Texas Gov. Greg Abbott (R) has ordered the state’s Department of Family and Protective Services (DFPS) to investigate parents of transgender children.

In a letter sent to DFPS, which critics branded “shameful” and “horrifying,” Abbott urged the department to target parents who have enabled “abusive” gender-affirming care for their children, including hormone therapy and gender confirmation surgery.

Abbott cited an opinion issued earlier this week by his Attorney General, Ken Paxton (R), who stated that that all the forms of surgical and hormonal interventions for transgender youth constitute “abuse.”

According to Paxton, the Constitution protects a fundamental right to procreation, and because minors are “legally incompetent to consent” to transition-related procedures, treatments that cause sterilization infringe upon that right.

“Each of the ‘sex change’ procedures and treatments enumerated above, when performed on children, can legally constitute child abuse under several provisions of chapter 261 of the Texas Family Code,” Paxton wrote.

In his order, Abbott demanded that DFPS “conduct a prompt and thorough investigation of any reported instances of these abusive procedures in the State of Texas.”

DFPS is also to investigate the parents of transgender children who receive gender-affirming care, as well as the facilities where such care is carried out.

Abbott also directed licensed professionals to report children who undergo “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.”

Doctors, teachers, and other licensed professionals who interact with children will face criminal penalties if they fail to report “children who may be subject to such abuse.”

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Abbott’s order goes even further, warning of “similar reporting requirements and criminal penalties for members of the general public.”

The Biden administration slammed Abbott and conservative officials in states across the country for “inserting themselves into health care decisions that create needless tension between pediatricians and their patients.”

“No parent should face the agony of a politician standing in the way of accessing life-saving care for their child,” Principal Deputy Press Secretary Karine Jean-Pierre told the Dallas Morning News.

“Our nation’s leading pediatricians support evidence-based, gender affirming care for transgender young people,” Adm. Rachel Levine, Biden’s assistant secretary for health and the highest-ranking out transgender official in the U.S., told Dallas Morning News. “HHS stands with transgender youth and their medical providers.”

The American Civil Liberties Union of Texas tried to allay fears among parents of transgender youth that they might lose their children, stating that Abbott’s order was “not legally binding.”

“DFPS cannot remove any child from their parents or guardians without a court order,” the ACLU of Texas said. “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 the consensus of every major medical association and the evidence-based and peer-reviewed standards of care.”

ACLU of Texas staff attorney Brian Klosterboer said in a statement that Abbott’s letter has “no legal effect and cannot change Texas law nor usurp the constitutional rights of Texas families.”

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“The law is clear that parents, guardians, and doctors can provide transgender youth with treatment in accordance with prevailing standards of care,” Klosterboer said. “Any parent or guardian who loves and supports their child and is taking them to a licensed healthcare provider is not engaging in child abuse.”

LGBTQ organizations and advocates condemned Abbott for the order, with many noting the potential harm that the Republican governor’s letter could wreak on trans youth and their families.

Chase Strangio, a staff attorney with the ACLU and transgender activist, called Abbott’s order “an absolute nightmare” in a tweet.

“Supporting your kid is NOT child abuse and families will be protected and defended as best we can and if we need to help you get out of Texas we will do that too,” Strangio continued. “I am sorry this is the horrible world we live in.”

Writer and transgender activist Charlotte Clymer tweeted that Abbott’s order “basically just told closeted trans children that if they come out, his state government is going to take them away from their affirming parents. Imagine being a closeted, scared trans child with that responsibility on your heart.”

The Trevor Project, the world’s largest suicide prevention and crisis intervention organization for LGBTQ youth, condemned Abbott’s order.

“Texas parents who support their trans kids should be applauded, not prosecuted,” Amit Paley, CEO and Executive Director of The Trevor Project, said in a statement. “The Trevor Project’s research demonstrates that trans youth who feel accepted by the adults in their lives — including family members, teachers, and doctors — are less likely to attempt suicide.”

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Paley noted that gender-affirming hormone therapy “has been linked to lower rates of depression and suicide risk among trans youth who wanted it.”

“The government should not be involved in personal decisions that force doctors and families to act against the medical community’s standards of care for transgender young people,” he continued.

“To all the transgender and nonbinary young people in Texas who are feeling scared and worried right now, please know that The Trevor Project and a broad coalition of organizations are fighting for you, and our counselors are available 24/7 if you ever need help or support.”

The Human Rights Campaign slammed Abbott for his order, saying it was not legally binding and calling it “a craven, politically motivated attempt to criminalize healthcare decisions made between parents, medical experts, and transgender youth.”

“Governor Abbott’s actions are unconscionable,” HRC’s Texas State Director  Rebecca Marques said in a statement. “The Paxton opinion is poorly researched, poorly reasoned — and entirely political. While it is not legally binding, it is discriminatory and dangerous, and will have real-life consequences for trans kids and their families.”

Marques said Abbott’s order was a “shameful attempt to score political points by attacking Texas’s transgender youth — who are, again and again, the Governor’s target — in an attempt to one-up and outdo other radical anti-equality politicians by attacking best practice, age-appropriate, medically-necessary care that in many cases is lifesaving.”

Sarah Kate Ellis, president and CEO of GLAAD, called Abbott’s order “horrifying” in a tweet.

“Governor Abbott and politicians across the country are using trans kids and their loving families to sow division and insight fear,” Ellis wrote. “[Greg Abbott] should be ashamed of himself.”

She added: “Every major medical association in the country supports healthcare for transgender youth, but Republican Gov. Abbott is ignoring experts on children’s issues to cruelly and viciously target transgender young people.”