Texas AG Paxton Declares Therapists Affirming Trans Youth To Be Illegal And Child Abuse

The declaration echoes his 2022 efforts to target parents of trans youth with child abuse, and may force conversion therapy on trans youth in the state.

Jorge Sanhueza-Lyon/KUT News

Attorney General Ken Paxton of Texas announced on Monday a new interpretation of state law that would extend the state's ban on gender-affirming care for minors to mental health providers, declaring that any therapist who affirms a trans youth's gender identity is "facilitating" illegal treatment and committing child abuse. Under his interpretation, therapists, counselors, psychologists and social workers who provide gender-affirming mental health care would be barred from receiving any public funding, including Medicaid, and could face revocation of their licenses and criminal penalties. The opinion also invokes mandatory reporting requirements, meaning therapists could be legally obligated to report colleagues and potentially the parents of transgender children as well. The announcement came one day before the Texas Republican primary for U.S. Senate, in which Paxton is running against incumbent Sen. John Cornyn, and carries echoes of his 2022 child abuse declaration that led to sweeping state investigations attempting to remove transgender children from their supportive families.

“Attorney General Ken Paxton has issued a legal opinion declaring that the prohibitions under S.B. 14 making it illegal for health care providers to ‘transition’ kids does apply to ‘mental health care providers’ licensed by the Texas Behavioral Health Executive Council,” says a press release issued by the attorney general’s office. The release describes therapists who affirm transgender youth as “activists providing mental ‘health care’ designed to confuse children about their gender,” and claims that the path to children being “transitioned” is actually “unethical indoctrination” and “child abuse.”

“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.”

You can see the full press release here:

Under the new interpretation, any therapist in the state could find their license pulled, lose the ability to take Medicaid dollars, or even risk child abuse charges if they provide gender-affirming care, according to the seven-page legal opinion released alongside the press release. On page six, the opinion explicitly reaffirms Paxton's 2022 declaration that "any person that facilitates these procedures or treatments could be engaged in child abuse, whether that be parents, doctors, counselors, etc.," adding that even "the failure to stop a doctor or another parent from conducting these treatments or procedures on a minor child" could carry the same consequence. Notably, the entire memo treats mental healthcare that affirms transgender youth as included in this due to stretching the word “facilitates” to include all affirmation in mental healthcare settings. It further warns that therapists who are mandated reporters under Texas law face criminal penalties for failing to report suspected “child abuse” by their colleagues or even potentially parents.

The opinion also seems to argue that mental health care providers should practice conversion therapy on youth instead. It cites professional ethics rules requiring psychologists to "rely on scientifically and professionally derived knowledge when making professional judgments" and to act in their client's "best interest," while citing rules for marriage and family therapists requiring use of therapeutic services that assist with "stabilizing," "alleviating," or "overcoming" a child's underlying "mental, emotional, or behavioral" condition. The implication is clear: if affirming transgender youth is child abuse and disallowed under Texas law in this interpretation, then a therapist's professional duty is to help trans youth "overcome" being transgender.

Conversion therapy is widely rejected by medical organizations and extremely harmful for LGBTQ+ youth. More than two dozen medical and psychological professional associations representing over 1.3 million health care providers have endorsed a joint statement calling for an end to the practice. A peer-reviewed study published in the American Journal of Public Health found that young people who underwent conversion therapy were more than twice as likely to attempt suicide and more than 2.5 times as likely to report multiple suicide attempts in the past year. According to the Trevor Project's 2024 national survey of more than 18,000 LGBTQ+ young people, 13 percent reported being threatened with or subjected to conversion therapy, and those who experienced it had more than three times the rate of attempting suicide compared to those who did not.

As the Texas Tribune says, “Paxton’s opinions aren’t legally binding, although state agencies often use his conclusions to set policy.” In 2022, Paxton issued a legal opinion declaring that parents of trans youth were guilty of child abuse under Texas family law. Governor Greg Abbott then directed the state's Department of Family and Protective Services to investigate parents who provided such care, extending mandatory reporting requirements to licensed professionals and members of the general public alike, with criminal penalties for failure to report. The directive was used to launch investigations into families of transgender youth across the state, terrorizing parents and threatening to have their children removed from their homes, before it was blocked by a state court.

The opinion is the latest escalation in a years-long campaign by Republicans to weaponize every arm of state power against transgender youth. If enforced, it could make Texas the most hostile state in the country for transgender young people. The practical effect will be to drive therapists away from seeing transgender youth altogether, or worse, to force the mass adoption of conversion therapy across the state. For transgender children in Texas, the message from their own government is now unmistakable: there is no one left who is safe to talk to.