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88th Texas Legislature

Transgender Texans and doctors say Republican lawmakers misconstrue what science says about puberty blockers and hormone therapy

In 2021, a bill that would block transgender kids’ access to transition-related care passed the Senate but died in the Texas House. This year, a majority of House members back such a ban.



People hold up a transgender flag at an event held by Equality Texas at the Capitol in Austin in 2021. (Sergio Flores/The Texas Tribune)

This article originally appeared in The Texas Tribune

Several Republican Texas lawmakers are clashing with medical groups over whether puberty blockers and hormone therapies help or hurt transgender kids. Those conflicting positions come as some legislators push bills that would limit — or completely block — queer youth from accessing transition-related treatments that many medical associations support.

Sen. Donna Campbell, R-New Braunfels, is championing a bill that would bar doctors from providing such treatments — but only if they’re used to help a child gender transition. During a debate last week on her Senate Bill 14, Campbell and opponents of transition-related care portrayed doctors who provide such care as opportunists capitalizing on a “social contagion” with treatments that lack sufficient scientific data that could determine whether the care is safe and effective.

“I got into the Senate, or government, because I wanted government out of our lives,” Campbell said during the Senate State Affairs Committee hearing. “But if there comes a time when a profession, such as the medical profession, cannot regulate itself to protect patients, protect children, then the government needs to step in.”

Yet medical groups, doctors and transgender Texans say the scores of lawmakers backing such bans are either missing the point of how transition-related health care helps trans people — or are deliberately misconstruing information to target an already marginalized group of people.

They say puberty blockers and hormone therapies — transitition-related surgery involving sex organs is almost never performed on children — are aimed at improving the mental health of trans kids, who are far more likely to be depressed and attempt suicide than their cisgender peers. A 2015 report by the National Center for Transgender Equality found 40% of the roughly 27,000 transgender people surveyed had attempted suicide — almost nine times the average rate in the country.


Dr. Jessica Zwiener, an endocrinologist who works with trans youth and adults in Houston, told lawmakers in both her testimonies against SB 14 and the identical House Bill 1686 that her patients’ mental health dramatically improves once they start taking hormones — such as when trans girls take estrogen and trans boys take testosterone.

“They become more outgoing, they take better care of themselves, they try harder in school. They’re just happier; they can see a future,” Zwiener testified on SB 14. “Nobody talks about that.”

In 2021, the Senate passed a bill similar to SB 14, but that measure died in the Texas House. This year, though, a majority of House members have also signed on as authors or co-authors to HB 1686.

Spanning several hours on Monday, the House Public Health Committee’s discussion on HB 1686 is touching on similar debates as those of SB 14 regarding the science and research behind transition-related care for trans youth, including puberty blockers, hormone therapies and surgeries. The committee has also seen more pushback against social transitioning and psychiatric care for trans youth, particularly from Republican State Rep. Tony Tinderholt of Arlington.

“Would you agree with me that trying to psychologically transition these children is harmful to them, along with what the bill already covers?” Tinderholt asked.

State Rep. Tom Oliverson, the Cypress Republican who filed HB 1686, responded that they are “not neutral acts” — but noted that their “effects are a little less well understood than the effects of the medicines.”


Tinderholt also repeatedly asked medical providers to define woman — and whether they would “push” their patients and families to go to another state to access transition-related care, if the legislation passes.

On the other hand, the three openly gay Democrats sitting on the House committee — state Reps. Ann Johnson of Houston, Jolanda Jones of Houston and Venton C. Jones of Dallas — brought more lines of questioning for lawmakers and witnesses backing the bill. They also invoked their own personal stories to fight HB 1686.

“You may not remember the moment you found out you were straight. I remember the moment I knew I was gay and it’s because society told me there was something wrong about me,” Johnson said, pushing back against the argument that there’s an overwhelming reliance on youths’ self-perception in providing care. “I hope that this state will find a way to make decisions that [are] compassionate and protecting of all Texas children.”

At about 9 p.m. Monday, Johnson announced that under 100 people have registered in support of HB 1686, while over 2,700 are against the legislation. Of these figures, 470 people signed up to testify — though the committee had only heard from just over a dozen people by that point. A few hours earlier, hundreds of LGBTQ Texans and advocacy groups filled all three levels of the Capitol’s outdoor rotunda to rally against the legislation and the numerous other bills that target this community.

