Texas Supreme Court upholds ban on transition-related care for minors

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The Texas Supreme Court upheld a recent state law that prohibits doctors from prescribing gender-affirming care to transgender minors after parents and medical professionals challenged the constitutionality of the restriction.

Justice Rebeca Aizpuru Huddle, who delivered the opinion of the court, said “fit parents” have a right to raise their children without government interference, but also said that such a right is not absolute.

“When developments in our society raise new and previously unconsidered questions about the appropriate line between parental autonomy on the one hand and the Legislature’s authority to regulate the practice of medicine on the other, our Constitution does not render the Legislature powerless to provide answers,” she wrote.

State lawmakers barred transgender teenages from accessing puberty blockers and hormone therapy last year, despite fierce opposition from LGBTQ+ advocacy groups and parents of trans children. Texas’ ban on transition-related care mirrored those in dozens of states led by Republican legislatures.

Justice Debra Lehrmann was the only dissent in the 8-1 decision.

Texas parents, doctors and advocacy groups argued in a lawsuit filed last summer that Senate Bill 14 violated their right to make decisions about their children’s health, which is enshrined in the state constitution.

During an August hearing in Travis County district court, Texas medical professionals testified that the state law would strip them of the ability to provide the standard of care to transgender patients.

Doctors prescribe puberty blockers and hormone therapy to treat gender dysphoria, a dissonance felt by some transgender people between their sex assigned at birth and their gender identity. The terms transition-related care or gender-affirming care can also include surgeries, but those are rarely performed on minors.

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Trans kids, their parents and major medical groups say puberty blockers and hormone therapy are important to protecting the mental health of an already vulnerable population, which faces a higher risk of depression and suicide than their cisgender peers. At the same time, doctors say cutting off these treatments — gradually or abruptly — could bring both physical discomfort and psychological distress to trans youth, some of whom have called it forced detransitioning.

Attorney General Ken Paxton lauded the ruling on X, saying that it protects children.

“My office will use every tool at our disposal to ensure that doctors and medical institutions follow the law,” Paxton wrote.

Republican state Rep. Tom Oliverson of Cypress, who sponsored SB 14, said that the morning’s ruling was gratifying.

“Throughout the entire debate on #SB14, @DonnaCampbellTX and I have consistently argued that Texas has the constitutional authority (and quite frankly the duty) to regulate the practice of medicine,” Olverson wrote on X.

“We think the Texas Supreme Court made the wrong decision, and that the result means that there’s going to be continued suffering for transgender youth and their families in Texas,” said Ash Hall, a strategist on LGBTQ+ rights for the ACLU of Texas.

Hall said that the decision of whether or not to undergo medical treatment for gender dysphoria should be left up to trangender youth, their parents and their doctors. With Friday’s ruling, however, the state government is stepping in and withholding the ability for transgender youth and their families to make a decision about their medical treatment, said Hall.

Hall also said that it’s hypocritical to allow medications such as puberty blockers to be allowed for people with conditions such as precocious puberty, while banning them for people with gender dysphoria.

“It’s proof that those who oppose having this health care for trans youth know that this health care is safe and helpful, they just don’t want it to be available to people of this particular demographic,” said Hall.

Karen Loewy, senior counsel and director of constitutional law practice for Lambda Legal, said that this morning’s ruling would be hard to bounce back from for those fighting for LGBTQIA+ right in Texas.

“It’s devastating for trans youth across Texas, and their families who love them and support them and want them only to have access to the medically necessary health care that they need,” said Loewy.

The law was part of a broader coalition of bills that LGBTQ+ advocates say have targeted their community. Some Texas Republicans campaigned on prohibiting transition-related care under the banner of protecting children.

The Texas Supreme Court, which is composed of nine Republican justices, heard the case in January after a Travis County district court temporarily blocked the law from going into effect. State district court Judge Maria Cantú Hexsel said that the law infringed on Texas parents’ right to make medical decisions about their children. But a state appeal to the Texas Supreme Court enabled the law to go into effect in September.

Justices said that they were not weighing in on the best course of medical action for someone with gender dysphoria, but were determining whether the law violates the Texas Constitution.

“We conclude that the plaintiffs failed to meet that burden,” the ruling states.

Justices concluded that the Legislature can regulate how medicine is practiced.

“We conclude that 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,” reads the ruling.

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