Endocrine Society alarmed at criminalization of transgender medicine

The Endocrine Society condemns the directive by Texas Governor Greg Abbott ordering the Department of Family and Protective Services (DFPS) to investigate any reported instances of Texas children receiving gender-affirming care as “child abuse.” This policy rejects evidence-based transgender medical care and will restrict access to care for teenagers experiencing gender incongruence or dysphoria.

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.

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.

The governor’s directive reflects widespread misinformation about gender-affirming care. 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.

Only reversible treatments to delay puberty are recommended for younger adolescents after they have entered puberty, according to our Clinical Practice Guideline and joint policy perspective issued with the Pediatric Endocrine Society. Puberty-delaying medication is a safe and conservative approach that gives teenagers and their families more time to explore their options. The same treatment has been used for decades to treat precocious puberty.

Older adolescents who demonstrate the ability to provide informed consent to partially irreversible treatment and experience persistent gender incongruence may start gender-affirming hormone therapy to help them experience puberty in a way that matches their gender identity.

Being forced to experience puberty consistent with the sex recorded at birth is extremely distressing for many transgender and gender-diverse individuals.

Gender-affirming care benefits the health and psychological functioning of transgender and gender-diverse youth. When an individual’s gender identity is not respected and they cannot access medical care, it can result in higher psychological problem scores and can raise the person’s risk of committing suicide or other acts of self-harm.

There is widespread consensus within the medical community about the importance of this care. Other major international medical and scientific organizations such as WPATH, the European Society of Endocrinology, the European Society for Pediatric Endocrinology, the Pediatric Endocrine Society, the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics are in alignment with the Society on the importance of gender-affirming care.

Widespread misinformation about medical care recommended for transgender and gender-diverse adolescents is fueling efforts to limit access to needed care. Arkansas passed a bill to bar such care in March 2021, and 19 states have proposed legislation to limit access to care this year, according to the Freedom for All Americans campaign.