The claim: "During our last session, our legislators decided to pass a law protecting Texans from e-cigarettes until they reach the age of 21. They left children able to be sterilized and mutilated at any point in their life. This was a failing, and we need a remedy.” — Cindi Castilla, president of the Dallas Eagle Forum, a conservative advocacy group.

Castilla made the statement about gender transition treatments for young children during an Oct. 31 press conference. She was referencing an ongoing legal battle in Dallas over the gender identity of a 7-year-old.

Politifact ruling: Mostly false. Castilla is right that there is no law regulating transition-related treatment separately from other medically-necessary care and the same age regulations apply — minors need parental consent.

Widely accepted guidelines for transition care emphasize gender-affirming care and therapy as primary tools for children. More intensive options, like surgery or hormone treatment, are typically reserved for older adolescents (with parental consent) and adults.

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Discussion: When reached via email, Castilla said that she is unaware of any state laws that "protect children from being given treatments that can lead to sterilization and no law prohibiting surgeries that would seek to make a child appear to be a gender different than the gender they were born."

"Thus far, it appears very young children have been protected from this only because of the good sense of the medical community," she said. "As we see this protection waning among a small portion of the medical community we would like to make sure that the most vulnerable Texans are protected."

Medical or surgical treatments used by doctors for transitioning must meet the same safety requirements of other medications or surgeries.

The legal battle in Dallas that Castilla mentioned is a custody dispute between a mother and father that centers on the gender identity of their 7-year-old child.

The child’s mother says the 7-year-old is a transgender girl and wants to dress as a girl and be identified by female pronouns — a process referred to as a social transition . The child’s father disagrees and insists that the child is a boy.

The case has spurred a national debate about children and their gender identities, with some Texas Republicans pledging to pursue legislation to prevent minors in Texas from transitioning by medical means.

Gillian Branstetter, spokeswoman for the National Center for Transgender Equality, said an important point to consider in this case is the child’s age.

"This child is 7 years old," she said, noting that "no one is talking about" pursuing a medical or surgical transition. "We’re talking about gender affirming parenting and letting the child explore who they are."

Gender transition treatment can take many forms, according to multiple resources on gender identity and gender dysphoria.

People can be diagnosed with gender dysphoria at any age, even as children.

"While some children express feelings and behaviors relating to gender dysphoria at 4 years old or younger, many may not express feelings and behaviors until puberty or much later," reads an article on the subject from the American Psychiatric Association. "For some children, when they experience puberty, they suddenly find themselves unable to identify with their own body.

When it comes to caring for children who might be exhibiting signs of gender dysphoria, the American Academy of Pediatrics recommends the "gender-affirmative care model" that prioritizes validating a child’s gender identity and supporting their exploration and expression of that identity.

"There are absolutely no medical interventions or surgical interventions on any prepubertal child," said Colt Keo-Meier, a Texas-based psychologist and author who specializes in gender and sexual health. "That is not happening."

Once a child starts puberty, other options emerge. Keo-Meier said the most common treatment — medication to delay the onset of puberty — is fully reversible.

"That is literally just hitting pause," he said.

The World Professional Association for Transgender Health outline minimum criteria that must be met before a child can receive puberty-suppressing medication, including that the child has demonstrated a "long-lasting and intense pattern of gender nonconformity or gender dysphoria" and that it "emerged or worsened with the onset of puberty."

Other, interventions like hormone therapy (partially reversible) or surgery (irreversible) won’t be considered until a patient reaches adolescence.

Even then, the Standards of Care stress that certain procedures should not be performed until a patient is old enough to consent on their own (typically 16-18 years old) and others should occur only once a person has received other treatments for a specific time period.

For more on the research and the conclusion, visit Politifact Texas, www.politifact.com/texas/