Meanwhile, SB 14 has moved quickly this legislative session. Hundreds of people debated the bill for hours on March 16. Senate Affairs Committee members voted 8-3 along party lines March 20 to advance it to the full Senate. Lt. Gov. Dan Patrick made the matter a priority for the Senate this year. The full chamber could vote on SB 14 this week.

The issue is fraught with vehement political division. SB 14 and similar bills are among a bevy of legislation Republican lawmakers are pushing that could upend the lives of LGBTQ Texans. During this month’s hearing on SB 14, GOP activist Steven Hotze went on an anti-trans tirade, calling doctors who provide this type of health care pedophiles. Sen. José Menéndez, D-San Antonio, asked Hotze not to lob baseless and incendiary attacks. Menéndez said trans people are “living their true selves.”


“That’s bullshit,” Hotze replied before he was kicked out of the hearing.

Care aimed at mental health

Transition-related care works to address mental health issues associated with gender dysphoria — the distress someone experiences when their gender identity doesn’t match the sex assigned at birth. Not all transgender people experience gender dysphoria, though depression and suicidal ideation are often worsened by the discrimination and stigma transgender people face.

Parents are involved in making decisions about the practices and treatments that make the most sense for transgender children. Doctors overwhelmingly follow a care timeline recommended by major medical associations. Many recommend waiting until a trans child can give informed consent, usually around age 16, before beginning hormone therapy. Medical providers are dissuaded from pushing young people to identify as transgender, socially transition or begin medical treatments.

Campbell said transition-related care does not help children overcome depression or anxiety related to gender dysphoria, even though several studies have demonstrated decreases in depression or anxiety symptoms for transgender youth receiving medical care that facilitates transitioning.

A study funded by the National Institute of Health and published in January — which followed over 300 young trans people for two years while they were receiving hormone therapies — found decreased symptoms of depression and anxiety and improvements in life satisfaction. There’s an abundance of research indicating transition-related care improves the mental health and well-being of transgender youth and adults. A recent survey conducted by the Washington Post and the Kaiser Family Foundation found 78% of the transgender respondents said living as the gender with which they identify has made them more satisfied with their lives.

Campbell did not return multiple requests for comment, but her statements in last Thursday’s hearing and her written support of SB 14 contained multiple claims that contrasted with guidance released by major medical associations and peer-reviewed research.


Campbell is a doctor herself. She received a medical degree from Texas Tech University. Campbell completed her residency in ophthalmology, a surgical specialty in eye disorders. She is also a board-certified emergency medicine physician, according to her campaign website.

Critics of puberty blockers and hormone therapies, including Campbell, say there isn’t sufficient data to indicate these treatments address gender dysphoria.

Megan Mooney, a licensed psychologist in Houston who represented the Texas Psychological Association in testifying against SB 14, said the science is clear about the mental health benefits of medical interventions, including puberty blockers and hormone treatments, for transgender youth.

Mooney also said there is data about the potential harms of delaying treatment, which shows that patients who receive transition-related care at later ages are at increased risk of suicidal attempts and self-harm.

“I urge you to consider what science tells us consistently: Gender-affirming medical care is the recommended, evidence-based approach to treat gender dysphoria in youth,” Mooney said in this month’s hearing. “This legislation will harm children as opposed to helping them.”

Zwiener acknowledged there aren’t large-scale studies stretching back decades about the long-term effects of puberty blockers and hormone therapy on transgender youth. She said that’s because, until recently, this care was relatively uncommon. She also said research institutions have not historically been interested in this area of study, given the stigma and lack of funding.


“The solution to ‘lack of data’ is more studies, not banning care — especially when the smaller studies and anecdotal evidence are overwhelmingly positive,” Zwiener said.

“A huge shift”

In this month’s Senate State Affairs Committee hearing, Campbell said puberty blockers, hormone therapy and surgery are permanent treatments. Puberty blockers are reversible after a person stops using them, and hormone therapies are partially reversible, major medical associations say. Minors can sometimes undergo surgeries on their breasts and chests — but only around ages 16 or 17, and only in specific circumstances after doctors weigh a patient’s situation with family support. Kids rarely, if ever, receive what’s called “bottom surgery,” or procedures involving their genitals.

Campbell claimed that most children will grow out of gender dysphoria with appropriate counseling. Opponents of transition-related care in Texas have pointed to studies that claimed roughly 80% of children with gender dysphoria eventually “detransition.” Working groups have found deficiencies in research supporting that statistic, including insufficient study sizes and unreliable sampling techniques.

