Dr. Sara Ashitey first saw statements by Texas leaders on gender-affirming care for trans youth on Instagram. She is a family medicine physician with Southwest Family Medicine Associates in Dallas, and provides care for adult and pediatric trans patients.
"It's not like the state decided, 'Oh we're going to consider this as criminal, so let's give the doctors a heads up,'" Ashitey said. "We don't get a letter from the Texas Medical Board saying, 'Hey, now this is illegal, so you're supposed to change your medical practice.'"
Both she and Dr. Chriset Dharma, the medical director for the practice, have been confused and unnerved by the past few weeks.
"It's very disturbing to us to be caught in the middle between trying to help out our patients and then trying to understand what we are legally allowed to do," Dharma said.
In February, both Gov. Greg Abbott and Attorney General Ken Paxton wrote that gender-affirming care for trans youth should be considered "child abuse," including both gender confirmation surgeries and hormone replacement therapy. They directed the Texas Department of Family and Protective Services (DFPS) and mandated reporters, which include physicians and teachers, to investigate and report families.
"As a family medicine doctor, my practice is not something that is supposed to be legislated, right?" Ashitey said. "I went to medical school. I didn't go to the Texas Legislative whatever. The governor is not the one who dictates what medical practice should be."
Gender-affirming care decreases negative mental health outcomes for trans youth
Multiple medical associations across the country, including the American Academy of Pediatrics, the Texas Pediatric Society, and the American Psychological Association, have highlighted the scientific evidence that gender-affirming care reduces suicidality, depression and anxiety in trans youth.
"It's not just something that people have made up, there's science that backs it," Ashitey said. "To not allow people the opportunity to be and live 100% like themselves, in a way that's the real form of abuse."
Dharma also said Texas leaders make this care seem commonplace, when in reality there are a limited number of physicians who offer gender-affirming services. Insurance may not cover gender transition support, including access to puberty blockers, and she's concerned that insurance could deny coverage in the future even if Texas laws don't change.
"There are very stringent requirements as to what happens before you can even consider [puberty blockers]," Dharma said. "It's not like you can just walk into our office and we're going to say, 'Oh, here, let me give you a $1,000 blocker.' There's a whole team of people that are involved. There is at least a year of monitoring someone. No one does surgery on an under 18 year-old."
Ashitey noted that blockers are temporary and "slow the process to allow the child enough time to come to their own decision."
Despite the back-and-forth in Texas courts about the legality of investigating families for "child abuse" for providing gender-affirming care, Ashitey and Dharma said their work hasn't changed.
"We in the medical community are just not willing to sit by and let it happen without fighting for them," Dharma said. "That's what everyone needs to know: we will continue fighting for you. We will not stand by and let this happen. We've got you covered, so don't worry."
Got a tip? Email Elena Rivera at erivera@kera.org. You can follow Elena on Twitter @elenaiswriting.
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