Texas Appeals Court Upholds Temporary Block on Investigating Parents Who Allow Genital Surgery, Drugs for Gender Dysphoric Children

The appeals court upheld the temporary injunction against the Family Services department and its commissioner but overturned the parts against the governor.

Chloe Cole, an 18-year-old woman who regrets surgically removing her breasts, holds testosterone medication used for transgender patients in Northern California on Aug. 26, 2022. John Fredricks/The Epoch Times

A Texas court of appeals upheld a lower court’s order on Friday, allowing families who allow minors to access procedures that alter the appearance or function of their sexual organs to go on unimpeded by the Department of Family and Protective Services.

Texas Gov. Greg Abbott in February 2022 signed a directive ordering the department to investigate Texan parents who allow their gender dysphoric children to receive such procedures, like surgery and chemical drugs.

But his administration met with pushback from LGBT families and advocacy groups when the directive was challenged and a temporary injunction was issued by Judge Amy Clark Meachum of Texas’s 201st District Court in Travis County in March 2022.

In a challenge lodged in the 3rd circuit appeals court, the state attorney general’s office argued that child abuse investigations of parents who support such treatments could continue under the state law in question as the appeals courts determine the constitutionality of the directive.

A year later, the appellate judges on March 29 upheld the Abbott v. Doe temporary injunction against the department and its commissioner, Stephanie Muth, freezing them from any further investigations (pdf).

However, it reversed all parts of the order asserted against the governor for a lack of standing over who has the “statutory authority to control [Department] investigatory decisions,” citing an earlier ruling by the Texas Supreme Court that the governor and attorney general are “free to share their legal and policy views,” and that the department “was not compelled by law to follow them.”

Mr. Abbott’s February 2022 directive to the Department of Family and Protective Services to conduct a review of the medical procedures came shortly after his attorney general, Ken Paxton, noted that the sex-related procedures for children “can legally constitute child abuse under several provisions of chapter 261 of the Texas Family Code.”

After the directive was announced, one hospital in Dallas stopped providing such procedures to minors, and the Texas Children’s Hospital said it would also end access to hormone replacement therapy for minors.

The Department of Family and Protective Services also independently wrote a determination that genital mutilation of a child through gender transitioning surgery constitutes child abuse.

“Genital mutilation of a child through reassignment surgery is child abuse,” department commissioner Jaime Masters wrote (pdf) at the time. “This surgical procedure physically alters a child’s genitalia for non-medical purposes potentially inflicting irreversible harm to children’s bodies.”

The ACLU, one of the plaintiffs in the case, celebrated the Friday ruling by the state’s 3rd Court of Appeals in Austin.

“A Texas judge upheld injunctions barring the state from investigating families with transgender youth solely because they accessed gender-affirming medical care,” it said in a post on X. “This is great news for trans youth and their families in Texas.”

“We are grateful the court saw through this dangerous and transparently discriminatory action by Texas officials,” Chase Strangio, deputy director for transgender justice at the ACLU’s LGBTQ & HIV Project, said in a statement.

“Our clients and countless families like theirs are guided by love and compassion for their transgender youth, following the guidance of their doctors and fighting for the futures their family deserves,” the statement continued.

“These baseless and invasive investigations are a dangerous abuse of the state’s power and one we’re thankful the Texas courts have consistently ruled against.”

Procedures Already Banned

Texas already banned sex-related procedures for gender transition in May last year with Senate Bill 14.

It bars medical professionals from providing surgeries that sterilize children, such as removing parts of their reproductive systems, mastectomies, and prescribing drugs that induce temporary or permanent infertility, such as cross-sex hormones and puberty blockers, or removing any otherwise healthy or non-diseased body part.

Detransitioner Cat Cattinson speaks outside of the annual Pediatric Endocrine Society conference held in San Diego, Calif., on May 6, 2023. John Fredicks/The Epoch Times

Violators risk losing their license. However, exceptions exist for intersex individuals as well as those prescribed drugs by their doctors if puberty starts too early. Individuals already on the treatments may also continue, but must “wean” off the medication with the help of their doctor.

In July 2023, the ACLU, alongside LGBT-identifying parties, also challenged the ban on behalf of five families with transgender-identifying children and their doctors, claiming that the law violates the Texas Constitution by allowing discrimination of a group based on sex and transgender identity.

One family, who has a 16-year-old teen, was investigated after the parents supported their teen’s wish to undergo a scheduled mastectomy. The teen had already been on puberty blockers to disrupt her sexual maturation ahead of the procedure, which had to be canceled because of Senate Bill 14, which was to going into effect on Sept. 1 to ban such procedures for minors.

Another family of a 15-year-old said the law would be a significant inconvenience. The family were having to consider whether and how to get out-of-state treatment for their son, who identified as a girl. They said it would temporarily separate the family and put them thousands of dollars out of pocket for medical and travel expenses. They also argued that if they did not proceed with the procedures recommended by their doctor, they could face charges of child neglect.

The ban remains in effect pending a decision on Loe v. Texas from the Texas Supreme Court.

More than 20 Republican-led state legislatures have passed similar laws with the view that it can constitute child abuse, with many facing legal challenges by the ACLU and other left-wing groups.

Sunny Bryant poses in her bedroom at her Houston, Texas, home on March 4, 2022. Francois Picard/AFP via Getty Images

Competing Beliefs on Efficacy of Treatments

The appeals of Texas’s laws regulating medical interventions for gender dysphoria come amid disagreements among parents and medical professionals on whether such interventions in the case of minors are ethical or can be considered a form of child abuse.

Republican state Rep. Tom Oliverson, a doctor who helped pass the bill through the House, said that evidence of adverse outcomes for such “treatment” in children is growing.

“Risks including bone demineralization, abnormalities of brain and cardiovascular development, strokes, blood clots, chronic pain, infertility, and incontinence are known to accompany these treatments for a lifetime,” he said, citing the experience of detransitioners.

Abel Garcia, Billboard Chris, and Chloe Cole take part in a demonstration in Anaheim, Calif., on Oct. 8, 2022. Brad Jones/The Epoch Times

Plaintiff lawyers claim “decades of clinical experience and a large body of scientific and medical literature” support such procedures on children.

Proponents of transgender procedures have also argued that transitioning is safe and positively affects the mental health of those with gender dysphoria. Some claim that if parents deny a child’s chosen identity, it can lead to suicide or worsening mental health.

But opponents believe that children are not mature enough to make such life-altering decisions that could lead to serious medical and reproductive problems without improving mental stability.

Recently, Britain’s National Health Service said it would no longer prescribe puberty suppressing hormones, citing a lack of evidence to support claims of their “safety or clinical effectiveness.”

Darlene McCormick Sanchez contributed to this article.