Texas
Legal fight over Texas law banning transgender health care for youth centers on whether treatments help or hurt
Texas families and health care providers sued the state over Senate Bill 14, which restricts transgender youth from accessing gender-affirming care. The groups are requesting an injunction from a state district court judge before the law goes into effect on Sept. 1.

This article originally appeared in The Texas Tribune
At the heart of the legal fight over Texas’ new ban on puberty blockers and hormone therapy for transgender children is an ongoing debate about whether those treatments help or hurt youth with gender dysphoria.
During a two-day hearing over an attempt to block the law from taking effect Sept. 1, medical experts testified that such gender-affirming treatments are safe. The state attorney general’s office called on its own scientific professionals, who cast doubts on the existing research.
Families of trans youth and medical professionals are suing Texas, asserting that state lawmakers discriminated against trans youth in crafting the prohibition and that the law violates the rights of parents to choose medically approved care for their children.
The new law does not ban any particular treatments or medical care outright. They are prohibited only for the purpose of gender transitioning.
“Make no mistake, our doctors are not being targeted for the type of care they provide. They are not being targeted for the quality of their care. They’re being targeted because of the community they are providing care for,” Alex Sheldon, executive director of GLMA, an association of LGBTQ+ health professionals that is one of the plaintiffs, told reporters outside the courthouse on Wednesday.
The state rejected the claim of discrimination. In her opening statement, Assistant Attorney General Heather Dyer rejected the plaintiffs’ claim that Senate Bill 14 discriminates based on sex because, she said, people with gender dysphoria are not a protected class.
“SB 14 was designed to protect minors from scientifically unsound treatments,” Dyer said.
The new law would ban transgender youth from taking puberty blockers, receiving hormone therapies and having transition-related surgery, the latter of which is rarely performed on minors. Such medical interventions are used to treat gender dysphoria, a medical term for the distress someone experiences when their gender identity doesn’t match their body. The plaintiffs assert that the new law violates their parental rights and interferes with their ability to practice medicine.
Legal groups including the American Civil Liberties Union of Texas, Lambda Legal and the Transgender Law Center requested that Travis County District Court Judge Maria Cantú Hexsel issue an injunction against the law.
Doctors defend gender-affirming care
Dr. Johanna Olson-Kennedy, a doctor who treats adolescents and has been providing gender-affirming care for 17 years, said the body of medical research demonstrates these treatments have a high success rate in improving mental health outcomes of trans youth. But in her clinical work, the evidence is more obvious.
“Recently, I had one of my patients tell me, ‘If you had not allowed me, and helped shepherd me through these interventions, I don’t think I would be here,’” said Olson-Kennedy, the medical director of the Center for Transyouth Health and Development at Children’s Hospital Los Angeles.
She added that hundreds of her patients have expressed the same sentiment in her nearly two decades treating roughly 1,100 young patients.
A central argument of lawmakers supporting SB 14 during the legislative session was that puberty blockers and hormone therapies put young patients at risk for fertility loss and a reduction of bone density. Defense attorneys for the state repeated these claims.
The medical experts called on by the plaintiffs rejected those claims Tuesday, arguing that the scientific literature supports the use of hormones or puberty blockers as a means to improve the mental health of transgender youth and reduces the dysphoria these young people feel.
“I would not consider estrogen or testosterone the end of the story for fertility,” said Dr. Daniel Shumer, a pediatric endocrinologist at the C.S. Mott Children’s Hospital in Ann Arbor.
Pediatric endocrinology is the field of medicine that specializes in transgender adolescent health care.
Representing the state, Assistant Attorney General Johnathan Stone asked Shumer about the number of his patients who stopped receiving gender-affirming treatment. A group of people who refer to themselves as detransitioners have been vocal opponents of gender-affirming care for youth in legislative hearings throughout the country. During this year’s regular Texas legislative session, Republican lawmakers called on several people who had detransitioned to testify in support of SB 14.
Shumer said of his roughly 400 patients, 10 had stopped taking puberty blockers, a reversible treatment that delays the onset of puberty, and two had stopped taking hormones.