A recent study published by the American Academy of Pediatrics followed over 300 trans youth over five years after social transitioning and found less than 3% of those children detransitioned.

“A lot of it just kind of comes down to the whole alternative facts thing, like what is true and what is not true,” Zwiener said.

Critics of transition-related care have called transgender identity a “social contagion.” Campbell and others have also suggested the significant increases in the number of children seeking transition-related care should raise suspicions.


“This leaves room to speculate a potential profit motive for those who perform these purely elective and very expensive procedures,” the Senate Research Center’s analysis of Campbell’s bill says.

Doctors who treat transgender patients say the growing visibility and social acceptance of trans people is driving the increasing numbers of youth identifying as transgender.

Zwiener said that adult patients in their 50s and 60s came to her after stumbling across the trans community online and realizing there were others who shared their same sense of identity.

Doctors who spoke with The Texas Tribune said medical providers closely follow guidelines established by the American Academy of Pediatrics, the World Professional Association for Transgender Health and the Endocrine Society when administering transition-related care.

Puberty blockers and hormone therapies, like many medical treatments, can have side effects. That includes bone mineralization and the potential for fertility loss. But doctors say the positive impact of transition-related care on mental health outweighs the risks of those side effects.

The families Zwiener works with are well aware of the side effects, even if the majority don’t have prior experiences with transgender people. But they’re following the medical guidance of professionals and the pleas of their children, Zwiener said, because parents want the best outcome for their kids.


“We’re talking about these [minor bone density issues] … when it’s just such a huge shift in these kids’ lives,” Zwiener said.

Walking a political tightrope

Campbell criticized Texas medical associations for supporting transition-related care, which she alleged harmed children. Those who oppose her SB 14 include the Texas Pediatric Society and the Texas Psychological Association.

The Texas Medical Association, though, has not taken a position. That group previously opposed similar legislation. But Dr. John Carlo, a member of the association’s board of trustees, said the group is remaining neutral in hopes that it can continue discussions with lawmakers and help shape the legislation.

TMA wants to ensure children already receiving transition-related treatments — approved by their medical team — continue receiving that care, Carlo said. This includes allowing any youth, including those from out of state, to continue taking hormone therapy or puberty blockers while hospitalized for an extended time in a Texas hospital, TMA President Gary Floyd said during the Monday hearing for HB 1686. The association also wants to make sure that doctors who provide the care don’t lose their licenses.

Carlo said TMA’s Council on Legislation is weighing each bill individually and making judgements that will best serve patients in Texas.

“We’re not essentially closing the door on any one argument, because I think at this point this is such a highly politicized topic,” Carlo said. “What we’re trying to do is maintain a basis of scientific evidence, look at it from the perspective of how we best take care of patients.”


Andrea Segovia, senior field and policy adviser for the Transgender Education Network of Texas, said people should be able to decide what’s best for their own health care with their doctors. The scope of transition-related care is different for every trans person, Segovia said, and is not a one-size-fits-all approach.

“This blanket approach that we see with this health care [ban], but also in general when talking about trans issues, affects people’s freedoms and liberties in the state of Texas, where we are the state that says freedom and liberty matters the most to us,” Segovia said.

Republican Texas lawmakers and officials — and far-right groups — have politicized several aspects of LGBTQ peoples’ lives in recent years. This legislative session, GOP lawmakers are also trying to severely restrict classroom lessons, school activities and teacher guidance about sexual orientation and gender identity. They are also pushing bills that would limit when kids can see drag shows and restrict the college sports teams that trans student athletes can join.

Earlier this year, the Tribune found that a small but influential cadre of activists and extremist groups have fueled anti-drag panic as they characterize all drag as inherently sexual. Those claims have then been used to justify legislation targeting the LGBTQ community as a whole, often under the guise of protecting kids.

After GOP lawmakers failed to ban puberty blockers and hormone treatments for trans kids in 2021, Republican Attorney General Ken Paxton issued a nonbinding legal opinion that equated transition-related care with child abuse. Gov. Greg Abbott then sent a letter to the Department of Family and Protective Services directing the agency to investigate parents who provided transition-related care to their transgender children. LGBTQ advocacy groups are fighting that directive, which a Travis County judge largely blocked last year. But Paxton earlier this month also asked that the injunction be lifted.

