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Texas Anti-Trans Legislation Has Mental Health Professionals Asking How They Can Still ‘Do No Harm’

Do no harm. The motto is the first line of the Hippocratic Oath taken by medical doctors and its sentiments resonate to all service professionals’ codes of ethics. Therapists, social workers, counselors, teachers, and mental health professionals work to first and foremost do no harm. We work to help heal and support others, especially those who are the most vulnerable of our population — children and even more-so trans children. So when Texas state attorney general Ken Paxton and other law makers consider gender-affirming surgeries and medically-accurate care for trans children ‘child abuse’ while state governor Greg Abbott orders the Texas department of family and protective services and all mandated reporters to investigate families who support trans children’s medical needs, this call to heal feels threatened.

In 2021, authors Almazan and Keuroghlian asked: “Are gender-affirming surgeries associated with better mental health outcomes among transgender and gender diverse (TGD) people?” and found that transgender people who received one or more gender-affirming surgical procedures had a 42 percent reduction in the odds of experiencing past-month psychological distress, and a 44 percent reduction in the odds of past-year suicidal ideation. You can read the complete study in the JAMA Surgical Journal. Although there is a clear benefit for trans and gender diverse people in having access to affirming surgery, for children gender affirmation is typically less surgical and more psychological and social.

Rafftery, et al (2018) in the American Academy of Pediatrics journal found that medically suppression of puberty with blockers can reduce distress for trans children who do not want to develop secondary sexual characteristics (i.e. breasts, Adam’s apple, voice change, etc). Using hormone therapy pubertal suppression can lead to improved psychological functioning. If medicalized affirmative care is not provided, significant reduction in psychological impairment was also found when a trans kid was able to socially transition and received support from their own family unit. Familial support along with community building and affirming mental health care helped create a solid psychological springboard for adulthood. By mandating affirmative care as ‘abuse’ politicians have condemned trans children, their families, and those of us who support their actual well-being.

Every single person has their own bias, therapists, counselors, medical professionals, teachers and social workers included. And at the end of our grueling schoolwork, internships and days of paperwork documenting medically necessary interventions, we all have vowed to do no harm. As mandated reporters we are required to break confidentiality when a person wants to harm themselves or harm another person, has intent and a plan.

And at the end of our grueling schoolwork, internships and days of paperwork documenting medically necessary interventions, we all have vowed to do no harm.”

This ban harms trans kids directly and affects how Texan mental health professionals can support their trans clients and families. Under the directive, as mandated reporters, helping professionals can be reported and have licenses – which are often tied to the ability to work and sustain employment- suspended while being forced to attend court for the violation. Fortunately, there are five District Attorneys in Texas who state they will not prosecute cases brought forth under this ban; however, the fear, time, and potential threat of loss could be enough to coerce mental health professionals in going against their oaths to do no harm. And all of this happens to the detriment of trans children.

Children. Children who want to be seen, heard, validated, and celebrated — just like any other child. A child who has to learn to be comfortable with who they are as the figure out who they are, while existing in a society that often does erases and invalidates their existence. Trans children have a right to exist in euphoric childhood bliss just as any other child, and instead are consistently silenced and harmed by policies like Abbott’s order or bills like Florida’s #DontSayGayBill.  As Dr. MaryJo Podgurski– President and Founder of the Academy for Adolescent Health, Inc. says, ‘’Each person is a person of worth. This includes trans, non-binary, gender non-conforming, questioning and two-spirit young people.”

Trans children deserve to know that they are worthy too- worthy of love, worthy of affirmation, worthy of social acceptance, worthy of safety, and worthy of a life free of suffering.

What can you do?

For health professionals: Write your licensing boards and ask them to publicly denounce this ban and use their lobbying power to call for an end to this oppressive and harmful mandate. State and national boards of Marriage and Family Therapist, National Association of Social Workers, National Board of Certified Counselors, The American Academy of Pediatrics, The American Psychological Association and American Academy of Family Physicians are places to start.

Also, visit Equality Forward to fill out this form telling Texas Department of Child Protective Services that investigating families for abuse is wasteful of time, effort and money while being detrimental for the mental health of trans children and their families. Let DCPS of Texas know that they should not be investigating families.

You can use your privilege, if you say you are an ally to LGBTQ+ community, you can use your privilege to act out against harmful legislation that affects the people around you. You can recall a time when you might have been targeted, maybe even harmed, for simply existing and use that tenacity to protect others who need support now.

Before you go, check out our favorite and most affordable mental health apps available:


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