When Texas lawmakers gathered in Austin for the first time since 2021, Amber Briggle woke up 250 miles north, in Denton, and worried about her two kids. It was a chilly day in January, and both children were home with strep throat, and Briggle and her husband Adam strategized over who would take them to the doctor and who would pick up their meds. But her concerns ran deeper. In the afternoon, as homemade chicken soup simmered on the stove, Briggle sat at her kitchen table and composed seventy emails to state senators and representatives. Her message was simple: please don’t take my children from me.
Even before the Legislature convened, as it does every two years, Briggle, whose fifteen-year-old son is transgender, had seen a raft of bills prefiled by lawmakers targeting gay and trans Texans. She’d started a spreadsheet to track the progress of each piece of legislation. Some of the bills she’d flagged expanded on red-meat conservative issues that have captivated legislators since last session. Representative Valoree Swanson of Spring, for example, proposed a bill to make it illegal for transgender athletes to compete in scholastic sports, expanding on a similar bill she authored that passed in the 2021 session. Senator Charles Perry of Lubbock authored legislation to make it illegal for minors to change their sex on their birth certificate to match their gender identity. And multiple other Republican legislators filed bills calling for schools to remove books with LGBTQ characters from their libraries. These measures rankled Briggle, but she knew what her plan would be if they passed. She would stay in Texas and fight them.
There were, however, a set of bills that she didn’t think she could fight—“the ones that would basically turn me and my husband into criminals,” as Briggle put it. Four bills filed this year seek to change the state’s child-abuse statutes to include allowing children to receive health care that supports changing their gender identities. (The bills were filed by four right-wingers: representatives Cole Hefner of Mount Pleasant, Jared Patterson of Frisco, Nate Schatzline of Fort Worth, and Bryan Slaton of Royse City.) If passed, the proposed laws could lead to the surveillance, scrutiny, and even arrest of Texan parents with transgender children.
These bills seek to codify a nonbinding legal opinion that Attorney General Ken Paxton issued in 2022, declaring that certain forms of gender-affirming medical care constitute child abuse. Briggle had invited Paxton to her house in 2016: the attorney general and his wife, now a state senator representing a district just northeast of Dallas, sat at Briggle’s kitchen table, met her son and daughter, shared dessert, and left smiling. “He knows I’m not a child abuser,” Briggle said. But soon after Paxton wrote his legal opinion, Governor Greg Abbott instructed Child Protective Services to “investigate” families raising transgender kids, and a CPS caseworker showed up at her door. The agent interviewed the family and inspected the house. A lawsuit brought by Briggle and two other families in June halted the investigations. But the experience left her traumatized ahead of the legislative session.
For years, Briggle, who operates a massage studio, has dealt with her anxiety by staying busy: she has testified in the Texas capitol and met with lawmakers. (On Thursday, she will be featured in the Texas Democratic Party’s official response to Abbott’s “State of the State” address.) Around the new year, when her therapist asked her if she wanted to take some time to let out her feelings, Briggle told her, “Nope, I gotta get to work.” But as the Legislature met on the first day of its new session, Briggle couldn’t shake her awful feelings. After her kids were in bed, Briggle sank to the kitchen floor and began to cry. Her husband sat down next to her, and she pulled up her list of bills. “When one of these passes, we need to know: where are our important papers in the house?” she told her husband quietly. “Where are we going? What happens next?”
Over the last six years, Briggle has watched as more and more state officials targeted trans Texans. In 2017, Lieutenant Governor Dan Patrick championed the so-called “bathroom bill,” which would have made it illegal for Texans to use public building restrooms that didn’t match the gender on their birth certificate. Based on the false premise that men were pretending to be transgender in order to prey on girls in women’s restrooms, the bill stirred up a nationwide protest movement, with many major Texas-based businesses voicing opposition. While it passed in Patrick’s Senate, the bill failed in the House during a special session, after then-Speaker Joe Straus refused to bring it to that chamber’s floor, enraging Patrick.
Even as they say they champion “parents’ rights” in other contexts, including education, Republicans have spent hundreds of hours debating how transgender Texans and their families should live their lives. While a 2022 study found that the number of youth who identify as transgender has doubled in the last five years nationwide, only 1.42 percent of Texans aged 13 to 17 identify as trans, and only 0.71 percent of Texans older than 18 to 24 identify that way. The bills that target those Texans have often addressed hypothetical issues. Take Swanson’s ban on trans athletes, for instance. When legislators debated its Senate counterpart, Perry, the Republican Senator from Lubbock, admitted he knew of no cases of a trans student playing high school sports in Texas.
