Texas AG Ken Paxton extends ban on gender-affirming care to include talk therapy for trans kids

Texas Attorney General Ken Paxton has expanded the state ban on gender-affirming care for minors to include talk therapy, affecting psychologists, therapists, and social workers. The move raises concerns among medical experts about access to supportive mental health care for transgender youth.

Texas Attorney General Ken Paxton, who is actively running for a U.S. Senate seat, has issued a legal opinion extending the state's restrictions on gender-affirming care for minors to include mental health professionals. This advisory affects licensed psychologists, family therapists, and social workers under the oversight of the Texas Behavioral Health Executive Council.

Background of the Law

The opinion interprets the 2023 Texas law SB 14, which initially prohibited physicians from providing gender-affirming medical treatments to children. Paxton clarified that the law’s restrictions are not limited to medical procedures but also cover mental health services that support gender transition. Providers assisting minors in transitioning may face license revocation, while institutions could lose Medicaid reimbursements and other public funding.

Political Context

The opinion was released one day before the March 3 Republican primary, where Paxton ran against Senator John Cornyn and Representative Wesley Hunt. No candidate surpassed the 50% threshold to avoid a May runoff. The advisory followed a request from Dr. Darrel Spinks, executive director of the Texas Behavioral Health Executive Council, seeking clarification on whether SB 14 applied to mental health providers delivering talk therapy to minors.

Paxton’s Position

In his advisory, Paxton stated that any mental health provider offering services related to gender transition is engaging in prohibited activity. Key points include:

• Healthcare providers are subject to the law even if they do not perform medical procedures.
• Mental health professionals, often gatekeepers for medical transition interventions, fall under the law’s scope.
• Assisting minors in gender transition is defined as child abuse under Texas law.
• Use of public funds for gender-affirming care constitutes a legal violation, exposing providers to potential penalties.

Response from Medical and Mental Health Organizations

Paxton’s interpretation conflicts with guidance from major U.S. medical and mental health organizations. Positions include:

• The American Medical Association warns that state bans on transition-related care interfere with medical practice and encompass counseling and psychological support.
• The American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and American Psychological Association recognize gender-affirming care as including talk therapy, family counseling, and social transition support, differentiating it from universally condemned conversion therapy.
• A study by the Trevor Project showed that suicide attempts among transgender and nonbinary youth aged 13–24 increased by 3,844%, with the highest rise (772%) in those under 18, highlighting the importance of counseling and supportive mental health care.

Legal and Regulatory Implications

Dr. Spinks had sought guidance on whether SB 14 applies to mental health providers, noting that the law explicitly targets medical procedures rather than psychological counseling. Paxton responded that the law defines healthcare providers broadly, including non-surgical interventions. His advisory specifies:

• Mental health professionals providing care related to transitioning minors risk losing their licenses.
• Institutions offering such services may face loss of Medicaid reimbursements and other public funding.
• Legal consequences will apply to providers who engage in prohibited care.

Official Statements

Paxton stated that “any radical facilitating the transitioning of our kids is committing child abuse” and emphasized that Texas law explicitly bans such procedures. He indicated that the advisory should be seen as a clear warning to all medical and mental health providers across the state.

Related Developments

Paxton has previously filed a lawsuit against a doctor providing gender-affirming care to minors, representing the first case of this type in the United States. Courts have blocked attempts by Paxton to obtain data from organizations supporting transgender youth, including PFLAG. Ongoing legal disputes continue regarding the enforcement and interpretation of SB 14 in Texas. This legal opinion signals a stricter approach that could affect a broad range of health professionals offering care related to gender transition for minors.

Sources:

• Texas law bans state-licensed mental health providers from giving gender-transitioning care to minors, AG Ken Paxton says
• Texas AG Maligns Therapy That Affirms Trans Youths’ Identities as “Child Abuse”
• Ken Paxton extends ban on youth gender transitions to mental health professionals
• Texas AG Ken Paxton says ban on gender-affirming care for trans kids also applies to talk therapy

Author: Maya Henderson
Maya Henderson is a journalist focused on technology and startups. She has experience in leading IT publications and excels at conducting interviews and creating visual content.