By Gyan Moorthy

The day Gov. Greg Abbott ordered our state’s Department of Family and Protective Services to investigate parents who pursue gender-affirming care for their transgender children, 16-year-old “Antonio Voe” attempted suicide by swallowing a bottle of aspirin. 

According to a lawsuit filed by Parents, Families, and Friends of Lesbians and Gays, Antonio told the doctors who saved him he was terrified his family would be torn apart and that he did not want to be a burden to them. Unfortunately, instead of receiving reassurance and protection, Antonio watched as his parents were investigated after staff at an outpatient psychiatric facility learned he was prescribed hormone therapy and reported them for abuse.

Abbott’s Feb. 22 order closely followed a non-binding legal opinion issued by Attorney General Ken Paxton that most gender-affirming care constitutes child abuse under existing provisions of the Texas Family Code. Both Abbott and Paxton faced re-election bids against popular challengers this November. Both won, despite the controversies that plagued their campaigns. 

Paxton has been mired in scandal since at least 2014, and he is currently awaiting trial on criminal securities-fraud charges. Abbott, for his part, invited accusations of abuse of power last year after unilaterally defunding the state Legislature for refusing to consider his elections overhaul bill. The two weaponized hot-button cultural issues like abortion, immigration and transgender rights to distract from their personal shortcomings and, perhaps, in Abbott’s case, to prepare to run for president.

The election is over, but the gruesome effects of Abbott’s anti-child, anti-transgender move remain. There are more stories like Antonio’s, and many are sure to conclude still more tragically. 

Some families have left Texas to protect themselves and their transgender children as the state closes in with additional restrictions on bathroom use, sports participation and access to vital medical care. In the wake of Abbott’s order, large hospitals temporarily stopped providing hormone treatments to transgender children for fear their employees could be fined or jailed. 

Although the Texas Supreme Court ruled in May that the order lacked legal force and upheld an injunction against DFPS investigation granted to one family of a transgender child, “Mary Doe,” it struck down a statewide injunction, permitting investigations against other such families to continue. The state is presently appealing a September injunction covering families associated with PFLAG issued by the Travis County District Court.

Health care professionals have a duty to fight hard against policies that criminalize essential medical treatment – and children for being who they are. Abbott’s policy is particularly egregious because it would oblige them as mandatory reporters to be a part of its enforcement. 

All major medical associations endorse gender-affirming care including puberty blockers as standard of care for gender dysphoria, or the distress experienced due to a perceived mismatch between biological sex and gender identity. The Texas Medical Association rightfully condemned Abbott’s order in a brief in the Doe case. The current president of the American Psychological Association warned the order would exacerbate mental health risks to transgender children. 

However, health care professionals should also advertise what Abbott’s order means for other vulnerable children.

My parents have practiced pediatric medicine in El Paso for 25 years. I hope one day to join them. 

In that time, they have treated countless victims of violent beatings, incestuous rape, starvation and refusal to permit necessary medical care – from newborns to adolescents. My father has been deposed and testified in numerous criminal trials against alleged perpetrators; my mother helped lead both El Paso’s Court Appointed Special Advocates and Center Against Family Violence.

They are appalled at Abbott’s order. For every child they help, there are many children they can’t. For every truly abusive family DFPS investigates, who are prosecuted, there are many more who fly under the radar. 

Like our health system, Texas DFPS is chronically understaffed and under resourced. This fact underlies the central findings of a 363-page report conducted by federal monitors in 2020: Texas’ child protection system is “disjointed and dangerous,” and “harm to children is at critical times overlooked, ignored, or forgotten.”

Yet Abbott’s order adds copious counterproductive work to the plates of already overwhelmed investigators, pulling them from the tasks for which we the public truly depend on them. Moreover, nearly 2,300 DFPS employees quit between January and August this year, a few citing the order as their reason. 

At least one DFPS employee who is parent to a transgender child  – Mary Doe from the lawsuit against Abbott – was placed on administrative leave by the agency. Trans DFPS employee Morgan Davis was assigned to investigate two families of transgender children, and the experiences left him reeling. He ultimately resigned, but he was conflicted. His resignation meant still more work for his colleagues, or that they, who may have been less sympathetic to parents of transgender children than he, would be conducting the investigations instead.

We’re probably stuck with Abbott until 2026, but we don’t have to be stuck with this dehumanizing policy or the uncertainty of on-again, off-again injunctions. We don’t have to be stuck with traumatizing investigations that themselves constitute a form of child abuse and endanger real victims of child abuse by diverting resources from them. 

Abbott could change his mind – and health care professionals and child welfare advocates could make him. The Texas Supreme Court could issue its own, broader injunction. 

Texas is booming, and we should want as many to share in that prosperity as possible. We have a chance to set a moral example for the rest of the country: families who support their transgender children seeking gender-affirming care should be lauded, not persecuted.

Gyan Moorthy is a second-year medical student at the University of Pennsylvania Perelman School of Medicine. He has strong interests in child welfare and policy concerning the fair distribution of scarce resources. He received his AB in Linguistics from Dartmouth College in 2020 and his MSc in Bioethics from Columbia University in 2021. He was born and raised in El Paso, where he maintains his permanent residence.