatfile, Replicate, Modal, and so much more. You can go to adio.com slash todayexplained to get 15% off your first year.
--:-- Noel King: Deals, brands, well. Lauren McGaughey, investigative reporter with the Dallas Morning News.
--:-- Lauren McGaughey: Thanks for having me on the show.
--:-- Noel King: A thing I have been very curious about. When did lawmakers in Texas begin to train their attention on transgender children and on writing laws that would affect them?
--:-- Lauren McGaughey: There was a huge cheer then singing as the decision reaches the crowd out front. The Supreme Court case legalizing gay marriage across the nation.
--:-- Lauren McGaughey: The historic ruling struck down the bans on same-sex marriage still in effect in 14 states, all of them in the South and the Midwest.
--:-- Lauren McGaughey: At that point, you know, many conservative politicians, conservative legal scholars believed that they had lost on the gay marriage issue.
--:-- Lauren McGaughey: And so the attention was redirected towards the trans community.
--:-- Lauren McGaughey: After that gay marriage ruling, we saw legislatures in states like Texas trying to pass bathroom bills. Remember that whole fight several years ago?
--:-- Lauren McGaughey: State Representative Ron Simmons authored a House version requiring public school students to use the bathroom of the gender on their birth certificate.
--:-- Lauren McGaughey: This is legislation that would have blocked trans people from using the bathrooms that conform to their gender identity.
--:-- Lauren McGaughey: How do you balance someone's right as a transgender child or person with the rights of other people that say, you know what, I respect that and I don't want to degrade that, but I also don't want my children sharing changing rooms and locker rooms with people of the opposite biological sex.
--:-- Lauren McGaughey: In Texas, there was a huge fight over the bathroom bills. Don't discriminate in the long-star state. They failed. They were not passed.
--:-- Lauren McGaughey: And after that failure, we saw a shift in attention to trans kids. The first bills that were kind of the primary focus were the trans sports bills.
--:-- Lauren McGaughey: The Texas Senate has passed a bill restricting transgender youth from playing on sports teams consistent with their gender identity.
--:-- Lauren McGaughey: And then more recently we seen this attention on access to health care for trans kids.
--:-- Lauren McGaughey: So there has been this focus on the trans community for several years now, and more recently it's come, the focus has shown a lot more brightly on trans kids.
--:-- Lauren McGaughey: It seems to me, and tell me if I'm wrong, has this become one of those issues that in practice affects very few people and is a very personal thing between and among families, children, parents, their loved ones?
--:-- Lauren McGaughey: But it seems as if it's been made into a political issue that almost everybody feels as though they have to have an opinion on.
--:-- Lauren McGaughey: I can agree with that. I mean, it's a litmus test issue. You know, 10, 15, 20 years ago, the litmus test issue might have been gay rights, might have been gay marriage.
--:-- Lauren McGaughey: Now the issue is the rights of transgender people and even more minutely, the rights of trans kids and the parents of trans kids.
--:-- Lauren McGaughey: While it does affect technically a small number of people, we have to remember that for every trans kid, there's a guardian, there are siblings, there's an extended family, there are teachers, there are friends.
--:-- Lauren McGaughey: And so the ripple effects for who might be emotionally affected by an issue like this go far beyond the trans person themselves.
--:-- Lauren McGaughey: But yes, the most dire consequences of targets like this to fall on that individual.
--:-- Lauren McGaughey: And it does happen to be, you know, a very, very small number of people having to deal with this burden.
--:-- Lauren McGaughey: Do you think this attempt by Governor Abbott and by other Republican legislators, do you think that health care for trans youth is going to continue to be something that Texans will hear about and will see litigated and will have to have opinions on almost certainly because it is in front of them all the time?
--:-- Lauren McGaughey: Well, that's a good question. We will know in the future, Tuesday, March 1st was election day in Texas, primary election day.
--:-- Lauren McGaughey: And Governor Abbott won his primary campaign outright. He's not going into a runoff.
--:-- Lauren McGaughey: Political observers in Texas believe that this issue of healthcare for trans youth became such a flashpoint because Texas politicians, Republicans were dealing with their first real competitive GOP primary season in a long time.
--:-- Lauren McGaughey: So we had people like Governor Greg Abbott being pressured by people from within his party to move in a more conservative direction on these issues.
--:-- Lauren McGaughey: Now that Greg Abbott has won his primary, it will be seen whether he continues to aggressively effectively push this issue, pursue it in the courts and more.
--:-- Lauren McGaughey: While Abbott won his primary, Texas Attorney General Ken Paxton, who actually issued the opinion that this whole thing was based on, did not win his primary outright.
--:-- Lauren McGaughey: He is going into a runoff with another Republican, George P. Bush of the Bush family.
--:-- Lauren McGaughey: And because the Republican primary is now gone to a runoff in at least one of the major statewide races for attorney general, this issue could remain at the top of the political conversation for at least a few more months.
--:-- Lauren McGaughey: I think there's a temptation to look at Texas and say, that's just Texas. Texas is different in a lot of ways.
--:-- Lauren McGaughey: When you look at Texas from where you sit in Austin, do you look around at the rest of the country and think, uh-uh, this is not just Texas.
--:-- Lauren McGaughey: This could very easily spread beyond Texas to many states in the country.
--:-- Lauren McGaughey: I do believe that where Texas goes, oftentimes other red states follow.
--:-- Lauren McGaughey: We have seen that with other issues. We have seen Texas kind of set the bar on a conservative issue.
--:-- Lauren McGaughey: And then other states have followed suit, either with what their state legislatures are focusing on or what elected officials focus on.
--:-- Lauren McGaughey: Sometimes I see that coming out of Florida, too, kind of Florida and Texas being places to watch.
--:-- Lauren McGaughey: You could say the same for California and New York for liberal policies.
--:-- Lauren McGaughey: You know, these are huge states, they're very populous, and they lead on these issues.
--:-- Lauren McGaughey: Thank you so much for taking the time today. We really appreciate it.
--:-- Noel King: Thanks for having me.
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--:-- Noel King: Today's show was produced by Haleema Shah with help from Hady Mawajdeh, edited by Matt Collette, engineered by Paul Mounsey, fact-checked by Laura Bullard.
--:-- Noel King: I'm Noelle King. Today Explained is part of the Vox Media Podcast Network. Thank you.
