It's a pretty rare occasion that I fully agree with Texan Senator about a law they want to institute. Children should absolutely not be taking HRT before puberty. If Timmy is dead set on being Tiffany, I don't think it'll kill him to wait to 18 before adjusting that noose around his neck.
Jack has mentioned, I forget where, that he can't have sex with Caiti because she supposedly has a physical condition that makes sex hurt, and that he's fine with that because a sexless marriage isn't the end of the world. They don't do anything for that condition, nor do they do alternative sex acts. They just live together as platonic friends that occasionally kiss.