Zwiener said the threat of banning transition-related care has actually made doctors closely adhere to best practices and pay attention to their patients’ progress and outcomes — despite what opponents say about the field of care.


“People who support gender-affirming care are always very worried that it’s going to be taken away, or it’s going to be made illegal, and so people tend to do things very conservatively, very by the book,” she said.

Alex Nguyen and Maia Spoto contributed to this story.

Disclosure: The Texas Medical Association and Texas Tech University 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 Tribune’s journalism. Find a complete list of them here.

The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.


William Melhado is an Austin-based journalist and a 2022-23 Poynter-Koch media and journalism fellow. Originally from Boulder, Colorado, William graduated from Middlebury College with a degree in chemistry and taught science at a public high school in the Bronx, New York, while completing a master’s in secondary science education at CUNY Lehman College, also in the Bronx. William worked as an educator for five years, also teaching in international schools in Tanzania and Nepal, before changing careers to pursue journalism. He previously worked as a staff writer at the Santa Fe Reporter, an alt-weekly newspaper in New Mexico.

88th Texas Legislature

Texas Senate votes to defund libraries where drag queens read to kids as it tries to limit the performances kids can attend

The Senate expanded the bill targeting drag queen story hours to target all public funding for libraries. The upper chamber also approved a bill limiting other drag performances kids can see.



Drag queen Nadine Hughes performs in the Capitol Rotunda during the Youth Capitol Takeover last week. (Leila Saidane/The Texas Tribune(

This article originally appeared in The Texas Tribune

The Texas Senate on Wednesday approved two bills aimed at restricting drag performances that children attend or see. One of them, Senate Bill 1601, would defund public libraries where drag queens are allowed to read to children. The other, Senate Bill 12, bars kids from drag shows if the performances are overly lewd and lascivious.

SB 12, which is a priority for Lt. Gov. Dan Patrick this session, was approved in a 20-11 vote. Sen. Royce West of Dallas was the only Democrat to vote yes for SB 12.

SB 1601 was approved in a 19-10 vote on the chamber floor, with West also being the only Democrat to vote in favor of the measure. But the Dallas senator later switched his stance to a no vote, according to the Senate Journal. His office confirmed the change to the Texas Tribune, but didn’t provide a reason for it. Sens. Borris Miles, D-Houston, and Robert Nichols, R-Jacksonville, were present but did not vote on SB 1601.

Both bills now head to the House.

For months, Texas Senators have said their bills targeting drag shows are meant to protect children from sexually explicit performances.


Some Democrats, drag performers and businesses catering to LGBTQ Texans have fiercely pushed back against the implication that all drag performances are inherently sexual. They’ve also said some bills restrict free expression enshrined in the First Amendment as they’ve testified against bills in legislative hearings and rallied in opposition at the Texas Capitol.

And, bill opponents say, the Republican proposals are helping to fuel an overall backlash against drag — as performers have increasingly seen protests and threats coordinated against them by activists and extremist groups.

“We just need to understand that drag is not inherently sexual, and queer expression is not inherently sexual,” Austin-based drag performer Brigitte Bandit told the Tribune last month.

Amid some of the criticism, Republican Sen. Bryan Hughes of Mineola, who was the architect of some of Texas’ most conservative legislation in 2021, narrowed his legislative push to restrict drag shows. And this week, he secured formal Senate approval for his SB 12, which prohibits kids from seeing sexually drag shows only if they’re sexually explicit.

But the Senate also approved SB 1601, which could cut public libraries’ major source of funding if they let drag performers read to children. SB 1601 does not tie its financial penalties to the performers’ behavior — and essentially targets all libraries’ drag queen story hours, which are aimed at promoting literacy and encouraging children to read.

“It’s a very short bill, very straightforward bill,” Hughes said this week.


Hughes didn’t explicitly say what SB 1601 would protect kids from. Instead, during the bill’s Senate and committee debates, he brought up an example of the Houston public library hosting a registered sex offender as one of its storytime program’s drag queens because the library didn’t do a background check as evidence for backing the bill.

On the other hand, drag performers and their allies pointed out during the bill’s committee hearing that kids are more likely to be harmed by gun violence or sexual abuse perpetrated by church members.

Lawmakers, most of whom are Republicans, are pushing a bevy of bills during this legislative session that threaten to upend the lives of many LGBTQ Texans. The Senate last week approved a bill that would prohibit transgender kids from updating their birth certificate so that it matches their gender. GOP lawmakers want to limit classroom instruction, school activities and teacher guidance about sexual orientation and gender identity in schools. And also on Tuesday, the Senate gave final approval to a proposed ban on transgender kids accessing puberty blockers and hormone therapy.