Olson-Kennedy noted that there are a variety of reasons people detransition — including a lack of acceptance of their new identity or a loss of health care access — but overall, the number of people who do take this step is very small.
Dr. Aron Janssen, a psychiatrist at the Ann & Robert H. Lurie Children’s Hospital of Chicago, testified to the evidence that psychotherapy alone cannot alleviate gender dysphoria, asserting that puberty blockers or hormone therapy is medically necessary. By restricting access to these treatments, young patients will have worse outcomes, Janssen said.
“There’s an intense improvement we see amongst these kids,” Janssen said of his clinical experience.
The defense
The state disputed the efficacy of puberty blockers and hormone therapy based on the amount and quality of research. Other witnesses for the state argued transgender people can not change their sex and that young people cannot comprehend the long-term implications of these treatments.
The state’s first witness on Tuesday was evolutionary biologist Colin Wright, who has a Ph.D. in evolutionary biology and ecology from the University of California Santa Barbara. Wright testified that humans can only be “observed and recorded” as either the male or female sex. While individuals can modify their secondary sex characteristics, like body hair and breast development, Wright said people cannot change their sex.
Lawyers for the plaintiffs noted that Wright was not an expert in gender dysphoria and had not published original research on the topic of biological sex. Wright, who is vocal on his social media platforms about his opposition to gender-affirming care for minors, was asked if he thought transgender individuals were delusional. Of the idea that people can change their sex from what was assigned at birth, he said, “that specific belief is a delusional belief.”
Dr. Michael Laidlaw, an endocrinologist affiliated with the Sutter Roseville Medical Center in California, said Wednesday that the risks of using puberty blockers and hormone therapy outweighed the benefits. He said reviews of the existing research on these treatments indicate there is limited evidence to show the benefits of using puberty blockers on minors.
Katrina Taylor, an Austin-based therapist designated as an expert witness in psychotherapy, offered starkly different testimony about the origin of gender dysphoria in children.
“When there is gender dysphoria, I see it as a symptom of the family,” said Taylor, the state’s expert witness on psychotherapy. “There’s something going on in that family system that is awry, that is going wrong.”
The state focused attention on the concept of “informed consent” — the agreement to provide care between a health care professional and their patient — and whether minors could agree to receive puberty blockers, hormone therapies and surgery.
Dr. Clifford Hopewell, a North Texas neuropsychologist and former Texas Psychological Association president, said an adolescent’s reasoning was limited based on their brain development and therefore couldn’t appreciate the risks of some gender-affirming care treatments.
“They don’t know what puberty blockers are,” Hopewell said. “An adolescent doesn’t understand that.”
Texans testify
Wednesday was the second day of Nathan Noe’s new school year, but instead of spending the morning at high school, he was in the Travis County Civil and Family Courthouse testifying on how SB 14 would cut him off from life-changing medical treatments. For two years, Noe — who is using a pseudonym as a plaintiff for the lawsuit — has been taking testosterone, which he said dramatically shifted his life for the better.
“I was able to go about my life as a teenage boy, like I wanted to,” Noe said, smiling on the stand.
Parents of trans youth like Noe testified about the impact SB 14 would have on their families. Another parent, identified by the pseudonym Mary Moe, said she and her daughter have moved out of the state in the wake of SB 14.
“I would like to return to Texas, but Texas has become very ugly to me and my family,” Moe said.
Texas health care workers, also named as plaintiffs in the lawsuit, spoke to SB 14’s impacts on their practice. Dr. David Paul, a pediatric endocrinologist who works at Texas Children’s Hospital in Houston, said SB 14 would strip him of the ability to provide the standard of care for his transgender patients.
“They are probably the most positive outcomes of all the patients I see,” Paul said of patients who receive gender-affirming care. If his patients couldn’t access this type of care, Paul said he worries their physical and mental health will deteriorate. He added he has already lost one of his patients to suicide.
To attest to the regret some people experience after receiving gender-affirming care, the state called on Soren Aldaco, a woman who took testosterone when she identified as transgender boy and received top surgery when she was 19.
Aldaco testified that her mental health did not improve after taking hormones and was forced to deal with a number of complications from receiving chest reconstruction surgery. She has since filed a lawsuit against her medical providers for failing to follow their duty of care.
