TRAVIS COUNTY, Texas (Nexstar) — For the first time since the law was passed, a state court heard from a Texas transgender teenager Wednesday about how that law that banning gender-transition health care for minors will impact him.
16-year-old Nathan Noe — a pseudonym he uses out of fear of being targeted — testified in a Travis County district court about how he felt uncomfortable in his skin before beginning hormone therapy to transition from female to male.
“It felt like something was wrong with me, or something wrong was happening to me, and I couldn’t describe that,” Noe said.
About two years ago, Noe began taking testosterone after seeking mental health care and said he and his family consulted with his primary care physician.
“When I started taking testosterone, it really improved my life to a point where gender dysphoria didn’t bother me as much,” he said. “It felt like a weight being lifted…I felt better about myself.”
Noe represents one of the five Texas families with transgender children as well as three doctors filed suit in July, marking the first legal challenge to Senate Bill 14 — a bill passed this legislative session that will prohibit transgender minors from getting healthcare to assist in their gender transition.
What is gender transition care, and what does the law do?
Gender-affirming care is a phrase used to describe medical care that affirms or recognizes the gender identity of the person receiving medical care. This can include puberty-blocking medication, hormone therapies or surgeries — although those are rarely performed on minors, Texas doctors who provide this type of care could also lose their medical licenses.
These treatment practices for children and adolescents have been supported by major medical associations in the U.S. — including the American Academy of Pediatrics (AAP), the American Medical Association (AMA), the American Psychological Association (APA), the Pediatric Endocrine Society (PES), the Texas Pediatric Society (TPS), and the American Board of Pediatrics (ABP) as best practices for care.
According to the AAP, 56 percent of youth who identified as transgender reported having thought about suicide at some point, and 31 percent reported a previous suicide attempt.
Republican lawmakers who wrote the legislation, however, argued restrictions on gender-transition care were necessary to protect children, who they say are too young to make possibly life-altering decisions.
“These are permanent decisions. They’re not decisions that are appropriate for children to be making, or for parents or their doctors to be making on their behalf,” said Rep. Tom Oliverson, R-Cypress, co-author of SB 14.
Oliverson, a physician, said he believes the scientific studies on gender transition care for minors are “experimental.”
Advocates for the transgender community have said outcomes for transgender kids have been positive, and say the law is already harming Texas trans kids’ mental health and will put their lives at risk.
“SB 14 is already terrorizing parents that just want to keep their kids safe and do the right thing so they can survive and thrive in Texas. They want to stay in Texas,” said Brian Bond, the CEO of PFLAG — an LGBTQ rights organization.
Some of the parents of trans kids who testified Tuesday said they felt as though their rights to choose what is best for their children have been stripped away.
Nexstar asked Oliverson to respond to this criticism, considering Texas Republicans have shown overarching support toward expanding parental rights on other policy issues. He said there are a variety of areas the state has long regulated in the “best interest” of children, citing the example of not letting parents sign off on minors’ getting tattoos.
“These children can’t even sign the consent for the treatment. They aren’t mature enough to be making adult decisions — to sign legal documents on their own behalf,” he said. “I don’t think this is about good parents or bad parents. I think that, unfortunately, we have a medical community that has followed very, very poor science.”
Noe said he is not sure what he and his family will do once the law goes into effect on Sept. 1, as many clinics in Texas that previously provided this type of care have shut down in anticipation of the law going into effect.
“I feel very helpless, and it makes me feel like I am going to have to go back to a place that I was really uncomfortable in,” he said. “This really saved my life.”
Differing medical opinions from doctors who testified
Lawyers for the Office of Attorney General called several physician expert witnesses on Wednesday — including a clinical psychologist and endocrinologist. Plaintiffs called the majority of witnesses and experts during Tuesday’s hearing, including parents of transgender children and pediatricians who discussed the benefits of gender-affirming care.
During Wednesday’s testimony, the state’s endocrinologist expert — Dr. Michael Laidlaw of California — discussed concerns he had about the long-term risks of puberty blockers and hormone therapy on minors. Endocrinologists treat disorders that stem from the endocrine system, which houses the hormone-producing glands in the body.
“There’s multiple risks for puberty blockers, one being puberty is time of rapid development of bone and bone density…it will flatline and leaves them at risk for osteoporosis. There are changes to the brain that happen under the influence of sex hormones which will be blocked,” Laidlaw said. “The potential benefits do not outweigh the risks.”
The California doctor noted puberty blockers are not approved by the Food and Drug Administration. Laidlaw said he had not treated any patients with gender dysphoria.
However, the plaintiffs’ medical experts disagreed with the notion that gender-transition health care put transgender youth at risk during their Tuesday testimony.
Dr. Aron Janssen — vice chair of clinical affairs at the Pritzker Department of Psychiatry and Behavioral Health at the Lurie Children’s Hospital of Chicago — said he has seen gender-affirming care to be positive, safe and effective.
“There’s a number of profound impacts of these interventions,” Janssen said in court Tuesday. “We see improvement in gender dysphoria. We see improvement in distress. We see improvement in mental health symptoms.”
Judge Maria Cantú Hexsel heard the final arguments in the lawsuit Wednesday. She has not yet indicated when she might issue a ruling. If Cantú Hexsel rules in favor of the plaintiffs — who are asking to block SB 14 from going into effect on Sept. 1 — the state is expected to appeal immediately.