Fighting care for transgender kids shifts from a fringe issue to a litmus test for Texas Republicans

People held up a transgender flag at a protest last year at the Texas Capitol in Austin. (Sergio Flores For The Texas Tribune, Sergio Flores For The Texas Tribune)

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Gov. Greg Abbott sparked a national uproar last month when he authorized child-abuse investigations into families that allow transgender kids to receive gender-affirming care.

But the political momentum toward the move had been building for months, after the failure at the Legislature of a bill to block such treatments for kids paved the way for executive action amid a competitive primary season. Along the way, the issue emerged as a new litmus test for Texas Republicans.

The issue is no longer contained to just the party’s fringes — and it is unlikely to go away any time soon as the national fervor grows, Abbott’s directive faces legal challenges and it factors prominently into a slew of GOP primary runoffs.

“This is a winning issue,” Abbott’s top political strategist, Dave Carney, told reporters last week, brushing off any general-election concerns. “Texans have common sense.”

Abbott’s directive came shortly after the attorney general, Ken Paxton, issued a legal opinion classifying certain types of gender-affirming care as child abuse. Within days, the state was investigating a family after the parents received such treatment for their 16-year-old transgender daughter. The American Civil Liberties Union and Lambda Legal sued on the family’s behalf, and a state district judge temporarily blocked the investigation but did not stop Texas from opening other, similar probes.

On Friday, Texas Children’s Hospital, the largest pediatric hospital in the country, said it was ending prescription of gender-affirming hormone therapies in response to Abbott’s directive. Another major hospital, University of Texas Southwestern Medical Center, closed a clinic for transgender teens last year. On Tuesday, The New York Times reported that the clinic had faced pressure from the governor’s office in the days before it dissolved.

Texas Republicans’ growing focus on what they call “child gender modification” is the latest illustration of the state’s swing to the right after the 2020 election. And it reached an apex as both Abbott and Paxton were in the final days of primaries where they were getting pressured from their right over the issue.

Conservatives pushing the initiatives say they are protecting children from making dramatic changes to their bodies before they are old enough to understand the ramifications. LGBTQ advocates say permanent treatments almost never happen in children and that Texas Republicans are making a cynical play with a vulnerable population with legitimate treatment needs in the crosshairs.

“I think what is happening here is that anti-LGBT politicians realize it’s politically advantageous to attack a minority or marginalized community that people know very little about,” said Ricardo Martinez, CEO of Equality Texas. “They are exploiting that knowledge gap … with disinformation about who transgender people are as a fear tactic.”

Caught in the political crossfire are parents like the Baizes, who have a transgender son. Melissa Baize lived in Fort Worth for 15 years before her family left the state last year, concerned about the ramp-up of legislation targeting trans children.

Baize said it’s been painful and surreal to be on the receiving end of political attacks from the state’s most powerful leader.

“As a parent, you try so hard to protect your kids whether they’re straight or gay or trans or anything,” Baize said. “And to have someone who’s in power, who has a voice out there and is saying that this is wrong and you need to turn on these people.”

Baize said she considered Fort Worth her home, and her husband was born and raised in Texas. But she said “we’re never going back, especially now” with the new directive.

From “bathroom bill” to now

The fight over gender-affirming care is the biggest policy battle in Texas over LGBTQ rights since the 2017 “bathroom bill” that sought to restrict which restroom transgender Texans could use. The legislation, a priority of Lt. Gov. Dan Patrick, never reached Abbott’s desk, stymied by stubborn opposition from the business community and then-state House Speaker Joe Straus, a Republican.

When the bathroom bill was first introduced, Baize’s son was just 10 years old. But she said her son understood then that lawmakers were talking about kids like him. He started to feel afraid to use the bathroom he felt more comfortable in. That was the beginning of the stress that prompted them to leave town.

“We thought, if this is always going to be going south for us, it’s not going to be good for us as a family as a whole,” Baize said. “We needed to get our family back on track, and we needed to be somewhere safe.”

