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In a small town about an hour outside Dallas, a transgender teen I’ll call Amber began plotting out a safety plan with her mom. It was late February, and Texas Gov. Greg Abbott had just ordered child protective services to investigate parents who appeared to have authorized certain types of health care for their kids—care that Amber was receiving to assist with her gender transition. Puberty blockers and hormonal therapy are standard treatments approved by mainstream medical associations for trans teens like her. But the governor was now labeling them as a form of “child abuse.” He urged teachers, doctors, and community members to report their trans teen neighbors to authorities.

“It just knocked the breath out of me,” Amber’s mom, Kate, recalled of the moment she read the news. She and Amber began thinking through how they might avoid scrutiny in their tiny conservative town. “Who do we know who is anti-LGBTQIA?” Kate wondered. “Who do we need to avoid?” (I’ve used pseudonyms for both Kate and Amber because of their concerns that they might be reported to child protective services.) They also began brainstorming about how to get out of Texas quickly if investigators came looking for them.

Abbott’s directive was unprecedented in the United States, according to attorneys who study anti-transgender policies and legislation. He issued it one week before a crowded Republican primary election, based on a legal opinion written by state Attorney General Ken Paxton, who is facing a tough reelection later this year. “There is no doubt that these procedures are ‘abuse’ under Texas law, and thus must be halted,” Paxton said in a statement. “I’ll do everything I can to protect against those who take advantage of and harm young Texans.”

The governor’s directive was nonbinding. But the Texas Department of Family and Protective Services (DFPS) has already started investigating at least one couple with a 16-year-old trans teen, according to a lawsuit filed on Tuesday by the American Civil Liberties Union and Lambda Legal, an LGBTQ rights group. The couple alleges that an investigator arrived at their home to interview the family and asked for the teen’s medical records. A DFPS spokesperson told reporters at the 19th that the agency has received at least three reports alleging abuse or neglect based on gender-affirming care for minors. On Wednesday, a state judge issued a temporary restraining order that prevents DFPS from continuing to investigate the parents who sued. But the agency can still investigate other parents, at least until the court meets again later this month.

And trans teens, advocates, and their families are worried that the directive could become enshrined in law: Last year, the Texas Legislature debated a bill that would have classified gender-affirming medical care as child abuse. Though the bill failed to pass, there’s a chance that the state’s lawmakers, emboldened by the governor’s directive, could approve a similar bill when they reconvene next year. “We know that families are terrified,” Chase Strangio, an attorney at the ACLU, told reporters during a press call. 

President Biden condemned Gov. Abbott’s directive during his first State of the Union speech on Tuesday. He said he supported a federal bill that would protect LGBTQ Americans from discrimination. “The onslaught of state laws targeting transgender Americans and their families, it’s simply wrong,” he added.

Abbott’s directive was likely motivated, at least in part, by politics. After the Republican primary election on Tuesday, which saw Abbott secure a spot on the ballot, the governor’s campaign strategist Dave Carney acknowledged that preventing trans children from seeking medical care was a political “winner.” “That is a 75, 80 percent winner,” Carney reportedly said on a call with reporters, adding that Democrats who condemned the policy were “out of touch.” Attorney General Paxton is also eager to mobilize his base ahead of a tough reelection; he has been charged with securities fraud and is dealing with a federal investigation over alleged bribery and abuse of office. After the primary, he is headed to a runoff against another candidate.

The governor’s directive baffled medical experts around the country. In his legal opinion, Paxton incorrectly described gender-affirming medical treatments as a form of sterilization. (Puberty blockers and hormone therapy do not cause sterilization.) No court in the United States has ever found that gender-affirming care constitutes abuse, according to attorneys who study transgender policies. Indeed, gender-affirming medical care for transgender teenagers has been approved by the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics. And many trans people who receive puberty blockers and hormone therapy say that it saved their lives, helping them overcome suicidal thoughts that they experienced while living with gender dysphoria, a mismatch between their gender and how they present to the world. Maddie Deutsch, a medical director for the gender-affirming health program at the University of California-San Francisco, says studies show that transgender youth who can access hormonal therapies with their family’s support are happier and have better life outcomes than their peers who do not. “This is a mainstream accepted standard of care,” she told reporters on a press call. 

“Caring for your child and doing what is best for your child should never be defined as child abuse,” Alison Mohr Boleware, the government relations director at the Texas chapter of the National Association of Social Workers, added during the same call.

On Wednesday, the US Department of Health and Human Services released a guidance saying that, despite the order in Texas, doctors are not required to disclose private patient information regarding gender-affirming care. The department encouraged families in Texas who are investigated because of the governor’s directive to contact the department’s civil rights office for assistance.