Texas’ new law will still allow transgender people 18 or older to receive chest reconstruction surgery. It will also allow cisgender girls under 18 to have breast augmentation surgery.
Texas lawmakers’ efforts to restrict gender-affirming care in Texas followed nearly identical campaigns from other Republican-led state legislatures. Across the country, 19 other states have passed similar legislation. Prohibiting doctors from providing gender-affirming care to trans youth is widely popular among Republican voters — over 85% of registered GOP voters in Texas supported these restrictions to some degree, according to an April poll by the Texas Politics Project.
But the wave of new legislation invited a series of lawsuits across the country seeking to block the laws from going into effect. Those suits have largely proved successful in federal courts.
In June, a federal judge ruled that Arkansas’ ban on gender-affirming care for minors is unconstitutional because it violates the due-process and equal-protection rights of transgender children and their families. Federal judges in Florida, Kentucky and Tennessee have also blocked those states’ laws from going into effect. An appeals court intervened to allow Tennessee to implement its ban, and the Kentucky federal judge lifted the injunction he issued, allowing the law to go into effect.
This lawsuit is filed in state court and claims SB 14 violates parental-right protections laid out in the Texas Constitution.
Disclosure: The ACLU of Texas has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.
Houston
Texas consistently leads the nation in attacks on trans people. Here’s how Houstonians are fighting back.

After attending the Houston Pride parade in June, Søren Beregan just wanted to dance. Beregan, a trans man, and his partner, who is nonbinary, were enjoying themselves at a Montrose-area nightclub when a man approached them.
“I’m better than you,” the man said aggressively.
Caught by surprise, Beregan laughed it off. “In a way it felt almost affirming as a trans guy to have a cis guy feel threatened by me,” he said, using a shortened form of the word cisgender, which means someone whose gender identity corresponds to their sex at birth. “But then later, I was like, wow, that sucks. It is scary to walk around in public … and know that there are people who are upset seeing you just living your life.”
Although he didn’t show it, Beregan felt helpless. In the past, when he was femme-presenting, he occasionally wore dresses and heels. “I was never taught how to fight. I was never taught how to defend myself. It was always ‘have a guy around you,’” he said.
But since transitioning over a year ago, things are different. He wants to be self-sufficient at a time where there have been increased attacks and hateful rhetoric against his community statewide.
On a recent Saturday morning, Beregan was among roughly 20 attendees in a de-escalation and self-defense workshop at the Montrose Center aimed at training participants on how to defend themselves from a physical attack, in lieu of carrying a gun.
It’s one of the ways that some trans Houstonians are taking matters into their own hands to protect themselves in Texas, a state that introduced more anti-LGBTQ+ and anti-transgender bills than any other state this year, and at a time when data shows anti-LGBTQ+ rhetoric is on the rise.
Texas lawmakers passed three bills this year that impact trans rights: Senate Bill 12, which bans “sexually oriented performances” – a term originally used to classify drag shows – in the presence of minors; Senate Bill 14, which bans medical care for trans youth to treat gender transitioning or gender dysphoria; and Senate Bill 15, which requires trans college athletes to compete on sports teams based on their biological sex. SB 14 and SB 15 went into effect on Sept. 1, while SB 12 awaits a final ruling from a federal judge in Houston after the ACLU of Texas challenged the law on behalf of several LGBTQ+ organizations.
“With all the anti-trans legislation in Texas, it’s like we’re the next target,” said George Zemanek, the president of Transmasculine Alliance Houston. The group, which organized the weekend workshop, provides community support to anyone assigned female at birth who is questioning their gender or who identifies as non-binary, female-to-male or transmasculine – a term that includes both trans men and nonbinary people assigned female at birth who define their gender as masculine, or who seek medical transition towards masculinization.
Zemanek said the thinking behind the quarterly workshops was, “Let’s do a physical safety training and let’s talk about all these things, because it may become an issue.”
