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

cigaretteman

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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.

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.”






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“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.
FAQ: What you need to know about transgender children
“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.”
Biden accuses Texas Gov. Abbott of ‘government overreach at its worst’ for investigating parents of children transitioning genders
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).
‘These are powerful people who are attacking children’: Parents respond to Texas’s latest anti-trans directive
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.”
 
“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.”

This is child abuse and the perpetrators should not be practicing medicine or allowed around children.
 
“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.”

This is child abuse and the perpetrators should not be practicing medicine or allowed around children.
You’re right, politicians deciding these things instead of family and doctors is child abuse.
 
You’re right, politicians deciding these things instead of family and doctors is child abuse.

Citizens elect political representatives to enact laws to, among other issues, protect children from harm. Whether it is harm caused by parents or crackpot malpractice doctors.

Adults forcing impressionable children to question their sexuality and then seek the means to mutilate their bodies and disrupt their natural hormones is child abuse.

The State has a vested interest in preventing child abuse by adults and their crackpot enabler doctors. Start revoking medical
licenses and bringing charges against them as soon as possible.
 
Citizens elect political representatives to enact laws to, among other issues, protect children from harm. Whether it is harm caused by parents or crackpot malpractice doctors.

Adults forcing impressionable children to question their sexuality and then seek the means to mutilate their bodies and disrupt their natural hormones is child abuse.

The State has a vested interest in preventing child abuse by adults and their crackpot enabler doctors. Start revoking medical
licenses and bringing charges against them as soon as possible.
Do you believe this nonsense? These are punitive laws meant only to rile up the bigoted base because it’s proven that punching down works in republican majority states.
 
This has nothing to do with sports. Rs want an outright ban of trans people to even exist.
This is the eventual goal. Some of the Righties here are at least honest about it. Each victory against TG citizens will lead to another demand from the Christian jihadists. Each and every time the GOP leadership will bow down to the extremists. This was never going to stop at kids in sports. Bathrooms will be revisited. Then denying care for adults. Denying rights for adults. It will never end.
 
Citizens elect political representatives to enact laws to, among other issues, protect children from harm. Whether it is harm caused by parents or crackpot malpractice doctors.

Adults forcing impressionable children to question their sexuality and then seek the means to mutilate their bodies and disrupt their natural hormones is child abuse.

The State has a vested interest in preventing child abuse by adults and their crackpot enabler doctors. Start revoking medical
licenses and bringing charges against them as soon as possible.
Care to share what makes you an expert on this?
 
There are studies out there that 60-90% of kids don’t continue the transition when they become adults. I don’t think it is unreasonable to wait for children to go through puberty before giving them hormone therapy.

 
There are studies out there that 60-90% of kids don’t continue the transition when they become adults. I don’t think it is unreasonable to wait for children to go through puberty before giving them hormone therapy.

This is a good piece that summarizes a lot of the research. Bottom line is that most kids will desist as they grow into adulthood, if they do not receive affirming treatment.

Article
 
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There are studies out there that 60-90% of kids don’t continue the transition when they become adults. I don’t think it is unreasonable to wait for children to go through puberty before giving them hormone therapy.


This shows your lack of education. Most of those kids will never qualify for puberty blocking medications because they don't have gender dysphoria severe enough to warrant therapy.
 
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This is a good piece that summarizes a lot of the research. Bottom line is that most kids will desist as they grow into adulthood, if they do not receive affirming treatment.

Article
There are some flaws with many of those quoted studies:

1. Many of them are very old and don't have the current definition of gender dysphoria or define gender identity. Many of them will be comprised of gay boys at time. Can you imagine being a parent of a gay boy in the 80s during the AIDS epidemic? Many of these gay kids were hauled in by parents simply because they weren't behaving like all the other boys and wouldn't be considered transgendered today.

2. Steensma has one of the largest and most frequently quoted studies. He has admitted that some of the kids in his study would not be classified as transgender today. 38 of the 127 were below threshold for meeting definition of transgender.

3. Steensma also used an accepted methodology in research but probably doesn't work for a study of this kind. 80 out of the 127 were defined as desisting (going back from their transition). However 28 of the 80 never returned their questionnaires and as a result were defined as desisted by default even though we don't really know how they define themselves. This is commonly done in clinical trials for chemotherapy. If you are testing a new drug and the patient doesn't come back for follow up, you basically presume them to be dead.

 
For the documentary buffs here is a good work up from PBS. All interviews with trans kids and their families. No opinions or commentary. I think you will find three things:

1. Very intelligent and well spoken kids who are struggling through a problem most of us can't understand.

2. Clinicians and researchers taking a very guarded approach to therapy and heavily weighing the risks and benefits of hormonal therapy in the treatment of these patients. All are looking for more answers.

3. Parents struggling to do what they think is right for their kids because they love them. You will find this is creating a split amongst families.

Here is what you won't find:

1. Kids who are super excited to be going through this process or who seem completely whackadoodle.

2. Unethical doctors looking to make a fast buck on this care and strong arming parents and kids into taking therapy they don't want.

