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Texas Children’s Hospital has stopped prescribing gender-affirming hormone therapies—a move that could affect thousands of transgender children in Texas—in response to a controversial directive from state leaders to investigate medical treatments for transgender youth as child abuse.

The nation’s largest pediatric hospital revealed the decision Friday, dealing a blow to parents of transgender children who were seeking access to medicine that slows the onset of puberty or hormone treatments that help older children develop into bodies that match their identities.

“The mission of Texas Children’s Hospital is to create a healthier future for all children, including transgender children, within the bounds of the law,” the hospital said in a statement. “After assessing the Attorney General’s and Governor’s actions, Texas Children’s Hospital paused hormone-related prescription therapies for gender-affirming services. This step was taken to safeguard our healthcare professionals and impacted families from potential criminal legal ramifications.”

Armed with a nonbinding opinion by Attorney General Ken Paxton, Gov. Greg Abbott last month ordered the Texas Department of Family and Protective Services to investigate parents who seek gender-affirming care as child abusers. Earlier this week, a Travis County district judge stopped the state agency investigating from the parents of a 16-year-old who underwent gender-affirming care.

But the court stopped short of blocking such investigations statewide — at least for now.

Paxton’s opinion followed multiple failed attempts by Republican state lawmakers in the GOP-led Texas Legislature to pass measures that would punish parents and health care providers who support such interventions.

Abbott and Paxton, who are Republicans, are both seeking re-election and made these announcements shortly before Tuesday’s GOP primary.

Most major professional medical organizations support evidence-based care for treatment of gender dysphoria, which is defined by the American Psychiatric Association as psychological distress and anxiety due to a mismatch between a person’s sense of their gender and their assigned sex at birth. According to the American Medical Association, gender-affirming care has been linked to dramatically reduced rates of suicide attempts, a decrease in depression and anxiety, reduced drug use, improved HIV medication adherence and a drop in harmful self-prescribed hormone use.

Dr. Moira Szilagyi, president of the American Academy of Pediatrics, said parents trust pediatricians to help their children stay healthy and thrive.

“What is happening in Texas directly undermines the care pediatricians provide their patients,” Szilagyi said in a statement after Paxton issued his opinion. “This harmful directive leaves families seeking gender-affirming care in Texas with nowhere to turn.”

There were an estimated 13,800 transgender kids in Texas between the ages of 13 and 17, according to a 2017 study from the University of California, Los Angeles.

Lou Weaver, a transgender man in Houston and community advocate for transgender children and adults, said very few facilities offer gender-affirming care for children. Texas Children’s is among the biggest programs in the state that offer it, he said.

“This is a truly frightening time for trans youth and their parents and guardians,” he said. “The doors to lifesaving health care are literally being shut in their faces.”

According to reports, GENECIS, a program at Children’s Medical Center Dallas that offers hormone treatment for transgender youth, last year stopped taking new pediatric transgender patients.

Weaver said teens who already have a prescription for hormone-related therapy should be OK, but those who haven’t begun puberty blockers or hormones would have to seek help elsewhere. He said people in the community are already going into a “headspin,” especially after Texas Children’s announced the official pause.

“They are likely already planning whether they’ll have to go out of state or to Mexico for care,” he said.

One Houston mother who asked not to be identified for safety reasons said her preteen transgender daughter has been undergoing blood tests at Texas Children’s to keep tabs on the onset of puberty.

The hospital on Friday informed her that her daughter can still undergo blood tests, but doctors will not be able to prescribe puberty blockers.

The mother said she is looking for appointments with a specialist at UCLA.

Another mother who asked to remain anonymous said she drove from her Dallas-area home to Texas Children’s on Monday to explore treatment options for her transgender child. The mother had sought appointments at GENECIS but the program had already stopped accepting new patients.

At the mother’s appointment, a doctor told her that the hospital’s legal department said they can no longer prescribe gender-affirming care.

“I think this particular issue is just so shocking and painful because it’s such a cruel assault on children,” she said. “It’s just very hard to put into words. There’s such a callous disregard for the mental and physical affects on children.”

Taylor Goldenstein contributed to this report.

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