A good amount has changed since then for Republicans. In 2020, the GOP defeated the most serious effort in recent memory to turn the state blue and then used the redistricting process last year to shore up its majorities for the next decade. Combined with a national environment favoring the GOP in November, that laid the foundation for Texas Republicans to return to a time when the primary is far more consequential for them than the general election.

It was against that backdrop last year that the GOP-led Legislature, with Abbott’s support, became a red-meat factory, churning out laws that almost totally banned abortion, allowed permitless carry of handguns and tightened Texas’ already stringent voting rules. Some called it the most conservative session ever.

That year, Republican leaders moved forward on legislation targeting trans student athletes that forced them to play on teams based on their sex at birth. That proposal failed in the regular session but passed in a special session after Abbott prioritized it.

Even as Republicans raced to the right on a host of issues, though, going after transition-related medical care for transgender kids remained on the back burner. Despite the efforts of some of the farthest-right members — and passage in the Senate — it never made it through the House.

Straus’ modern-day successor is Dade Phelan, a Republican from Beaumont who initially gave LGBTQ advocates cautious optimism due to his 2019 comment saying he is “done talking about bashing on the gay community.” But their optimism dimmed when he allowed the bill on transgender student athletes to reach the floor last year.

Still, through four legislative sessions last year, Phelan and his leadership team were able to keep off the floor an array of proposals targeting gender-affirming care for minors. That laid the groundwork for it to become a primary-season issue when the Legislature finally gaveled out in October — and raised the possibility that Abbott would have to take executive action to appease his right.

It was not long before the issue became a political liability for both Paxton and Abbott. Paxton got flack from some of his primary opponents who wanted to know why he was taking so long to formally weigh in on whether gender-affirming treatments constituted child abuse. The request for the legal opinion came in August from state Rep. Matt Krause, R-Fort Worth, who would go on to wage a short-lived challenge against Paxton in his primary that fall.

Meanwhile, Abbott got badgered over the issue by primary challengers including Don Huffines, a former state senator from Dallas.

“Texans deserve a governor who will fight against the radical Leftist sickos and end their war on children,” Huffines said in one statement.

Another Abbott challenger, former Texas GOP chair Allen West, was able to crusade on the issue long before he launched his campaign because it was one of the legislative priorities of the state party he led.

Paxton released his opinion on Feb. 21, the middle of the early-voting period for the March 1 primary, and Abbott issued his directive the next day.

Paxton advanced to a runoff in his primary, and Abbott easily won his outright with nearly two-thirds of the vote. He nows faces a Democratic opponent, Beto O’Rourke, who has criticized the directive, pledging to protect transgender children in Texas and more broadly expand LGBTQ rights in the state.

Abbott’s campaign is not worried about the fallout.

“That is a 75-to-80% winner,” Carney, the Abbott strategist, said during a call with reporters the morning after the primary. “I don’t believe that even O’Rourke would think that if a parent cut off the hand of their kid, it wouldn’t be considered child abuse.”

There has not been any public polling on the issue recently in Texas. But the state’s Republicans overwhelmingly backed a primary ballot proposition last week calling for a ban on “chemical castration, puberty blockers, cross-sex hormones, and genital mutilation surgery on all minor children.” (Medical experts say surgeries and irreversible treatments for transgender children are exceedingly rare.) The proposition got 93% support, and it was the third most popular among the 10 nonbinding propositions that appeared on the ballot.

“Clearly as of right now, the Republicans feel safe enough to do as they please,” said Andrew Sanders, an assistant professor of political science at Texas A&M University-San Antonio. “They’re definitely feeling confident that this is an agenda that can keep them in power.”

Business breakup

Another thing that has evolved since 2017 is Republicans’ relationship with the business community.

Once a bedrock constituency of the GOP, Big Business has found less of an audience with state GOP leaders as it seeks to influence them on social issues, at least publicly. A stark illustration of that came last year when American Airlines came out against the Republican-backed voting bill — and Patrick went on a rampage against it, essentially making an example out of the Fort Worth-based company.

