Texas Court Confirms Ban on Gender-Affirming Care for Transgender Youths

The Texas Supreme Court upheld the state's ban on gender-affirming care for transgender youths, rejecting parents' pleas that it violates their right to seek medical care for their children. The 8-1 ruling from the all-Republican court leaves in place a law effective since September 1, 2023. Texas is the largest of at least 25 states with laws restricting or banning gender-affirming medical care for transgender minors.

Justice Rebeca Aizpuru Huddle wrote in the court's decision, "We conclude the Legislature made a permissible, rational policy choice to limit the types of available medical procedures for children, particularly in light of the relative nascency of both gender dysphoria and its various modes of treatment and the Legislature's express constitutional authority to regulate the practice of medicine."

Impact on Transgender Youths

The Texas law prevents transgender minors from accessing hormone therapies, puberty blockers, and transition surgeries, although surgical procedures are rarely performed on children. Children who had already started banned medications had to be weaned off in a "medically appropriate" manner. The lawsuit challenging the Texas law argued it has devastating consequences for transgender teens unable to obtain critical treatment recommended by their physicians and parents.

Justice Debra Lehrmann, the only justice dissenting with Friday's ruling, stated, "The State's categorical statutory prohibition prevents these parents, and many others, from developing individualized treatment plans for their children in consultation with their physicians, even the children for whom treatment could be lifesaving. The law is not only cruel — it is unconstitutional."

Advocates' Reactions

Advocates criticized the ruling. Karen Loewy, senior counsel and director of Constitutional Law Practice at Lambda Legal, said, "It is impossible to overstate the devastating impact of this ruling on Texas transgender youth and the families that love and support them." Ash Hall, policy and advocacy strategist for LGBTQIA+ rights at ACLU of Texas, added, "Our government shouldn't deprive trans youth of the health care that they need to survive and thrive. Texas politicians' obsession with attacking trans kids and their families is needlessly cruel."

Texas Republican Attorney General Ken Paxton vowed in a post on social platform X after the ruling that his office "will use every tool at our disposal to ensure that doctors and medical institutions follow the law." During legislative debates over the ban in 2023, transgender rights activists disrupted the Texas House with protests from the chamber gallery, leading state police to move demonstrators outside.

Broader Context

The restrictions on health care are part of a larger backlash against transgender rights, touching on everything from bathroom access to participation in sports. As more states enforce health care restrictions, families of transgender youths increasingly travel out of state for necessary care at clinics with growing waiting lists. At least 13 states have laws protecting care for transgender minors.

Over 300,000 people aged 13 to 17 identify as transgender in the US, with about 29,800 in Texas, according to estimates by the Williams Institute at UCLA School of Law. Not all trans people choose or can afford gender-affirming care. Gender-affirming care for youths is supported by major medical organizations like the American Medical Association and the American Academy of Pediatrics.

Medical Community's Stance

Medical professionals define gender dysphoria as psychological distress experienced by those whose gender expression does not match their gender identity. Opponents of gender-affirming care argue there's no solid proof of purported benefits and say children shouldn't make life-altering decisions they might later regret. Several doctors testified in a lower court hearing that patients risk deteriorating mental health if denied safe and effective treatment.

In a concurring opinion, Justice James Blacklock dismissed the position of medical groups: "The fact that expert witnesses or influential interest groups like the American Psychiatric Association disagree with the Legislature's judgment is entirely irrelevant to the constitutional question. The Texas Constitution authorizes the Legislature to regulate practitioners of medicine."

Texas officials defended the law as necessary to protect children and noted other restrictions for minors on tattoos, alcohol, tobacco, and certain over-the-counter drugs. The Texas ban was signed into law by Republican Gov. Greg Abbott, who was first to order investigations into families of transgender minors receiving gender-affirming care.

The US Supreme Court recently agreed to hear an appeal from the Biden administration attempting to block state bans on gender-affirming care. The case before the high court involves a Tennessee law restricting puberty blockers and hormone therapy for transgender minors, similar to Texas' law.