Republican Sen. Drew Springer of Muenster successfully broadened SB 1601 to bar libraries from receiving any public money the year following any events in which drag performers read to kids. This means facilities violating the proposed restriction could lose revenue streams from their local governments — a crucial part of their budgets.

The Texas Library Association declined to comment on the expanded version of SB 1601.

Several Democratic lawmakers attempted to add a clause limiting the bill to only drag shows that exhibit a prurient interest in sex, mimicking the language that Hughes has pushed for in SB 12. But that effort failed.


“It’s always good for us to try to work together and try to accept amendments. I think we agree that we will not sacrifice the effectiveness of a bill just to achieve unanimity,” Hughes said Wednesday.

During a Senate committee hearing last month, Baylor Johnson, an Austin Public Library spokesperson, said the drag story time events hosted by his employer were age-appropriate and well-received by families.

The vote on SB 1601 immediately followed that of SB 12, which restricts drag performances in private business and public spaces. SB 12 bars kids from lewd drag shows and is a scaled-back version of other legislation that would have defined anyone in drag as being sexually explicit. Still, dozens of drag performers and their supporters overwhelmingly opposed the measures during the legislative hearing last month.

SB 12 is not an outright ban on drag performances and would not automatically classify all drag shows as lewd. Instead, the bill would levy a $10,000 fine on businesses that host drag shows considered sexually oriented in front of children. Performers violating the proposed restriction would also face a Class A misdemeanor, which could result in up to a year in jail, a $4,000 fine or both. The bill describes sexually oriented performances as including someone who is naked or in drag and “[appealing] to the prurient interest in sex.”

The bill, also filed by Hughes, doesn’t clarify what prurient means — though the U.S. Supreme Court has defined it as “erotic, lascivious, abnormal, unhealthy, degrading, shameful, or morbid interest in nudity, sex, or excretion.”

During the Tuesday debate, Hughes successfully introduced an amendment that scales down the bill’s proposed restriction for performances on public property. Under the new version, SB 12 would also apply to any sexually explicit performances — not just lewd drag shows.


“This amendment will accomplish the purpose of making sure that all obscene performances — any sexual performance inappropriate for a child, regardless of who is the performer, regardless of how they’re dressed — will be affected by the statute,” he said.

SB 12’s backers — many of them social conservative groups — say the bill is needed to protect kids from seeing sexually explicit content. During the Tuesday Senate debate on the bill, Hughes echoed that reasoning.

“What adults do is a separate matter — this bill is about protecting children,” Hughes said Tuesday.

SB 12 is more narrow when compared to other Republican proposals for restricting drag shows. For instance, Hughes’ other proposal, Senate Bill 476, defines drag shows more broadly as individuals wearing outfits or makeup that indicate a gender different from their gender assigned at birth while performing in front of an audience for entertainment.

This wider definition could have covered activities unrelated to drag such as a transgender person singing karaoke with friends in a bar, for example, or an actor wearing a costume as part of a Shakespeare play that involves wearing clothes traditionally associated with a different gender.

Drag performers insist that SB 12 is an attack on their First Amendment rights and say the bill’s language is imprecise, opening it up to multiple interpretations. During the Tuesday Senate debate, some Democratic lawmakers also characterized the bill as “overly broad.”


“The language in the bill is so purposefully vague that it could encapsulate many forms of queer art and try to shut them down,” Austin-based drag performer Lawrie Bird told the Tribune last month.

The bill’s opponents added that it would harm restaurants and bars that use drag shows to draw in more customers or charities that host these performances as fundraisers. The measure could particularly impact businesses owned by LGBTQ Texans, they said.

“We are small-business owners in Texas trying to make our living just like everybody else,” Bird said. “And we’re a huge part of the tourism and entertainment economy here.”

During the SB 12 debate Tuesday, Democratic lawmakers peppered Hughes with questions about what kind of performances the bill could ensnare. Democratic Sen. Roland Gutierrez of San Antonio prompted a long back and forth that raised questions about whether various scenarios could be considered sexually explicit. That included Gutierrez’ question about whether two men in drag kissing while walking in a Pride parade would be considered sexually explicit under the bill.

Hughes didn’t directly answer.

