Parental custody fights don’t typically grab the attention of the press, politicians, and a governor. But for Jeffrey Younger and Anne Georgulas, a couple from Coppell, Texas, whose marriage was annulled in 2016, a custody dispute over their transgender seven-year-old has sparked the ire of conservative politicos and right-wing media.

Georgulas has fought for custody of the couple’s twins, one of whom was assigned male at birth and now identifies as a girl named Luna. Younger, however, claims the child actually identifies as a boy and the mother is trying to “manipulate” the child into a “false gender self-identity.” The father sought to prevent Georgulas from pursuing trans-related medical and psychological care for Luna.

Dismayed by the prospect of his child’s transition, Younger launched the now-defunct website SaveJames.com, where he posted a “dossier” accusing his wife of “abusing” Luna by subjecting the child to “chemical castration” and “pumping them full of hormones.” His site’s story went viral on right-wing media—including The Daily Wire, Church Militant, and Life Site News—before inspiring public comment from Texas Representative Dan Crenshaw, Texas Senator Ted Cruz and eventually, Texas Governor Greg Abbott, who pledged to investigate the abuse allegations.

The custody hearing was decided by a jury, a common practice in Texas, and it awarded full custody of the twins to Georgulas in an 11-to-1 ruling last month. Two days later, Family District Court Judge Kim Cooks reinstated the parents’ joint custody—an outcome that Texas family courts typically favor—and appointed a facilitator to mediate the parents’ decisions about Luna’s medical care.

The medical and legal communities largely agree that parents should let children explore their gender identity. But this case raises concerns that unsupportive parents, conservative politicians, and sympathetic judges could try to legally stop trans youth from receiving care, a reality that threatens to lead to tragic outcomes.

Luna’s mother is doing nothing out of the ordinary for parents of trans kids

Younger’s allegations of child abuse against Georgulas might sound credible if you believe his claims about chemical castration. But conservative media often distorts information about treatment options for kids who express gender dysphoria or a desire to transition, said Mary Romano M.D., from the Vanderbilt University Medical Center, which specializes in trans youth. They also misreport the low risks that typically come with those options.

It takes more than a young child simply asserting that they’re the opposite sex to declare them as trans. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) says that truly gender dysphoric children must insistently declare they are the other sex. Therapists and medical providers refer to this as “insistent, persistent, and consistent”—that is, a child’s transgender identity must be repeatedly and continuously asserted over many years, not just a brief period before any medical professional renders any kind of treatment.

Most of these kids will continue seeing their regular pediatrician for years before anyone ever sets foot in a trans-related clinic or specialist’s office.

Most family pediatricians will tell families, “The best thing you can do is let your child express themselves and see where it goes,” Romano said. Some kids may never end up identifying as trans but will merely express themselves in a way that’s not stereotypically gendered.

If a kid does end up as trans-identifying, they’re first encouraged to publicly express their gender identity and see a therapist. When the child reaches puberty, they can receive “puberty blockers” to stave off the irreversible physical changes that come with puberty.

These blockers simply delay puberty’s onset so that the patient and family have more time to explore the child’s identity.

“We have years and years of data to tell us that nothing wrong and nothing bad happens to those kids,” Romano said. In fact, the same medication has long been used to help kids who prematurely start puberty at ages 4 and 5. “We are not trying out some new medication.”

The medication’s risk on pubescent children are minuscule, Romano said, especially when compared to the mental health risks for trans children who aren’t given care at all.

Denying affirming care to trans youth literally puts their lives at risk

It’s this last point that seems particularly worrisome. As Abbott and his cohorts sic state child abuse investigators on Georgulas, Republican Kentucky state Rep. Savannah Maddox is drafting legislation to (in her words) “protect children under the age of 18 from gender reassignment surgery or from receiving drug treatments designed to alter their natal gender.”

“Any such legislation would carry a body count [and…] empower parents to reject what they are being told by doctors,” said Gillian Branstetter, a spokesperson with the National Center for Transgender Equality. She added that it’s “wildly inappropriate” for politicians and commentators to insert themselves into a private family matter and use a child to score political points—something which has only increased among the right-wing media and white supremacist groups in recent years.

Such a bill would create an environment where trans-supportive parents and health providers risk legal, social, and political persecution for trying to care for trans-identified children.

“We don’t have to wonder what the cost of rejecting trans youth looks like,” Branstetter said. Results from the 2017 Youth Risk Behavior Survey showed that trans youth are already three to five times more likely than their cisgender peers to experience sexual or physical violence, nearly twice as likely to experience depression and five times more likely to attempt suicide.

Conversely, a 2010 study in the Journal of Child and Adolescent Psychiatric Nursing showed that familial support can make such suicide attempts 50 percent less likely. A 2015 study by The Endocrine Society also showed that recognizing and treating gender dysphoria lessened mental health problems in more than 75 percent of trans youth.

Branstetter said that this is a medical issue, not a political one. She predicts courts will likely side with healthcare providers, who generally recommend allowing children to explore their gender identity despite attempts by anti-trans politicians and parents to frame trans-affirming care as “child abuse.”