This year, instead of stirring panic about the alleged danger that trans Texans pose to others, a strident group of Republican lawmakers have expressed concern about the harm they believe medical transitioning could do to trans children. Fifteen bills have been filed this session targeting “gender-affirming care” for minors—the term doctors and medical associations use to describe health care that seeks to support patients in understanding their gender identities. These sorts of healthcare interventions include lifestyle changes, therapies, medications, and—in rare cases and only for older teenagers—surgeries. Such care is widely supported by the medical community and endorsed by organizations as varied as the World Health Organization, the American Psychiatric Association, the Texas Medical Association, and the Texas Pediatric Society.
While large-scale, long-term research into gender-affirming treatments have only recently begun in earnest, existing studies find low rates of regret. A major meta-analysis published in 2021 found that, among 7,928 patients who had received gender affirmation surgery, only one percent experienced regret; a 2022 study in Lancet of 720 participants found that 98 percent of those who took gender-affirming hormones as adolescents continued treatment into adulthood. Another landmark study in 2022, focused specifically on children, found that among 317 participants who socially transitioned between the ages off three and twelve, less than 2.5 percent had gone back to identifying with their gender assigned at birth after five years.
Some state officials, including Abbott, Patrick, and Paxton, have adopted a punitive tone that suggests they believe they’ve found a potent wedge issue. Abbott’s political adviser, Dave Carney, last year boasted that the governor’s targeting of transgender youth and their families was a “75 to 80 percent” political winner. For the most cynical lawmakers, the issue lets them rile up an anti-trans base with claims that they’re fighting the “sexualization of children,” but then also fend off accusations of bigotry by describing their bills as “saving the children.” However, it would be incorrect to claim that all lawmakers are insincere in their concern. Part of what’s made the issue so politically potent is the fact that many officials—as well as some parents and doctors—do have real, specific worries about children’s well-being as they’re treated for gender issues.
Take, for example, Brian Harrison of Waxahachie, who authored HB 776, which would outlaw physicians from treating minors with surgical procedures that address gender identity, medications to block the onset of puberty, or other hormonal treatments. Harrison boasts a background in public health that few of his colleagues can match: during the Trump administration, he served as the chief of staff for the U.S. Department of Health and Human Services, where he played a part in the administration’s response to the COVID-19 pandemic. During the last legislative session, Harrison took aim at vaccine mandates. In the last year, he’s shifted his focus and become one of the most ardent opponents to gender-affirming care for minors in Texas. “I disagree at a fundamental level even with the semantics here, for instance ‘gender-affirming care,’ ” Harrison says. “My oldest kid is eight. If I affirmed everything, or even half, of what my children want to do, I’d be the worst parent in America.” He notes his bill would not regulate whether adults can access such care.
Harrison says he felt shocked into action when he came to believe that young children were undergoing significant, irreversible surgeries, including phalloplasty and vulvoplasty (which are sometimes referred to as “bottom surgery”). Harrison says he’s seen photos online that purport to show children who have undergone these procedures. “When I saw them circulating on social media—and honestly, it’s hard to avoid them at this point—of these young, beautiful children post-surgery: those photos look like something out of a horror movie. They’re heartbreaking,” Harrison says.
There’s one problem with Harrison’s story: the photos do not evidence something happening to young children in Texas. Across the United States, medical guidelines already prevent gender-affirmation surgery for any prepubescent patient. The American Academy of Pediatricians has the official position that gender-affirmation bottom surgery should be reserved for patients older than eighteen, and that “top surgery” (mastectomies or breast augmentation) can be offered on a case-by-case basis for patients older than fifteen. Last August, PolitiFact tried to find instances of young patients receiving surgery, in response to claims from Florida Governor Ron DeSantis that surgeons were “literally chopping off the private parts of young kids.” It could only find a solitary example of someone younger than fifteen receiving top surgery—a double mastectomy. Reporters likewise found just one example of a patient younger than eighteen receiving “bottom surgery”: Jazz Jennings, a reality TV star, who underwent the procedure when she was just shy of her eighteenth birthday (Jennings socially transitioned when she was six years old).
The other focus of Harrison’s legislation is an actual treatment being offered to young children. His bill would also outlaw puberty blockers—which delay the onset of puberty and can give children and their parents valuable time to decide what their long-term plans are—and other forms of hormonal therapies, such as testosterone or estrogen. While hormonal treatments are safe and largely supported by the pediatric community—and have been offered for decades to children who hit puberty at a very young age—both doctors and patients acknowledge that hormonal treatments come with side effects. Even when working exactly as intended, they have significant transformative effects on bodies. This, especially for younger patients and their parents, means the treatment can pose complex and sometimes life-altering questions.