The secret weapon
Trainers from Third Ward Jiu-Jitsu, a nonprofit organization that aims to provide affordable and inclusive self-defense training,led the workshop, which focused on de-escalation tactics and skills such as dodging a punch, or how to twist away if someone grabs your wrist. Instructors also reminded attendees to remain vigilant and put their phones away in public.
“If you’re just walking around with your head down like this the whole time, it is the perfect opportunity for someone to attack,” said Andrew Degar, the cofounder of the group, while demonstrating.
A studious Beregan meticulously watched as the instructors broke down different techniques. “I’m a little guy and [when] I do that frame, how do I then quickly back out of that position so that I’m not then just gripped by this giant?” he asked Degar, physically demonstrating the scenario he had in mind.
Other participants haven’t experienced physical attacks, but wanted to be proactive.
“I go to the University of Houston. I take public transit so I’m often out and about, so I thought knowing something about breaking away from grabs and getting away from people could be helpful,” said 31-year old Ed Kneelan who took turns practicing with the other participants.
“Fortunately I haven’t had anything fishy happen ever, but I know that can happen, so I think it’s better to be prepared,” he said.
A proactive approach
By taking a proactive approach, Zemanek believes that it will empower the trans community to be aware and know what to do in situations like a public protest, where people may be at an increased risk of physical violence.
“I foresee that at some of these protests against anti-trans legislation, you’re gonna start to see trans people getting arrested,” he said. “Some of these protests can be pretty wild.”
A spokesperson from GLAAD, an LGBTQ+advocacy organization, confirmed to the Landing that there have been 209 anti-LGBTQ incidents targeting drag events nationwide since early 2022. Texas consecutively had the most incidents and threats with 21 reported incidents so far this year, and 27 reported incidents in 2022, a representative said via email.
An April update on its 2022 analysis noted that there was an uptick in attacks beginning in Pride season that year, which is typically during June, and continuing through the midterm election cycle. At this year’s Pride celebration in Houston, participants spoke to the Houston Landing about the apprehension they felt due to the wave of anti-trans legislation. “You never know, there’s crazy people that do things that you don’t expect,” Carlos Gallardo told the Landing while celebrating Pride in Montrose.
It’s not just physical attacks and threats that have rattled the trans community. A joint report from GLAAD and the Anti-Defamation League released in June found that anti-LBGTQ rhetoric and harassment has also increased within the last year, with more than 350 hate and extremist incidents recorded in the U.S.; Texas had the third most with 30 incidents.
The return of community patrolling
The rise of anti-LGBTQ+ incidents over the last several years has motivated community activists like Ethan Ganz. He is the co-founder of the Montrose Residents Coalition, a group that is joining forces with the nonprofit Affinity Coalition To Overcome Unethical Theories HTX (ActOutHTX) to revive the work of a Montrose-area volunteer surveillance group called Q-Patrol, which launched in 1991 but dissolved in 2002 due to financial woes, newspaper archives show.
“I really think it’s necessary now,” he said to participants assembled in a circle following the training.
A group of citizens organized Q-Patrol shortly after the murders of Paul Broussard and Phillip Smith, two gay men who were killed outside a gay nightclub in Montrose. Their brutal deaths sparked civil unrest locally, led to national discussions and prompted the Houston Police Department to launch an undercover initiative, dubbed Operation Vice Versa, where officers masqueraded as gay men. Officers were attacked in multiple incidents and many people were arrested within two weeks, according to the website Houston LGBTQ History and ABC13.
Originally Q-Patrol worked in tandem with the police, but now, “That’s not really what they’re trying to do,” Ganz said. “A lot of our people do not feel safe around the police,” he added.
In the 1990s when the original Q-Patrol reigned, it was illegal to carry a handgun openly or concealed without a license, but open carry was made legal in 2021. Ganz still discourages open carry of any firearms, but said volunteers can carry a concealed weapon, mace or a taser at their discretion.
Beregan is uncomfortable carrying a gun and can’t pocket his mace or pepper spray into most bars, so he views self-defense as his best weapon. After taking a few classes recently, he now feels better equipped to defend himself and plans to continue training with the Third Ward Jiu Jitsu’s monthly LGBTQ+ focused self-defense classes. But he has no plans of joining Q-Patrol at this time.
