Texas AG Ken Paxton says ban on gender-affirming care for trans kids also applies to talk therapy

Texas Attorney General Ken Paxton, who is running for a seat in the U.S. Senate, says mental health professionals in the state can’t treat trans youth.

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The day before the March 3 Republican primary, in which he faced incumbent Sen. John Cornyn and Rep. Wesley Hunt, with neither candidate reaching the 50 percent threshold needed to avoid a May runoff, Paxton issued a letter with a legal opinion that a 2023 state law barring physicians from providing gender-affirming care to minors also applies to anyone licensed by the Texas Behavioral Health Executive Council

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While focused on medical procedures related to “transitioning a child’s biological sex,” Paxton, in his opinion, wrote that the law impacts all health care providers in Texas. That includes psychologists, family therapists, and many social workers.

The opinion puts Paxton directly at odds with every major U.S. medical and mental health organization. The American Medical Association has warned that state bans on transition-related care represent a dangerous intrusion into medical practice, and its guidance explicitly includes mental health counseling and psychological support as part of gender-affirming care for transgender and nonbinary minors.

A recent Trevor Project study found that suicide attempt rates among transgender and nonbinary young people ages 13 to 24 rose by 38 percent to 44 percent, with the sharpest increase, ranging from 7 percent to 72 percent, among those under 18.

The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Psychological Association similarly describe gender-affirming care as encompassing talk therapy, family counseling, and support for social transition, and distinguish that supportive care sharply from conversion therapy, which all major professional associations have condemned as harmful.

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Paxton provided the opinion in response to a request from Dr. Darrel Spinks, executive director of the Texas Behavioral Health Executive Council, who questioned whether the law, which focused on medical procedures affecting reproductive organs, also applies to those licensed by his board who provide talk therapy, according to the letter.

“The agency respectfully seeks clarification as to how such providers are impacted by SB 14, given that the prohibited activities and services are exclusively medical in nature and fall outside the scope of practice for mental health professionals,” Spinks wrote.

Paxton, in his advisory, scolded Spinks for questioning whether the law applies. “The unambiguous definition of ‘health care provider’ does not require a prescription pad or scalpel,” Paxton wrote. “For good reason, too, given that the multidisciplinary path to medically transitioningchildren often starts with mental ‘health care.’ We received several briefs highlighting that mental health professionals serve as the ‘clinical gatekeepers whose assessments and recommendations initiate the interventions’ prohibited by SB 14.”

Because of that, Paxton wrote that any mental health provider delivering care related to transitioning risked their medical license in Texas, and institutions could lose Medicaid reimbursements and public funding.

“Any radical facilitating the ‘transitioning’ of our kids is committing child abuse,” Paxton said. “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 there will be consequences for any medical professional, whether a doctor or a therapist, who is illegally ‘transitioning’ Texas kids.”