​​”Stay out of things you don’t know anything about,” Patrick said at the time, “and if you want to get involved, then you’re taking that risk.”

Businesses are taking notice of the fierce blowback they can incur from the highest levels of state government. The Texas Association of Business, which was instrumental in stopping the bathroom bill, did not respond to a request for comment on Abbott’s directive on transgender youth.

The TAB was a top organizer of bathroom bill opposition in 2017. Opponents also got a boost when the NFL warned the Legislature against passing the legislation, suggesting it could impact future games in the state.

There has nonetheless been noteworthy business opposition to Abbott’s recent directive. Texas Competes, a coalition of over 1,400 businesses and business groups that advocates for LGBTQ rights, issued a statement saying it was “gravely concerned” about the directive.

“When Texas sends this dangerous message, it is at stark odds with our members’ values and competitiveness — especially in a climate where all sectors have struggled to recruit and retain a talented workforce,” the statement said.

Jessica Shortall, the managing director of Texas Competes, said in a separate statement that the group has “heard from several big employers that the outreach — and outrage — from their workforce exceeds even what they experienced in the 2017 bathroom bill fight.”

How much that means to Abbott and other state Republican leaders is an open question. Matt Rinaldi, the Texas GOP chair who was serving in the state House during the bathroom bill battle, argued in an interview that Patrick was “really ahead of the game” in going toe-to-toe with the business community in 2017.

“You’re seeing now that people are realizing that Big Business is quickly siding with the most extreme elements of the Democratic Party,” Rinaldi said, “and the Republican Party, in one of the largest political realignments we’ve seen in a while, is becoming the party of small business, working Americans and parents.”

Not going away

The national attention over the directive is not receding.

U.S. Health and Human Services Secretary Xavier Becerra has said his agency is looking into what it can to help transgender kids in Texas in light of the directive. During his State of the Union speech, President Joe Biden decried the “onslaught of state laws targeting transgender Americans and their families.” And on Tuesday, White House press secretary Jen Psaki said the Texas policy was “discriminating against exactly the kind of kids who we need to be loving and supporting.”

Paxton appealed the judge’s ruling that halted the first known investigation to stem from the directive, but a court rejected the appeal Wednesday. That means a Friday hearing can proceed over whether the district judge will issue a statewide injunction blocking all such investigations.

Then there are the electoral ramifications going forward. Paxton is in a primary runoff against Land Commissioner George P. Bush, who has criticized Paxton’s opinion as an empty gesture, citing the money he has “accepted in campaign funding from gender transition clinics for illegal immigrants.” That is a reference to Paxton’s financial support over the years from Border Health PAC, the political arm of DHR Health in the Rio Grande Valley, which in 2017 opened a Gender Care Clinic at its Family Medicine Center.

It is unclear if that clinic is still operating. A DHR Health spokesperson did not respond to a request for comment for this story.

There are also at least two Republican primary runoffs for state House in which transgender rights rank as a leading issue. State Rep. Stephanie Klick of Fort Worth, the chair of the House Public Health Committee, is in a runoff against a challenger, David Loewe, who has been attacking her for not doing enough to stop “gender modification.” It is also a top debate in a runoff for an open seat in which one of the candidates is Jeff Younger, a North Texas father who came to prominence through a protracted custody battle involving a transgender child.

“I know how to use political power,” Younger wrote Tuesday on Facebook, sharing the news about Texas Children’s Hospital. “My five year campaign to shut down these barbaric abuses is bearing fruit.”

Baize said it’s still hard to watch what’s happening in her home state.

“It’s like, you pick on the weakest ones you can to get ahead, to get the attention they need.” Baize said. “They’re just bullies, and the worst kind to just keep attacking and attacking and attacking. And then thinking of new ways to attack us more and more.”

Sneha Dey contributed reporting.

Disclosure: UT Southwestern Medical Center, DHR Health, Equality Texas, Facebook, Texas A&M University, Texas Association of Business and The New York Times have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribunes journalism. Find a complete list of them here.