Acknowledging their limits, Ganz said the goal of Q-Patrol is to help people before police need to get involved.
“So if we see somebody that’s alone, we’ll walk them to the car. We see someone drunk in the street, we might engage with them and see what we can do to help them. This is more about being seen engaging our community, taking care of each other.” Ganz said they will also carry power banks to help people charge their phones to call a ride.
More training is needed in de-escalation, CPR, first aid, and, eventually, shooter response practice and Narcan training to ensure safety, Ganz said, but he anticipates Q-Patrol will hit the Montrose streets soon.
The Houston Landing is a nonprofit newsroom devoted to public service journalism for all Houstonians.
This article first appeared on the Houston Landing and is republished here with permission.
88th Texas Legislature
Federal judge bars Texas from enforcing book rating law
House Bill 900 requires book vendors to rate all their materials based on their depictions or references to sex before selling them to schools. Vendors say the law aims to regulate protected speech with “vague and over broad” terms.

This article originally appeared in The Texas Tribune
A federal judge said Thursday he will stop a new Texas law aimed at keeping sexually explicit materials off of school library shelves on the eve of the law going into effect, according to state attorneys and lawyers for a group who sued over the proposal.
District Judge Alan D. Albright indicated during a hearing that he will grant a temporary injunction sought by a group of book groups and sellers, including two Texas bookstores, who sued the state over House Bill 900 in July, the group’s lawyers said in a statement. Albright will issue a written order in one to two weeks; in the meantime, the state cannot enforce the law, according to the statement.
HB 900, which was approved during this year’s regular legislative session, requires school library vendors to rate all their books and materials for appropriateness before selling them to schools based on the presence of sex depictions or references. It also requires vendors to rank materials previously sold to schools and issue a recall for those that are deemed sexually explicit and are in active use by a school.
The plaintiffs argue that the law violates their constitutional rights by targeting protected speech with its broad and vague language. The lawsuit further alleges HB 900 would force plaintiffs to comply with the government’s views, even if they do not agree with them, and that the law operates as prior restraint, which is government action that prohibits speech or other expression before the speech happens. The vendors say it is impossible for them to comply with the rating system because of the sheer volume of materials they would need to review.
The law also calls for creating state school library standards that prohibit sexually explicit materials, requiring parental consent for students to check out materials classified by vendors as “sexually relevant” and giving the Texas Education Agency authority to review a vendor’s rating. If the TEA disagrees with the vendor’s rating and gives it a different one, the vendor must use the agency’s rating. Vendors who do not will be added to a list of vendors that schools cannot buy library materials from.
During the bill’s legislative hearings, librarians and legal experts shared concerns and worries that its language would ensnare books that are not inappropriate and, to the contrary, may be titles important for students whose lived experiences may not be reflected in other literature.
The proposal, from Rep. Jared Patterson, R-Frisco, arrived amid an ongoing debate about what materials are appropriate to be stocked in school and public libraries. Patterson and supporters of such regulations say libraries are infested with inappropriate books that must be vetted and removed.
However, skeptics of that panic and literary advocates counter that the books singled out by politicians often explore sexuality and race, topics that have been swept up in culture-war politics but remain important for youth who may not be comfortable talking about such matters with others.
Despite the concerns, HB 900 sailed through the legislative process before Gov. Greg Abbott signed it in June. It was set to go into effect Friday; however, the law’s language suggests the new requirements won’t have to be fulfilled immediately.
Most, if not all, of the state’s roughly 5.4 million public schoolchildren have already begun the 2023-2024 school year.
The lawsuit’s plaintiffs include two bookstores, Austin’s BookPeople and West Houston’s Blue Willow Bookshop, as well as the American Booksellers Association, the Association of American Publishers, the Authors Guild and the Comic Book Legal Defense Fund.
The Texas Attorney General’s office said Thursday it would move to reverse the injunction and appeal the judge’s decision. The office had not received the judge’s written order or decision by Thursday afternoon, a spokesperson said.
A court representative for Albright did not respond to an inquiry about his comments during Thursday’s hearing, reported by the plaintiffs’ lawyers and on social media by at least one plaintiff.
