A look at the future of hormone therapy in Texas


Clara Thompson

Three categories of interventions are available for adolescents with gender dysphoria.

Clara Thompson, Staff Writer

When J.C. was born, he said he was assigned the wrong gender. He began doubting his gender when he was 14, and throughout high school, he kept this struggle a secret. He grew up in a first-generation Hispanic household in Laredo, Texas, where conservative, Catholic family values dictated almost everything the family did.

Not surprisingly, he ran into a wall when he began looking into transitioning.

“I’m not exactly living in a supportive household, so that stopped me from looking into hormone replacement therapy seriously, so it wasn’t something I was planning to do yet,” J.C., who asked to be identified only by his initials, said.

Hormone replacement therapy is a part of the transition process for transgender people where a doctor prescribes medicine that blocks the body from producing either testosterone or estrogen, depending on whether the person was assigned male or female at birth. The doctor then will prescribe the corresponding hormone for their gender identity – testosterone for transgender masculine people and estrogen for transgender feminine people.

While not every transgender person medically transitions using hormones, this is an option J.C.  is actively seeking out. Hormone replacement therapy is considered a mainstay treatment in many patients with gender dysphoria, which is when a person’s gender identity doesn’t match with the sex assigned to them at birth and is proven to reduce said dysphoria and anxiety in transgender patients.

Despite a plethora of studies and research that outline the benefits of hormone replacement therapy, conservative politicians have been seeking to prevent others from getting it.

On March 1, Dr. Megan Mooney and “Jane, John, and Mary Doe” sued Gov. Greg Abbott and the Texas Department of Family and Protective Services after the governor ordered the department to investigate the families of transgender children as child abusers, according to the lawsuit.

Abbott’s order came after Attorney General Ken Paxton published an opinion that surgical procedures, such as vasectomies and mastectomies, as well as hormone replacement therapy, constitute child abuse under chapter 261 of the Texas Family Code when performed on a child.

“There is no evidence that long-term mental health outcomes are improved or that rates of suicide are reduced by hormonal or surgical intervention,” Paxton wrote.

But a group of doctors published an article in the Journal of Adolescent Health in December that found access to gender-affirming hormone therapy lowered depression rates and suicides within the transgender youth community, undercutting Paxton’s statement regarding hormonal intervention.

In the study, researchers recruited  more than 34,000 LGBTQ+ people, aged 13-24, via social media. Researchers concluded that, compared to those who wanted gender-affirming hormone therapy and did not receive it, those who received the therapy were significantly less likely to exhibit signs of depression and suicidality.

Data visualization shows the results of a study published in the Journal of Adolescent Health. Transgender youth who wanted and received gender-affirming therapy had lower rates of depression, thoughts of suicide and attempted suicides.
Transgender youth who want and receive gender-affirming hormone therapy have lower rates of depression, suicidal thoughts and suicide attempts, according to a study published in the Journal of Adolescent Health. To read the study, go to jahonline.org/article/S1054-139X(21)00568-1/fulltext. (Clara Thompson)

According to Paxton’s published opinion, medical interventions such as surgery, hormone replacement therapy and puberty blockers are dangerous and should not be available to minors. Paxton said allowing minors to take these medicines is akin to “forced sterilization” and constitutes child abuse. His opinion cited historical sterilization of people of color and a 2020 case in England, which was overturned in 2021.

Puberty blockers are supported by the Endocrine Society and the World Professional Association for Transgender Health for children who want to delay and possibly prevent changes that occur during puberty, including breast growth, facial hair growth, periods, voice deepening and widening hips, according to the St. Louis Children’s hospital. These puberty blockers are completely reversible, as once the medications are out of a child’s system, normal puberty changes occur and do not cause infertility or sterilization, contrary to Paxton’s claims.

Hormone replacement therapy for minors is considered a “partially reversible procedure” by the World Professional Association for Transgender Health and is typically agreed upon by an adolescent patient, their family and a treatment team. Informed consent is listed within professional guidelines for childhood and adolescent hormone therapy as well, and if a child or adolescent appears to not be able to give informed consent, treatment is withheld.

Irreversible interventions, which include sex-reassignment surgery, are listed in the guidelines as inadvisable until the patient reaches the legal age of majority, which in Texas is 18.

In Texas, access to gender-affirming hormone therapy is typically from a reproductive health provider such as Planned Parenthood. Individuals can also get this therapy from an endocrinologist and from certain online and phone services. These services typically require permission from a licensed mental health provider to start gender-affirming hormone therapy and have a long waitlist for treatment.

While he isn’t a minor, J.C. said he still faces many of the same obstacles regarding his access to gender-affirming hormone therapy. In the meantime, as J.C. waits for his turn for this treatment, he must settle for a social transition and fears that won’t be adequate.

“It’s really hard for me personally to walk around campus and be comfortable with myself,” J.C. said. “I definitely feel like I do not pass at all. If I was able to get HRT, this would probably be a different story.”