“Prurient interest in sex is well defined by the courts. You know that. Anybody on this floor, you and I both know — and that’s my answer,” he said. “It’s about protecting children.”


Gutierrez retorted that lawmakers should focus on gun violence instead if they want to protect kids. The San Antonio Democrat’s district includes Uvalde, where the deadliest school shooting in Texas occurred last year. Gutierrez has filed various bills this session seeking to limit access to guns.

“Listen, we could talk about protecting children all day long,” Gutierrez said. “You haven’t done a whole lot there.”

Gutierrez’s repeated comments about the lack of traction for his gun legislation drew rebuke from Patrick, who presides over the Senate. At one point, Patrick told Gutierrez that if he didn’t keep his remarks limited to the drag performance bill, the lieutenant governor may not continue letting him speak.

As bills focused on the LGBTQ community have moved through the legislature this year, drag performers, transgender Texans and community advocates have also questioned the sincerity of lawmakers’ claims that they’re trying to protect children. Many say legislators are further stigmatizing people.

“I’ve had shows canceled. We’ve had people show up with guns — that’s more terrifying to kids than me looking like this right now,” said Bandit last month, while donned in a bright pink floor-length gown and a big pink wig inside the Texas Capitol.

The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.


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88th Texas Legislature

Texas Senate scales back proposed restrictions on puberty blockers and hormone therapy for transgender kids

Senate Bill 14 would now allow trans children who are already receiving some transition-related treatments to continue getting that care. The Senate gave initial approval to the reworked legislation Wednesday.



People chant during the Trans Kids Call for HELP! rally in front of the Governor’s Mansion in Austin on March 13, 2022. (Lauren Witte/The Texas Tribune)

This article originally appeared in The Texas Tribune

The Texas Senate on Wednesday gave initial approval to a bill that would ban puberty blockers and hormone therapy for transgender youth wanting to gender transition if they are not already receiving such care. Major medical groups approve of such care and say it lessens higher rates of depression and suicide for trans youth.

Senate Bill 14 author Sen. Donna Campbell, R-New Braunfels, made a last-minute change on the chamber floor Wednesday that limited the scope of the legislation. The bill previously would have banned several transition-related treatments outright. On Wednesday, Campbell amended the legislation to allow children who are currently receiving puberty blockers and hormone therapies to continue such treatments if the bill is signed into law and takes effect.

That means SB 14 would ban puberty blockers and hormone therapies only for children who are not receiving it by early June.

The bill also bans transition-related surgeries, though they very rarely happen for trans youth. Health care providers also would not be eligible for financial reimbursement through Medicaid and the child health program for such treatments.

Johnathan Gooch, communications director for Equality Texas, said LGBTQ advocates and Texans are “deeply grieved” that SB 14 is advancing. He said it was “prudent” to allow kids already receiving puberty blockers and hormone therapy to continue such treatment but still considered the bill harmful.


“Trans kids of the next generation should not be disadvantaged because fear-mongering politicians decided to listen to their demons rather than their doctors,” he said in a statement to The Texas Tribune.

Campbell painted doctors providing transition-related care as opportunists capitalizing on a “social contagion” with treatments that lack sufficient scientific data that could determine whether the care is safe and effective.

But in an hourslong Senate committee hearing about the bill, medical groups testified about the wealth of scientific evidence backing mental health benefits of transition-related care for transgender youth. Trans youth who take puberty blockers are significantly less likely to experience lifelong suicidal ideation than those who want the care and don’t get it, according to recent studies.

Over the objections of hundreds of doctors, medical groups and LGBTQ Texans, Republican lawmakers have said the legislation is needed to protect children and that medical studies don’t support the benefits of such care.

“This is not science-based practice,” Campbell said Wednesday.

During the chamber debate, Democratic Sen. José Menéndez of San Antonio also introduced two floor amendments, including one that sought to ban conversion therapy, which aims to change someone’s sexuality. Both measures failed. The Senate voted 19-12 along party lines for SB 14, which is one of Lt. Gov. Dan Patrick’s priorities this session.


Under the amended bill, families have a shrinking window to begin this treatment before June 3.

Landon Richie, policy associate with the Transgender Education Network of Texas, said if the bill is “increasing the burden on families who may be in line for appointments to receive this care, but if time runs out before they receive it, they’re not going to get care in this state.”

Richie said many families don’t have the resources to leave the state to get this care, which will significantly restrict what treatment is available to address the mental health challenges trans youth experience.

