Officials in Texas this week urged that the state should halt gender-affirming care for transgender youth, going as far as to call it "child abuse." The move is a dangerous one that targets and politicizes evidence-based treatment that should be considered the standard of care, Admiral Rachel Levine, assistant secretary for health and the U.S. Department of Health and Human Services, told TODAY.
Texas Attorney General Ken Paxton said in an opinion released Monday that gender-affirming care procedures "constitute child abuse," NBC News reported. And on Tuesday, Gov. Greg Abbott then called for both the general public and "licensed professionals" to turn in the parents of trans kids who are receiving gender-affirming care to state officials.
“I was very concerned by the actions that were taken in Texas,” said Levine, who is a pediatrician, adolescent medicine specialist and the first openly trans federal official to be confirmed by the Senate.
"Trans youth are vulnerable. They are at risk of bullying and harassment. So we need to nurture them, we need to empower them," she said. "And, critically, they need access to this evidence-based, standard of care, gender-affirming treatment. Any suggestion that that's child abuse is entirely wrong and actually egregious."
What does gender-affirming care actually involve?
Gender-affirming care is a supportive, non-judgmental model of health care that allows patients to explore and, if they decide, to pursue medical affirmation procedures. It's recommended by the American Academy of Pediatrics and the American Medical Association.
The guidelines for transgender health care are set by the World Professional Association for Transgender Health (as well as its U.S.-based arm) and updated as experts' knowledge and understanding of the field evolves.
"The standards of care include a psychological evaluation and, if necessary, treatment and support for the young person and their family," Levine said. "It involves a medical evaluation and then considerations of medical treatment. And so, there's a guide — a standard of care — of how that medical treatment would go."
For a child who hasn't started puberty yet, "there's no medical treatment," Levine said. At that point, care would focus on counseling and taking in the considerations of the young person, their family and their school.
"At the beginning of puberty, there's a protocol of using what are called pubertal blockers," she explained. "These are medicines that are used for other conditions that can block the progression of puberty so the young person doesn't go through the wrong puberty, which can lead to lots of different psychological and physical challenges later on."
When everyone is "on board," including the therapist, the parents, and the young person, "then you can start cross-gender hormone therapy to essentially put the young person through the puberty that's consistent with their gender identity," Levine said.
"It's all very carefully done," she explained. "And sometimes the protocols are adjusted based on what the research says, just like any other medical field."
What impact can this care have on mental health?
"If trans youth are supported at home and in their community, and they have access to the standard of care of gender-affirming treatment, then they have excellent mental health outcomes. They do very well mentally, behaviorally and socially," Levine explained.
"If you have youth that are not accepted by their family or their friends or their school or community and do not have access to this care, then they have significantly increased mental health concerns such as depression and anxiety and potential risk of substance use. So, this gender-affirming care is really so important for the physical and mental health of the young person."
A new study published today in JAMA Network Open found that, among 104 transgender and nonbinary adolescents between the ages of 13 and 20, access to gender-affirming care significantly reduced the risks for depression and suicide over the course of a year.
What do you wish more people understood about gender-affirming care?
People tend to fear what they don't understand, Levine said. So "what we want to do is to make sure that these young people and their families have access to care, to educate the public about these issues of gender identity and to reassure them that this is a medical field like any other medical field."
And it's a field that "has medical professionals who are involved in this field of transgender medicine and youth transgender medicine. It has a standard of care and an evidence base that continues to evolve," she explained. "And it should not be politicized. It should not be used for political purposes."
What would you say to trans kids out there who might feel scared or frustrated right now?
"My message to trans youth and their families is that we see them. I see them. Our department and our secretary see them and we support them. Our President sees them and supports them. He has articulated that over the last year or more, numerous times," Levine said.
"So we will do everything we can to support and empower them to make sure that they receive the care that they need."
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