While Harrison says he maintains a strong belief in individual liberty, and that “parental empowerment” is one of his defining issues, he believes the state has an obligation to protect children from harm, including harm potentially caused by those children’s and their parents’ own decisions. And Harrison believes that hormonal treatments are dangerous. Citing his experience as the chief of staff for HHS, which oversees the Food and Drug Administration, he says that doctors are misleading families about the safety and efficacy of puberty-blockers and other hormonal treatments. “We don’t have enough clinical data on the adverse effects of these kids,” he says. “I’m unaware of a single one of these medications or procedures that are FDA-approved for the purposes they’re using it for. Medical professionals are using them off-label.” (While the FDA has approved multiple forms of puberty-blockers for use treating precocious puberty, none have been subsequently approved for use treating gender dysphoria. But off-label prescription of all types of drugs is common and legal, as Harrison acknowledges.)
The most aggressive bills filed this year argue that hormonal treatments are so extreme that doctors prescribing them or parents consenting to them are guilty of child abuse. Many medical professionals believe the treatments are safe. The FDA has declared these drugs as safe for young children to treat a variety of disorders, even though they have potential long-term side effects including growth spurts, effects on bone density, and potentially decreased fertility. What the FDA hasn’t evaluated is whether these drugs are effective in treating gender dysphoria, and what sort of effect that such a course of treatment might have on young patients’ mental health.
The sorts of difficult decisions and trade-offs young transgender patients and their parents must navigate are similar to the decisions any child and parent might have to make about medical care. Every day in Texas, families make major choices that will affect their children’s future health and well-being. The risks of playing high school football, for instance, can be greater than those of puberty blockers. Doctors prescribe children steroids—a form of hormonal treatment—for hay fever, hives, sprained ankles, and a host of other conditions. And while mastectomies have become more common in recent years as a treatment for gender dysphoria, the number of teens getting “top” surgery is still dwarfed by the number of teenage girls getting cosmetic breast enhancement surgery before they’re eighteen. Harrison and other Republicans have not filed legislation targeting hormonal or cosmetic treatments offered to young patients in these other common scenarios, remaining focused on doctors who help young patients embrace trans identities.
In January, Briggle watched the news as lawmakers strode into the Capitol and some began speaking about saving children from “sexualization” and “mutilation.” The Legislature fell into its traditional February lull, but after Abbott’s State of the State address, floor debates will begin in earnest. Briggle is racked with anxiety, looking for any hint about how likely each bill is to pass.
Scott Braddock, a veteran political journalist for Quorum Report, thinks it’s likely that trans issues will be entirely sidelined this session. He notes that while Republicans featured the issue prominently during the primaries, they mentioned it less often in speeches and commercials during the general election, focusing instead on fighting inflation and securing the border. He also notes that Republicans face a $32 billion distraction this year—the state’s enormous budget surplus, which lawmakers get to decide how to spend. “That’s going to take up a lot of the bandwidth at the Capitol,” Braddock says. “So, I think some of these [Republican] red meat issues will take a backseat to the financial discussions at the Capitol.”
Nonetheless, given the comfortable Republican majorities in both houses of the Legislature and the departure of centrist GOP leaders such as Joe Straus, there are no moderating forces to prevent any of these bills from passing. Indeed, gender-affirming care appears to be a top concern of some state leaders. In January, representative Steve Toth, who represents the Woodlands, accused Patrick of burying bills banning gender-affirming care in 2021. In response, the lieutenant governor shot off multiple press releases contesting Toth’s claims, and explained that the state Senate under his leadership was deeply concerned with health care for transgender Texans. When Patrick announced his thirty top priorities for the session on Monday, he included “Ending Child Gender Modification.”
Briggle will be watching closely. For years, blue-state liberals have aggravated her with one question many ask repeatedly, “Why don’t you just leave Texas?” The answer has always been simple: Denton is her home. She has a house there. She owns a business there. She enjoys what she calls her normal life in town: helping her son prepare for gymnastics competitions, cooking, posting photos of her homemade dinners. Texas is where she wants to raise her kids.
For the first time though, she’s asking herself the same question posed by her friends from other states. She says she hasn’t picked a destination yet, but she’s made a mental list of things to pack, in case the Legislature sics the police on her family.