For about six months, as their 4-year-old became increasingly despondent and withdrawn, Liz and Eugene would sit on the back porch of their Houston home, trying to figure out what was happening and how they could help.
Like most parents, when Cal was born the couple had imagined a future for the child they thought was their son. Eugene, a big football fan, had even joked to a friend that he had a linebacker in the family. But from the time Cal could talk, she asked for a “princess dress” and other feminine outfits. As she got older, she preferred Barbies over super heroes. After her fourth birthday party, Cal said the gifts she received — action figures and toy trucks — must have been intended for her younger brother. She wanted nothing to do with them. She said her clothes were uncomfortable and she “hated” wearing them.
For a while, Liz and Eugene told themselves Cal was just curious and exploring the world around her. They thought it might be a phase — until the insatiably curious Cal became uninterested in learning, avoided making eye contact and tried not to be seen. Trying to conform to gender expectations was causing Cal significant pain, and they realized she needed to know that they accepted and loved her for who she was. They had to be her safe space.
“It was painful to see our child go through that,” said Liz, a therapist who treats traumatized children in foster care. She found affirming therapists and medical providers. They allowed Cal to socially transition, and enrolled her in a day care and a scouting program that accepted her for who she was. Relatives also embraced Cal: Her first “princess dress” was a gift from grandma, and both sets of grandparents attended Pride events with the family.
Political leaders in Texas have targeted such affirming care as child abuse, threatening parents and clinicians who provide it.
In February, based on state Attorney General Ken Paxton’s nonbinding legal opinion that affirming care is “child abuse,” Republican Gov. Greg Abbott ordered the Texas Department of Family and Protective Services to investigate parents whose children are receiving gender-affirming health care, under threat of a foster care removal.
Social workers launched investigations almost immediately, according to a lawsuit filed by the American Civil Liberties Union. A district court has temporarily halted the investigations, with a final ruling expected in July. In the meantime, Paxton appealed the stay to the Texas Supreme Court, which has not yet ruled on the matter.
Access to affirming health care has become increasingly difficult following Gov. Abbott’s directive, as medical practitioners fear criminal penalties. The state’s three largest providers of gender-affirming care have either restricted their services or stopped providing hormone treatment, including Houston’s Texas Children’s Hospital, which announced it was halting hormone therapy for trans youth to protect doctors and nurses from “legal ramifications.”
Condemnation was swift, from the White House to the U.S. Department of Justice, which said denying access to affirming care may be a violation of federal law. More than half a dozen child abuse investigators told The Texas Tribune they’ve resigned or are looking to leave the Texas Department of Family and Protective Services as a result of the governor’s anti-trans directive.
Weaponizing foster care?
Earlier this month, Cal, her brother Clark and her mother Liz agreed to speak to a reporter working for The Imprint. They allowed a journalist to spend hours in their home, and spoke freely about their situation on the condition that their identities be kept confidential. They are being identified by middle names, chosen names and nicknames.
Liz, who has dedicated her career to helping repair the damage caused by childhood trauma, has a unique perspective. She is one of relatively few therapists in the area who treat patients younger than 5 suffering from trauma.
Using foster care — which is supposed to protect abused and neglected children — to target trans youth is a betrayal of the sanctity of Texas families, she said.
The Texas foster care system has been under court order for more than a decade for multiple abuses of children, including allowing them to sleep in county offices and sending them to residential programs where they’ve been assaulted by staff. An ongoing class-action lawsuit also highlighted the dire lack of mental health services for foster youth, up to one-third of whom identify as LGBT, according to recent studies.
Liz said it would defy logic to remove children from loving and accepting families because they are receiving widely approved gender health care, only to put them in an overburdened and troubled foster care system.
Until recently, even with its troubles, Liz believed staff at the Department of Family and Protective Services, including many of its leaders, tried to do what is best for Texas children. She worked closely with case workers and felt comfortable reporting when she believed a child was being abused.
