Top Texas court upholds gender-affirming care ban for minors

Texas’s Supreme Court on Friday upheld the state’s ban on gender-affirming care for minors, dealing a blow to a group of medical providers, national LGBTQ organizations and families with transgender children that sued to block it. 

The 8-1 ruling leaves in place a law that has upended care for an estimated 30,000 transgender Texans for nearly a year. The state’s highest court in August denied a motion to block enforcement of the ban, after an appeal from the state attorney general’s office automatically paused a lower court’s injunction. 

Texas District Judge Maria Cantú Hexsel, a Democrat, wrote in the Aug. 25 ruling granting the injunction that the law, Senate Bill 14, likely violates the state’s constitution by infringing on the right of parents to make health care decisions for their children and by discriminating against transgender youth based on sex and transgender status. 

It also violates the ability of health care providers to follow “well-established, evidence-based” standards of care under threat of losing their medical license, Cantú Hexsel wrote in August. 

Gender-affirming health care for transgender adults and minors is considered safe and medically necessary by every major medical organization, though not every trans person chooses to medically transition or has access to care. Texas’s law, signed last year by Republican Gov. Greg Abbott, bars transgender minors from accessing puberty blockers, hormones and transition surgeries, though the latter is generally not recommended for people younger than 18. 

Twenty-four other Republican-led states have passed laws similarly restricting care, according to the Movement Advancement Project, a nonprofit organization that tracks LGBTQ laws, though federal court orders are blocking enforcement of bans in Montana and Ohio. A federal judge earlier this month struck down a Florida law barring access to gender-affirming health care for minors and certain adults, and a similar Arkansas law was ruled unconstitutional last year. 

The Supreme Court this week said it will decide during its next term whether state bans on gender-affirming medical care for minors are constitutional, setting the stage for a blockbuster showdown over transgender rights. 

“We do not attempt to identify the most appropriate treatment for a child suffering from gender dysphoria. That is a complicated question hotly debated by medical experts and policy makers throughout this country and the world,” Justice Rebeca Aizpuru Huddle, who was appointed to the court by Abbott, wrote Friday in the court’s decision. “And, to be sure, neither this Court nor any party to this proceeding suggests that children suffering from gender dysphoria are undeserving of treatment and support.” 

Huddle emphasized Friday that the question before the court — whether Senate Bill 14 violates Texas’s Constitution — “is a distinctly legal one.” 

“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,” Huddle wrote Friday. 

Legal advocates who sued to block the law last summer slammed Friday’s ruling as “needlessly cruel.” 

“It is impossible to overstate the devastating impact of this cruel and arbitrary ruling on Texas transgender youth and the families that love and support them,” Karen Loewy, senior counsel and director of constitutional law practice at Lambda Legal, said in a statement. 

“The court’s decision to reject safe and affirming care will have lasting impacts on all people in Texas,” said Lynly Egyes, legal director at Transgender Law Center. “All Texans, no matter what they look like or the neighborhood they live in, should know that we will continue to work alongside our partners to fight for the rights of trans Texans and their families.”