3. Parents cheer-leading their transition and pushing their kids down this road.

The point is that this is something we don't completely understand and are working through as a society. More research needs to be done and the medical community is doing that. Politicians involvement is only going to make this problem worse and they need to stay out of medical affairs. Rendering this illegal does a disservice to patients, society, and research efforts.

 
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.”

Weird that doctors and the AMA would back down from "standard of care" based on some unenforceable state "policy" (it's not a law, it's something their AG "declared")
 
Weird that doctors and the AMA would back down from "standard of care" based on some unenforceable state "policy" (it's not a law, it's something their AG "declared")
The stakes are too high. The governor directed agencies to investigate anyone who is providing care. This means doctors and clinics could be arrested, investigated, etc. Basically unless there is someone toward end of their career that wants to test the courts, it is career suicide. Every time you apply for a medical license or hospital privileges, etc you have to report arrests and investigations. No hospital is going to take you on even if you were proven innocent. These people would be tracked and I'm sure religious zealots would protest any place that hires them.
 
The stakes are too high. The governor directed agencies to investigate anyone who is providing care. This means doctors and clinics could be arrested, investigated, etc.

And that's gonna shut down clinics and create a healthcare nightmare within TX.

So, let it happen. Let the voters figure out what their leaders are really creating here.

This wasn't a new law, it was an edict by an unelected official; ultimately, TX is going to pay out bigly for illegal actions, and every one of those clinics/doctors is gonna get a fat payout.
 
The stakes are too high. The governor directed agencies to investigate anyone who is providing care. This means doctors and clinics could be arrested, investigated, etc. Basically unless there is someone toward end of their career that wants to test the courts, it is career suicide. Every time you apply for a medical license or hospital privileges, etc you have to report arrests and investigations. No hospital is going to take you on even if you were proven innocent. These people would be tracked and I'm sure religious zealots would protest any place that hires them.

This is just overblown.

Few, if any, physicians ever have their licenses affected, except for only the worst misconduct. Panels of docs are reticent to take away another's livelihood except in only the most extreme circumstances. Those panels will see right through this political game.
 
This is just overblown.

Few, if any, physicians ever have their licenses affected, except for only the worst misconduct. Panels of docs are reticent to take away another's livelihood except in only the most extreme circumstances. Those panels will see right through this political game.
You don't think the governor directing the department of family and protective services, with the support of the state's attorney general, to investigate physicians and pursue criminal penalties is overblown? That is a republican governor, a republication attorney general, and a governor appointed director of DFPS.

FYI for physicians, legal trouble is the "worst" misconduct. Very few survive significant criminal charges to continue practicing medicine.

Governor's letter is linked below.

 
You don't think the governor directing the department of family and protective services, with the support of the state's attorney general, to investigate physicians and pursue criminal penalties is overblown?

It ain't gonna hold up, when there's no formal law to support it.

Remember: this was not a "new law", it was an edict pushed out by that AG, which is widely viewed as unconstitutional infringement on rights. And once the feds get involved, it crumbles, and TX ends up paying out restitution to all impacted by it.
 
Why would "guidance" and "risks" disclosures require them to be "banned"?

Be specific.
Most of the docs who are prescribing spironolactone to transgender kids are psychiatrists. They have a MD. They go to medical school. However in their internships they do 3 weeks in a medicine rotation. Spironolactone is a potassium sparing diuretic. Look up problems with hyperkalemia.

1st hand experience with a teen M->F transgender on spironolactone in a psychiatric setting. Kid was complaining of heart palpitations. EKG showed bigeminy. I asked for an order to draw labs. K+ was 6.1. Kid had to be transferred to a medical floor. When talking to the team about it the attending, fellow, and 2 residents seemed genuinely surprised that something like this happened. When I told them hyperkalemia is a known side effect of spironolactone they looked at me with blank looks in their faces. This is pharmacology 101. Uptodate.com states that an adolescent dose for hormone therapy is 25 mg. It also states that a standard dose to start for an adult with heart failure is 12.5 mg. 25 mg for a kid that weighs 90 lbs as opposed for an adult that can weight 200 lbs+.

I'm stipulating these docs did not know the risks of this medication well enough to give guidance in this situation. It was all about making sure this kid could take the meds to continue with hormone suppression. There seemingly was no concern of overall health. If we are going to be giving children medications like spironolactone there needs to be a standard of care involved that benefits the child's overall health. If that means drawing labs every month or what have you to measure K+ levels so be it. But unfortunately these things are not thought out.

In the situation above I was the only person advocating for this kid's health. What I mean by that I was the only one with the knowledge to be able to put 2+2 together in this scenario. Because I don't think kids should be talking spironolactone I will be labeled as someone who hates transgender kids. This couldn't be farther from the truth. I don't believe we can change our genders from birth but I also don't want to see a kid being hurt from taking a substance that is suppose to be developing his or her lifestyle.
 
I'm stipulating these docs did not know the risks of this medication well enough to give guidance in this situation.

Not true at all.
Likewise, inconsistent with your prior post in that docs "don't know the risks".

You LINKED pages that illustrate those risks.
 
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