Her professional relationship even led to her family welcoming one of the department’s home studies, a review allowing them to care for an infant in the child welfare system, whose foster parent needed some respite assistance.
Liz knew she had to protect her daughter and her patients who are in foster care last month, when the Texas Department of Family and Protective Serices placed on administrative leave one of its own employees who has a transgender child, and launched an investigation into the family.
Fearing an abrupt disruption in her patients’ care, should authorities open an investigation into her family, Liz began looking for other therapists who would take them. She will soon stop accepting Medicaid-funded payments for foster youth, and is no longer accepting referrals from the foster care system. She also said she will not report children who are receiving affirming care.
“It would not be ethical to place a CPS call on a family solely for following best practice medical or mental health care,” Liz said.
Children begin to develop gender consciousness and identity as young as age 2. Affirming health care provides a spectrum of closely monitored services, ranging from mental health support for youth who are socially transitioning, to the age-appropriate use of reversible puberty blockers or hormone therapies. Affirming care is endorsed by major medical associations, including the American Academy of Pediatrics, the Endocrine Society, and the American Medical Association.
She said threatening to investigate families who love and accept their trans youth — and denying them the medical and mental health care they deserve — is abuse. Forcing children to deny who they are is “deplorable,” she added, and is known to lead to self-destructive behaviors, such as self-harm, drug abuse, suicide and eating disorders.
Sitting in her tree-shaded home on a quiet residential street, most of its walls adorned with family photos and her children’s artwork, Liz says she tries to hide from her kids the constant fear she now feels.
“I save the crying for when they go to bed,” said Liz, adding that sleep is fleeting. “It sucks. It’s terrifying. It is exhausting, because I am constantly saying: ‘What else can I do to make things safer?’”
‘I love and value my child right where she is’
For her part, Cal’s anxiety and depression grew as she became more desperate to fit the mold of what society expected from her. It started taking two to three hours for Cal to go to bed at night. “She was crying and pleading with me: ‘When will I like boy stuff?’” Liz recounted.
“Whenever people say we wanted our child to be like this, I say: ‘I love and value my child right where she is and I will always love and value her right where she is,’” said Liz. “No one would want this type of attack from the state or from their family or from their peers.”
Affirming a child’s identity, for example using appropriate pronouns or supporting social transition, and assuring children that they are loved and valued is imperative to their mental well-being, according to Supporting and Caring for Transgender Children. The 2016 resource guide was produced by the Human Rights Campaign Foundation, the American Academy of Pediatrics, and the American College of Osteopathic Pediatricians.
Cal’s family has done just that. Her parents worked to “rediscover what our family looks like,” Liz said. Cal had initially tried to hide the depth of her despair from her dad. But Eugene ended up being the first member of the family to call her by her chosen name.
After school on an early April afternoon, 8-year-old Cal and her brother, Clark, who is 7, put their backpacks away, said “hello” to the family’s dog and cats, and looked through the mail, which was mostly children’s magazines about animals. Between conversations about video games, recess and books, they shared how they feel about the state’s threats against their family.
Clark occasionally accompanies Liz, Eugene and Cal to LGBTQ advocacy events and understands Cal’s transition. Advocacy isn’t his favorite thing to do, he said, but he thinks people should stop being “mean.” Clark said if he could talk to people who advocate for laws that could hurt Cal, he would tell them to “be nice, she is my sister. She’s pretty good once you get to know her.”
He added: “And then I’d protect her.”
Cal is a high-achieving second-grader who loves reading, genealogy, geography and animals — as long as they “aren’t the kind that can kill you.” She is a Girl Scout and likes “to do this and that as much as other people do.”
When asked what she thinks about people who suggest her parents have abused her by allowing her to transition, she rolled her eyes and said: “Oh my God. Of course they love me. They helped me get through it.”
Cal said she is angry about attacks on families like hers and she wishes people would leave them alone: “We’re just a normal family who just goes on with our daily lives.”