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Texas' push to outlaw gender-affirming care puts trans kids, families and physicians in 'gray area'

Demonstrators hold signs in support of transgender youth outside the Texas Capitol on March 1 in response to proposed legal action against parents seeking gender-affirming health care.
Gabriel C. Pérez
Demonstrators hold signs in support of transgender youth outside the Texas Capitol on March 1 in response to proposed legal action against parents seeking gender-affirming health care for their children.

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Kari didn't remember New Orleans being so expensive.

"I'm pretty sure they charge a surcharge just to breathe oxygen in that city," says the Austin mom, reflecting on her family's trip to Louisiana earlier this month.

She says it cost $50 a day to park the car at the hotel; they spent hundreds of dollars just to feed themselves; and gas to fuel the 18-hour round trip was a big dent, too. Factoring in the hotel, Kari reckons she paid more than $2,000 for the whole trip.

But it was worth it to get her teenage trans son's gender-affirming health care. Kari has asked KUT to withhold her full name, because getting that care for her son could put her at risk of investigation from Texas' child welfare agency.

Statewide, gender-affirming treatment has been the target of GOP state leadership which has branded it "child abuse." In February, Gov. Greg Abbott and Attorney General Ken Paxton directed Child Protective Services (CPS) to investigate families seeking gender-affirming care for minors and the doctors providing it.

The directive has pushed parents and physicians to fight for treatment that is considered the standard of care for kids with gender dysphoria. Currently, the American Civil Liberties Union (ACLU) of Texas and Lambda Legal have filed a lawsuit aimed at stopping the Texas Department of Family and Protective Services from enacting Abbott's orders. Meanwhile, some Texas families, like Kari's, have been left scrambling for care.

Gender-affirming treatment is a form of health care that helps someone with gender dysphoria transition into the gender they identify with. This care runs the gamut, from treatment that is socially affirming and support-based to medical care like hormone replacement therapy. It can also include hormones to stall puberty for adolescents in transition. Gender-affirming health care is approved by virtually every major medical association, and doctors and families say it is life-saving.

Kari, who calls herself a mama bear — a term mothers of trans kids have adopted to represent their unwavering vigilance needed to secure their kids' rights — said she immediately looked into treatment when her son came out as trans at 14 years old.

“My son was like, 'This is what I want,'" she says.

Kari got him testosterone shots. Next, he wanted chest masculinization surgery.

"He said, 'I know exactly where I want my nipples to be. I know everything. I just need somebody to do the surgery,'" she says.

After months of counseling and consultation with their primary care doctor, Kari made an appointment with an Austin-based surgeon who agreed to operate on her son in August — right when Texas lawmakers took up a bill to ban gender-affirming care.

The doctor canceled.

In February, Kari rescheduled. At the last minute, she got a call from the practice's manager. Kari had a bad feeling.

"I know what's going to happen," she said to the woman on the phone. "'They're canceling the surgery, aren't they?'"

The woman said yes. "The hospital is refusing to allow the surgery to proceed because your son is transgender and a youth," she said. "He's a trans youth."

Kari and her son were devastated.

Within days of the surgery, Abbott and Paxton pushed the state's child welfare agency to investigate families. The surgeon told Kari he "1,000%" would have done the surgery, but no hospital in Austin would let him operate.

"He said none of them will approve the surgery because of what's pending, because of the gray area," she says. "We don't know what's going to happen right now."

Last month, that surgeon referred Kari and her son to a couple of out-of-state clinics — one in California and another in New Orleans. Insurance covered most of the cost of the surgery, which ended up costing Kari roughly $700 out of pocket.

Sticker shock aside, Kari says it was worth it.

"The alternative was we don't do it, and what does that mean for my son and his mental health? You can't put a price on that. It's priceless," she says. "Looking at my son now ... he's so much more himself and who he has always been than he's ever been. And it was because of this, because this [Austin] surgeon stepped in and helped us."

Now, her son's healing from the surgery, following up on Zoom calls with the surgeon and getting his weekly testosterone shots in Austin. Her family is still at risk.

Earlier this month, the Texas Supreme Court said Child Protective Service investigations could proceed, though the court said Abbott and Paxton didn't have the authority to order the investigations directly.

In a statement to KUT, the Department of Family and Protective Services, the agency which oversees CPS, said it “treats all reports of abuse, neglect, and exploitation seriously and will continue to investigate each to the full extent of the law.”

Randa Mulanax resigned from her position as a CPS investigator because of the state's directive. She says this type of state intervention is "political."

"It’s a dangerous territory for the government to be trampling on,” she said.

Since Abbott and Paxton's directives, clinics have been in limbo, unsure whether their care could potentially be outlawed by state intervention.

Transgender patients in Houston were left without care after a clinic at Texas Children's Hospital in Houston shuttered as a result of political pressure.

The Genecis Clinic in Dallas, which is run jointly by UT Southwestern and Dallas Children's Hospital, faced similar pressure, closing in November last year.

The clinic’s lead doctor, Ximena Lopez, said she was forced to stop taking new patients because the governor pressured her bosses. She sued, and a court order temporarily allowed Genecis to reopen earlier this month. Yesterday, a judge extended it

Attorney Charla Aldous represents Lopez and says scores of new patients have sought care in the last few weeks. Many of them are anxious and even suicidal. On top of that, Aldous says patients feel the weight of the potential state investigations, too.

"They’re afraid because of the CPS investigations," she said. "It has really really traumatized families that have already been marginalized."

While the decision on Genecis is good news for trans families, gender-affirming care in Texas is still precarious. Parents throughout the state remain unsure on a day-to-day basis if they’ll be able to get the care their kids need — watching court cases and dreading the prospect that state lawmakers will ban gender-affirming care outright when they meet next year.

Back in Austin, Kari expects families will continue to go the distance, regardless of what lies ahead.

"I can guarantee you the parent of a transgender kid is not going to sit here and go, ‘Well, sorry, honey, you don’t get your hormones anymore. So sorry, the governor said ‘No,’" she says. "We’re not those kind of parents. We’re fighters."

Kari says one thing you shouldn't do in Texas is poke a mama bear.

Andrew Weber is a general assignment reporter for KUT, focusing on criminal justice, policing, courts and homelessness in Austin and Travis County. Got a tip? You can email him at Follow him on Twitter @England_Weber.
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