“We are grateful for the court’s swift action in deciding to enjoin this law, in the process preserving the long-established rights of local communities to set their own standards; protecting the constitutionally protected speech of authors, booksellers, publishers and readers; preventing the state government from unlawfully compelling speech on the part of private citizens; and shielding Texas businesses from the imposition of impossibly onerous conditions,” the plaintiffs said in a joint statement after the hearing. “We look forward to reading the court’s full opinion once it is issued.”
The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.
88th Texas Legislature
Federal judge issues temporary restraining order, says Texas law banning drag shows is “likely” unconstitutional
U.S. District Judge David Hittner heard from LGBTQ+ groups, businesses and a drag performer in a hearing this week, who argued Senate Bill 12 violated their First Amendment rights.

This article originally appeared in The Texas Tribune
U.S. District Judge David Hittner temporarily blocked a new state law Thursday from going into effect that would have criminalized sexually-oriented performances in front of children or effectively banned some public drag shows.
LGBTQ+ groups sued the Texas attorney general’s office, hoping to stop authorities from enforcing Senate Bill 12, which was signed by Gov. Greg Abbott in June and was scheduled like most new laws to go into effect Friday.
In a two-day hearing earlier this week in Houston, a drag performer and entertainment businesses said Texas lawmakers’ effort to regulate these shows was an unconstitutional attempt to stifle their freedom of expression. Though Hittner did not issue a final order on Thursday, he found the plaintiffs’ argument compelling.
“Based on evidence and testimony presented at the hearing, the court finds there is substantial likelihood that SB 12 as drafted violated the First Amendment of the United States Constitution under one or more of the legal theories put forward by the plaintiffs,” Hittner wrote in the temporary restraining order.
Hittner said allowing the law to take effect would likely cause “irreparable harm” to the plaintiffs. He issued the restraining order to maintain the status quo of the legal landscape while preparing a final decision — the restraining order does not guarantee a permanent injunction. He said his order could come two to four weeks after the hearing.
Hittner heard testimony earlier this week from LGBTQ+ groups, businesses and a performer, which were plaintiffs in one of two lawsuits against SB 12. They argued the law trampled on their First Amendment rights to perform and organize drag shows. They described drag as a healing, expressive and political form of performance art with historical connections to LGBTQ+ people.
“If allowed to take effect, SB 12 will make our state less free, less fair, and less welcoming for every artist and performer,” said American Civil Liberties Union of Texas Attorney Brian Klosterboer in a statement following the judge’s decision. “This temporary order is a much-needed reprieve for all Texans, especially our LGBTQIA+ and transgender community, who have been relentlessly targeted by our state legislature.”
Defending the law, attorneys with the Texas attorney general’s office said SB 12 was narrowly tailored to protect children from sexually-explicit performances. The new law did not explicitly ban drag shows, lawyers for the state said, and these performances should not be considered expressive or receive First Amendment protections.
However, shortly after signing the law, Abbott shared a story on social media about SB 12’s passage and declared he had banned drag performances in public.
“The people of Texas were appalled to learn of an increasing trend of obscene, sexually explicit so-called ‘drag’ performances being marketed to families with children,” said Paige Willey, the director of communications for the attorney general’s office. “The Office of the Attorney General will pursue all legal remedies possible to aggressively defend SB 12, the state law that regulates such performances to protect children and uphold public decency.”
Under the new law, business owners would have had to face a $10,000 fine for hosting sexually explicit performances in which someone is nude or appeals to the “prurient interest in sex.” Performers caught violating the proposed restriction could be slapped with a Class A misdemeanor, which carries a maximum penalty of a year in jail and a $4,000 fine.
Texas is one of six states that have passed a bill restricting “adult” or drag performances, according to the Movement Advancement Project, a nonprofit that tracks legislation related to LGBTQ+ issues.
Legal challenges to similar legislation in Florida, Montana and Tennessee have successfully blocked these laws from going into effect. In June, a federal judge in Tennessee, appointed by former President Donald Trump, ruled the law is unconstitutional in its effort to suppress First Amendment-protected speech.
The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues.
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