The bill will make its way to the lower chamber after a final vote in the Senate. In 2021, a bill similar to SB 14 was passed in the Senate but died in the Texas House. But this year, a majority of House members — all of them Republican — have signed on as authors or co-authors to House Bill 1686, which is more restrictive than the new version of SB 14. HB 1686 amounts to an outright ban on transition-related care for kids. HB 1686 was debated Monday, but has not yet been approved by the House Public Health Committee, which includes three openly LGBTQ lawmakers, all of them Democrats.

The House legislation saw overwhelming public opposition, as more than 2,800 people registered against the bill while just under 100 people expressed support. The bill’s opponents criticized Rep. Stephanie Klick, a Fort Worth Republican who chairs the committee, for cutting off testimony before hundreds of people could testify against it in person. Though several trans youths and their parents were able to make their case to the lawmakers.

Sunny Bryant, a nine-year-old trans girl from Houston who testified late in the night, said she had to miss school to wait for her chance to speak.


“If you pass this bill and we stay in Texas, I’d grow up looking like my dad and that’s a scary thought,” she said to laughter in the room. “I want to grow up looking like me — nobody else, just Sunny.”

Some parents also spoke through tears about how this legislation, if enacted, would push them out of a state that they have deep ties to so that their kids could continue accessing hormone therapy and puberty blockers.

“I’d have no choice but to leave this state,” said Lisa Stanton, mother to Maya Stanton, a 12-year-old trans girl from Houston.

She has a job that could allow her to relocate, but her husband’s work is in Texas.

“We have literally been having conversations about whether we will have to separate and move somewhere else and have him just visit us on the weekends,” Lisa Stanton said. “This is ruining our lives.”

And for some older trans youth, the legislation is already making them rethink where they want to build their future. On the same day as the House committee hearing, Topher Malone, a trans high school senior from Round Rock, received Rice University’s notice about whether or not the Houston college had accepted her. But she didn’t bother checking to see if she was admitted.


“I don’t want to stay here for college anymore, because of what this state government is doing to trans people like me and I can’t stand it anymore,” Malone testified.

Sen. John Whitmire, D-Houston, arguing against SB 14, said he’s built relationships with families of trans youth and urged the Senate to leave decisions about gender-affirming care up to parents. He noted he’s been a lawmaker for 50 years, but this issue was only recently debated at the Capitol.

“I would pray that it’s not just politics but it’s genuine concern for the health and welfare of the transgender children,” Whitmire said. “Let’s remember that the transgender children are God’s creations and we love them.”

The bills restricting transition-related health care are among a slew of legislation Republican lawmakers are pushing that could upend several facets of LGBTQ Texans’ lives. During this month’s hearing on SB 14, GOP activist Steven Hotze went on an anti-trans tirade, calling doctors who provide this type of health care “pedophiles.” Menéndez asked Hotze not to lob baseless and incendiary attacks. Menéndez said trans people are “living their true selves.”

A new research brief by the Trevor Project, a national LGBTQ youth suicide-prevention organization, found that trans kids who come out before age 13 experience higher rates of discrimination, physical harm and suicide attempts than those who come out after that age.

“Right now, transgender and nonbinary young people in the U.S. are dealing with an impossible duality: visibility and understanding of trans people are at an all-time high, and yet, at the same time, they are witnessing a historic wave of anti-trans political attacks all across the country,” Dr. Jonah DeChants, senior research scientist at The Trevor Project said in a statement to the Tribune.


The study found that those whose gender identity is met with a high amount of family support have significantly better mental health outcomes.

“Taking even small steps to support the trans young people in our lives can be, quite literally, life-saving.”

William Melhado and Sneha Dey contributed to this story.

Disclosure: Equality Texas and Rice University 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 Tribune’s journalism. Find a complete list of them here.

The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.

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88th Texas Legislature

Texas bill advancing in the Senate would block minors from updating gender on birth certificates

Opponents of the bill call it a “power play aimed at making the lives of transgender children as difficult as possible.” The chamber is expected to vote on this legislation Wednesday.



A protester waves a transgender pride flag during a protest at the University of North Texas in Denton on March 23, 2022. (Emil Lippe/The Texas Tribune)

This article originally appeared in The Texas Tribune

A bill seeking to block transgender and nonbinary Texas youth from updating their birth certificate with their gender identity has received its first approval from the Texas Senate.

