Mental health providers licensed in Texas are barred from offering therapy that could be interpreted as assisting minors in transitioning, according to a legal opinion from Texas Attorney General Ken Paxton.
In the February 27 opinion, Paxton responded to an inquiry from Darrel Spinks, executive director of the Texas Behavioral Health Executive Council, about whether a 2023 law applies to licensed therapists and counselors.
The law, Senate Bill 14, bans health care providers from providing or facilitating treatments for minors — including puberty blockers, hormones, or surgical interventions — intended to help them medically transition. It also prohibits public funds, including Medicaid, from covering the cost of transition-related care.
Paxton said the law applies to mental health professionals regulated by the Texas Behavioral Health Executive Council — including professional counselors, marriage and family therapists, psychologists, and social workers — even though they do not prescribe gender-affirming medications or perform transition-related surgeries.
In his opinion, he argued that mental health professionals often serve as the “clinical gatekeepers whose assessments and recommendations initiate the interventions” prohibited under Senate Bill 14.
Paxton also noted that violating SB 14 could result in a mental health provider losing public funding, such as Medicaid reimbursements, as well as their license to practice in Texas.
“Any radical facilitating the ‘transitioning’ of our kids is committing child abuse,” Paxton said in a news release. “The law is clear that these radical procedures are illegal, and in no world should Texans’ tax dollars be used to permanently harm children. This opinion should send a clear warning that there will be consequences for any medical professional, whether a doctor or a therapist, who is illegally ‘transitioning’ Texas kids.”
The transgender news site Transitics argues that Paxton’s broad definition of what constitutes “facilitating” a gender transition could allow Texas officials to target and prosecute providers who affirm a transgender youth’s identity.
“Simply put, psychologists that continue to help trans minors will be forced to adhere to Paxton’s belief that gender dysphoria can be ‘overcome,'” wrote Aleksandra Vaca. “Even if they want to, they can no longer affirm a trans kid’s identity, offer alternatives in another state, or encourage parents to accept their kids for who they are.
“Under Paxton’s opinion, doing anything other than push a child to accept being their assigned sex at birth will result in providers losing their license and/or being imprisoned,” Vaca added. “This is conversion therapy, which is recognized by the United Nations as being tantamount to torture.”
But Will Francis, executive director of the Texas chapter of the National Association of Social Workers, told the Texas Tribune that mental health workers do not have to stop treating youth with gender dysphoria because their counseling has long been considered “protected speech” under the First Amendment. He added that his organization plans to partner with civil rights groups to develop legal guidance for mental health providers on their First Amendment rights.
In his request to Paxton, Spinks, executive director of the Texas Behavioral Health Executive Council, noted that the U.S. Supreme Court is considering whether counseling from a mental health provider is protected by the First Amendment. The court recently heard a case, Chiles v. Salazar, in which a Colorado counselor is challenging the state’s ban on conversion therapy for minors, arguing that it violates her free speech rights.
During oral arguments last October, the court’s conservative majority appeared poised to rule that talk-based conversion therapy is a form of free speech rather than conduct, which can be regulated and has no First Amendment protection.
Paxton’s opinion did not address whether mental health counseling constitutes free speech, noting in a footnote that his office typically declines to answer questions that are the subject of pending litigation.
Paxton has previously used SB 14 to pursue doctors accused of providing gender-affirming care to transgender youth.
In one case, Dallas pediatrician May Lau surrendered her medical license after being sued by Paxton’s office. The attorney general also brought charges — later dropped — against El Paso endocrinologist Hector Granados and Dallas pediatrician Brett Cooper, whose case is scheduled for a court hearing in May.
While Paxton’s opinions aren’t legally binding, some critics say mental health professionals may drop transgender clients or stop treating transgender minors out of fear of retaliation from his office.
“In no uncertain terms, trans young people will die as a result of this. Access to mental health care will become more complicated for some of the most marginalized people in our state,” Jonathan Gooch, communications director of Equality Texas, told the Tribune. “To be messing with care for suicidal ideation among a population who face disproportionately high suicidal ideation is not just dangerous, it’s morally without method.”
Two major medical organizations have walked back their support for surgical interventions on transgender youth following a successful medical malpractice lawsuit brought by a detransitioner.
The American Society of Plastic Surgeons (ASPS), which represents more than 11,000 plastic surgeons in the United States, told members to delay transition-related chest, genital, and facial surgeries until patients are at least 19, according to The Washington Post.
Fewer than 1,000 minors in the United States receive surgery for gender dysphoria each year, according to research published in JAMA, and the overwhelming majority of those procedures are mastectomies, or "top surgery," rather than genital surgeries, or "bottom surgery."
A new study claims that transgender women exhibit strength and overall physical fitness comparable to cisgender women after several months of gender-affirming hormone therapy.
In the landmark study, published in the British Journal of Sports Medicine, Brazilian scientists reviewed existing research comparing the body composition and physical fitness of transgender people before and after hormone therapy with that of cisgender people.
Overall, the analysis examined 52 studies involving 6,485 people -- including 2,943 transgender women, 2,309 transgender men, 568 cisgender women, and 665 cisgender men -- ranging in age from 14 to 41.
A coalition of at least 47 right-wing groups, operating under the name "Greater Than," has launched a coordinated campaign to reverse the U.S. Supreme Court's 2015 marriage equality ruling in Obergefell v. Hodges, part of a renewed push by social conservatives to reshape national marriage policy.
At the center of the campaign's argument is the claim that the sole purpose of marriage is to raise children, and that the Obergefell decision, along with the cultural shifts that followed it, violates children's rights.
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