LGBTQ+ Health Updates

LGBTQ+ Health Updates


Press release

Disclosures: Safer reports no relevant financial disclosures.
February 24, 2022
3 min read

Endocrine Society condemns Texas directive defining gender-affirming care as ‘child abuse’


Press release

Disclosures: Safer reports no relevant financial disclosures.
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The Endocrine Society is condemning a new directive issued by Texas Gov. Greg Abbott defining gender care for adolescents as “child abuse,” according to a press release from the organization.

In a letter to Jaime Masters, commissioner of the department of family and protective services, Abbott wrote that, according to OAG Opinion No. KP-0401 issued by Texas Attorney General Ken Paxton, it is against Texas law to subject children to elective procedures for gender transitioning, “including reassignment surgeries that can cause sterilization, mastectomies, removals of otherwise healthy body parts, and administration of puberty-blocking drugs or supraphysiologic doses of testosterone or estrogen,” and defines issuing such medications or performing those procedures as “abuse.” The directive sparked outrage in the health care community.

Joshua D. Safer, MD
Safer is executive director of the Mount Sinai Center for Transgender Medicine and Surgery, senior faculty member at the Icahn School of Medicine at Mount Sinai, and an Endocrine Today Editorial Board member.

“The governor’s directive reflects widespread misinformation about gender-affirming care,” The Endocrine Society said in the press release. “When young children experience feelings that their gender identity does not match the sex recorded at birth, the first course of action is to support the child in exploring their gender identity and to provide mental health support, as needed.”

Abbott’s directive instructs the department of family and protective services to follow state law, which, he said, “imposes reporting requirements upon all licensed professionals who have direct contact with children who may be subject to such abuse, including doctors, nurses, and teachers, and provides criminal penalties for failure to report such child abuse.” According to the directive, parents of a child receiving gender-affirming care could also be punished under state law, and state agencies will be asked to investigate any licensed facilities where procedures occur.

Transgender procedures prohibited under the directive include sterilization through castration, vasectomy, hysterectomy, oophorectomy, metoidioplasty, orchiectomy, penectomy, phalloplasty, vaginoplasty, mastectomies and the removal of any healthy or non-diseased body part from children. The directive also prohibits administering puberty-suppression or puberty-blocking drugs and supraphysiologic doses of testosterone to girls or estrogen to boys that “induce transient or permanent infertility.” According to the directive, the opinion does not apply for “medically necessary procedures.”

“Health care providers should not be punished for providing evidenced-based care that is supported by major international medical groups — including the Endocrine Society, American Medical Association, the American Psychological Association, and the American Academy of Pediatrics — and clinical practice guidelines,” The Endocrine Society said in the release. “Medical evidence, not politics, should inform treatment decisions. We call on policymakers to rescind this directive and allow physicians to provide evidence-based care, including to prescribe medications to delay puberty.”

As Healio previously reported, access to gender-affirming care is associated with better mental health outcomes. In a study published in Pediatrics, transgender adolescents receiving pubertal suppression or gender-affirming HT had improvements in body satisfaction, depressive symptoms and total anxiety after receiving care compared with before.

Joshua D. Safer, MD, executive director of the Mount Sinai Center for Transgender Medicine and Surgery, senior faculty member at the Icahn School of Medicine at Mount Sinai, and an Endocrine Today Editorial Board member, said Abbott’s directive reveals how some government officials are ignoring evidence-based guidelines and supporting political stances that can cause harm to youths seeking gender-affirming care.

“The health care community in general has been quite good about methodically developing evidence-based conservative practices based on the data we have available,” Safer told Healio. “We depend on government leaders reaching out to the expertise in the medical establishment to inform policies. It makes no sense to me that an aspect of medical care should be treated like a political decision for which the choice of treatment is connected to political philosophy rather than data.”

Abbott’s directive is just the latest push from some states to restrict gender-affirming care for children. As Healio previously reported, legislators in more than a dozen states have proposed bills to prohibit gender-affirming procedures. Arkansas became the first state to pass a bill outlawing gender-affirming care for youths in 2021. According to the Freedoms for All Americans campaign, a bipartisan group working to protect the rights of the LGBTQ+ community, 19 states have proposed legislation limiting access to gender-affirming care.

“The hostile comments from government leaders are very harmful to children at an age when gaining self-confidence is difficult,” Safer told Healio. “Actually denying the necessary health care will be catastrophic, like for any medical condition.”


Freedom for All Americans. Legislative Tracker: Youth Healthcare Bans. Available at: Accessed February 24, 2022.

Governor Abbott Directs DFPS to Investigate Gender-Transitioning Procedures as Child Abuse. Accessed February 24, 2022.