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Texas Children's Hospital in Houston -- the nation's largest pediatric hospital -- will no longer provide gender-affirming care, including hormone therapies, to its transgender and nonbinary patients.

The decision came in response to a recent from Texas Gov. Greg Abbott (R) that called upon state welfare agencies to investigate pediatric gender-affirming care as child abuse, adding that "criminal penalties" would be issued to parties who failed to report cases involving such care.

In an emailed statement to MedPage Today, a spokesperson for Texas Children's Hospital wrote that the hospital's mission "is to create a healthier future for all children, including transgender children, within the bounds of the law."

"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," the spokesperson added.

It remains unclear if any other forms of gender-affirming care will continue to be offered at the facility.

Abbott's order cited a from the state's Attorney General Ken Paxton (R), who wrote that certain types of care -- including body modification surgeries, as well as hormone therapies and puberty blockers -- for trans/nonbinary youth are considered abuse under Texas law.

"There is no doubt that these procedures are 'abuse' under Texas law, and thus must be halted," said Paxton in a . "The Texas Department of Family and Protective Services (DFPS) has a responsibility to act accordingly. I'll do everything I can to protect against those who take advantage of and harm young Texans."

Surgical interventions for trans/nonbinary youth are extremely rare; any type of surgery typically associated with transitioning is only permitted when a person reaches the age of consent, has lived as their desired gender for at least a year previously, and has been approved by doctors and therapists.

Gender-affirming care for children mainly centers on the "social transition," which making non-permanent changes to one's gender expression, such as changing the way you dress, tucking to hide the appearance of genitals, or using a binder to flatten breasts; coming out to friends and family; and/or changing your name on legal documents.

Trans/nonbinary youth entering adolescence may have the option to take puberty blockers, or GnRH agonists, if they meet a number of criteria laid out in the World Professional Association for Transgender Health (WPATH) . According to WPATH, the use of GnRH agonists to suppress estrogen or testosterone production is a fully reversible intervention. Hormone therapies, which are partially reversible depending on what measures are taken, are reserved for older adolescents.

"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 in his legal opinion. This claim differs significantly from the existing literature, including a published last month in JAMA Network Open that found gender-affirming medical interventions for children were associated with lower rates of depression and suicidality.

Paxton's legal opinion also quoted a claim published on the for the Society for Evidence-Based Gender Medicine -- a group that has been of spreading misinformation about gender dysphoria and gender-affirming care -- which stated that "childhood-onset gender dysphoria has been shown to have a high rate of natural resolution, with 61-98% of children reidentifying with their biological sex during puberty."

The statistic cited a published in the Journal of the American Academy of Child and Adolescent Psychiatry. However, this study in full showed a strong association between the intensity of a child's gender dysphoria and the persistence of gender dysphoria later in life.

Texas Children's Hospital isn't the first healthcare facility in Texas to bend at the will of conservative backlash and threats of legal action. In November 2021, a Dallas-based program known as GENECIS that provided hormone therapies to trans youth was after being accused of child abuse.

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