Senate Bill 162, filed by Republican state Sen. Charles Perry of Lubbock, proposes requiring an individual’s sex assigned at birth to be included on their birth certificate and limiting the circumstances in which this information could be changed for minors. The proposal lists very few exceptions.

“Senate Bill 162 prohibits sex listed on the birth certificate of a minor from being amended unless the change is to correct a clerical error or complete the birth certificate if the sex was not listed at the time of birth or if the child is intersex and the sex is later determined,” Perry said during the Senate meeting.

The Republican-controlled Senate preliminarily passed SB 162 on Tuesday with a vote of 19-11 after hearing no debate. The bill now awaits its final vote from the full chamber before it could advance to the House.

LGBTQ advocates said the legislation would make it impossible for trans and nonbinary Texas youth to update their birth certificate and subsequently other government documents — such as those required for identification for education, traveling and employment — with their gender identity.


“Birth certificates are a foundational document,” Sasha Buchert, a senior attorney with Lambda Legal, testified during the bill’s committee hearing. “And when people have identity documents — especially trans folks — that are inconsistent with who they are, it places them at risk of violence, bullying and even harassment.”

Beyond these dangers, this proposal could interrupt the process of enrolling in school, participating in extracurricular activities and applying for a passport — according to Ash Hall, a policy and advocacy strategist on LGBTQ rights with ACLU Texas who also testified against the bill at its committee hearing.

The process to change a minor’s gender on a birth certificate is lengthy and convoluted, Hall said. Currently, there is no difference in the process for minors and adults requesting a change to the gender marker on a Texas document — such as the sex listed on a birth certificate — according to a guide from the Texas Legal Service Center. The guide recommends that families seek the advice of an attorney for changes to a minor’s gender marker.

A court order is required to change gender markers on Texas documents. The decision to allow or deny a gender marker change resides with local judges, who have discretion over what proof is needed to confirm the change before issuing a court order.

Individuals seeking a gender marker change on their documents then present the court order to make changes to IDs, such as birth certificates or driver’s licenses.

The proposal would essentially erase trans and nonbinary youth from public life, according to the bill’s opponents.


“It’s already really difficult for trans people to update their birth certificates, and the vast majority of trans people are forced to live with inaccurate documents [that don’t] reflect who we are in the first place,” Hall told The Texas Tribune. “It’s deeply unnecessary, and it is only meant to harm.”

Jacqueline Murphy, a trans woman, testified during the committee’s hearing earlier this month that she was able to update her birth certificate as a minor — and that has made it easier for her to acquire identification for college enrollment and employment.

“The benefits for my peace of mind and physical safety cannot be overstated,” she said. “I expect the aim of this bill is to undermine the legitimacy of trans identity as a whole, particularly among children. … This is a power play aimed at making the lives of transgender children as difficult as possible.”

Hall added this bill includes vague language about designating the sex of intersex children. The bill would require those issuing birth certificates to fill in this field for intersex children “whose sex is later determined.” But missing from the legislation, Hall said, is when that determination is made.

“The intersex community, one of the basic rights they’re asking for is that their bodies not be operated on as infants when they can’t consent and that they get the opportunity to decide what their gender is, instead of having one forced upon them,” Hall said. The bill could eliminate the option for intersex children to change the gender initially determined for them.

Meanwhile, SB 162’s supporters said the bill is needed to “protect current laws that we have to actually protect biological sex,” such as existing restrictions in Texas on trans student athletes’ participation at the high school level. Senate Bill 15, which seeks to extend these restrictions to the college level, has also received preliminary approval from the full chamber — and there’s already enough support for the proposal in the House.


“It’s vitally important to know a person’s sex at birth,” said Jonathan Covey, policy director for the conservative group Texas Values. “It’s particularly important in light of fairness in women’s sports competitions.”

The bill’s backers also support Senate Bill 14, which was heard in the same committee hearing as SB 162 and dominated the meeting. SB 14 seeks to block trans kids from accessing transition-related medical treatments such as puberty blockers and hormone therapies. The ban would also include surgeries, though these rarely happen for youth.

SB 14 is also a priority legislation for Lt. Gov. Dan Patrick, who presides over the Senate. The full chamber is expected to discuss and vote on this legislation this week.

William Melhado contributed to this story.

Disclosure: ACLU Texas has been a financial supporter 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 Tribune’s journalism. Find a complete list of them here.

The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.


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