Several Texas district attorneys have also pushed back on the governor’s directive, calling it “un-American.” The prosecutors, including in Dallas county, wrote in a statement last week that they would not “irrationally and unjustifiably interfere with medical decisions made between children, their parents, and their medical physicians.” Christian Menefee, the elected attorney who represents DFPS in civil child abuse cases in Harris County, where Houston is, said last week that he would not enforce the governor’s directive to investigate transgender teens. “We’ll continue to follow the laws on the books—not General Paxton’s politically motivated and legally incorrect ‘opinion,’” he said in a statement.

But even if families manage to avoid a knock on the door from child protective services, many worry that the governor’s directive could fuel anti-transgender sentiment and harassment in their communities or discourage doctors from prescribing medically necessary treatments. The ACLU and other organizations like Lambda Legal have been fielding messages from scared parents seeking advice. “We know this escalates the surveillance of families,” the ACLU’s Strangio said of Abbott’s directive. “Particularly immigrant families, Black families, Indigenous families that already face heightened surveillance from the child welfare system.”

The attack on transgender children in Texas comes amid a broader wave of anti-transgender legislation across the country that has escalated in recent years. Texas is 1 of 11 states that have passed laws banning trans kids from playing sports at their schools. (Iowa passed its version this week.) Last year, Arkansas approved a bill that prevented trans kids from receiving certain gender-affirming medical care. (A federal court temporarily blocked that law after the ACLU sued.) Similar bills are pending in Ohio, Idaho, Arizona, and Alabama.

But none of them would go as far as the Texas directive by labeling parents who provide their kids with medical care as child abusers. “This is a wholly anomalous intrusion into the practice of medicine as well as parental rights and the relationship between a parent and a child,” Strangio said of the directive. “There are no policies that look like this anywhere that I’m aware of in the world.”

Amber, the transgender teen, came out to her parents nearly three years ago. Previously, she had struggled with her mental health. After she went on puberty blockers and hormone therapy and started seeing a therapist who is also transgender, her mom noticed major positive changes at home. Amber embraced her hobbies, practicing photography and learning to play the guitar. “She went from considering suicide to being the happiest person who you could possibly live with,” her mom, Kate, told me. “To see her smile again is incredible.” After Abbott’s directive came out, the thought of losing access to those medical treatments scared them both.

Kate switched her daughter’s prescriptions to mail order, so nobody would spot her daughter at the pharmacy. And Amber decided to be extra cautious with her wardrobe, wearing a sweatshirt with the hood up around her head when she went outside. “I hate that she has to cover up and hide who she is,” Kate told me. “But if it’s between that and her safety, it has to happen.”

Amber showed her mom an ACLU statement that said the directive would not be legally binding, but Kate still worried. “In terms of them saying, ‘This doesn’t hold any weight or can’t be enforced,’ we also heard that about the abortion ban, and here we are, that’s actually a thing,” Kate said, referring to a Texas law passed last year that prohibits abortions in the state after about six weeks of pregnancy.

Unable to trust their neighbors, Kate turned to Twitter to vent her frustrations. And she started devising a plan to send the girl out of state, to live with a relative on the West Coast. Amber would need to say goodbye to some of her friends. If an investigator were to call or knock on the family’s door, they wanted to have her on an airplane within hours.

They aren’t the only ones thinking of fleeing the state. In the hours after Abbott issued his directive, other parents in Texas launched GoFundMe pitches to raise money to get their transgender teens to a safer location. “What choice do we have?” says a mom in Austin who I’ll call Stacey, who is fundraising to potentially relocate her 15-year-old transgender daughter. “I’d rather lose our home and our state than lose my child.”

But many families with trans kids don’t have the money or means to uproot their lives. For some, moving away would mean disrupting the schooling not only for the trans child, but also for their brothers and sisters. Or it would mean splitting up the family, with some siblings staying in Texas to finish up their education.

And there’s no guarantee things would even be safer in another state, given how many others are also considering anti-trans legislation. “Where would you like us to go?” Kimberly Shappley, who has a trans daughter and is now looking for jobs outside of Texas, said during a press call with the ACLU. “Literally the whole United States is on fire with anti-trans legislation. It’s not just Texas.”

Still, Amber is eager to pack. She’s thinking through how she might safely ship her computer and gaming equipment to her grandma’s place on the West Coast. Her mom, Kate, says her daughter can’t leave soon enough. “She’s ready to be on a plane yesterday.”


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