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AUSTIN, Texas -- Gov. Greg Abbott (R) ordered the state's Department of Family and Protective Services (DFPS) to "conduct a prompt and thorough investigation" of any instances of sex-change procedures in children, saying such procedures constitute child abuse under Texas law.

to the state agency, dated February 22, also notes that state law requires the DFPS to investigate the parents of such children and requires "other state agencies to investigate licensed facilities where such procedures may occur." The letter defines sex-change procedures to include "reassignment surgeries that can cause sterilization, mastectomies, removals of otherwise healthy body parts, and administration of puberty-blocking drugs or supraphysiologic doses of testosterone or estrogen."

Abbott's action came in response to a by Texas Attorney General Ken Paxton (R) concluding that certain "sex change" procedures, "when performed on children, can legally constitute child abuse under several provisions of chapter 261 of the Texas Family Code." These procedures include those listed by Abbott in his letter.

The opinion also says that "It is important to note that anyone who has 'a reasonable cause to believe that a child's physical or mental health or welfare has been adversely affected by abuse or neglect by any person shall immediately make a report' as described in the Family Code. Further, 'if the professional has reasonable cause to believe that the child has been abused, the professional shall make a report not later than the 48th hour" after the abuse is discovered. Paxton adds that "The term ['professional'] includes teachers, nurses, doctors, day-care employees, [and] employees of a clinic or healthcare facility that provides reproductive services ... A failure to report under these circumstances is a criminal offense."

The Endocrine Society swiftly condemned Abbott's action. "This policy rejects evidence-based transgender medical care and will restrict access to care for teenagers experiencing gender incongruence or dysphoria," the organization . "Healthcare providers should not be punished for providing evidenced-based care that is supported by major international medical groups -- including the Endocrine Society, American Medical Association, the American Psychological Association, and the American Academy of Pediatrics -- and ."

"Medical evidence, not politics, should inform treatment decisions," the society continued. "We call on policymakers to rescind this directive and allow physicians to provide evidence-based care, including to prescribe medications to delay puberty."

The Human Rights Campaign, an LGBTQIA advocacy group, that transgender children are not undergoing irreversible medical changes, adding that Abbott's letter showed a "fundamental misunderstanding" of gender transition in children, "which is primarily about providing social support, using the right name and pronouns, and allowing them to present in a way that is consistent with their gender identity. Therapists, parents and healthcare providers work together to determine which changes to make at a given time that are in the best interest of the child."

"For transgender people, being denied critically necessary transition-related care can extend and exacerbate the stress and discomfort caused by gender dysphoria, leading to increased incidences of depression and substance abuse, as well as health complications caused by delaying care," the organization said. "Ensuring that transgender and non-binary people have access to trans-affirming healthcare is lifesaving. A from the Trevor Project provides data supporting this -- transgender youth with access to gender-affirming hormone therapy have lower rates of depression and are at a lower risk for suicide."

The Texas branch of the American Civil Liberties Union also panned the moves by Paxton and Abbott. "Paxton's opinion is not legally binding, and it remains up to the courts to interpret Texas laws and the Constitution," the organization . "Moreover, DFPS cannot remove any child from their parents or guardians without a court order. No court here in Texas or anywhere in the country has ever found that gender-affirming care can be considered child abuse. The opinion released by Paxton cites highly partisan, outdated, and inaccurate information that ignores ."

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