Texas Attorney General Ken Paxton isn’t just drawing a legal line around gender-affirming care for minors — he’s going after doctors, therapists, and hospitals with lawsuits, license threats, and now a sweeping new legal opinion that extends the state’s reach further than ever before.
The moves represent one of the most aggressive enforcement campaigns in the country against gender-affirming care for children. On March 2, 2026, Paxton issued a formal legal opinion declaring that mental health providers licensed by the Texas Behavioral Health Executive Council — not just physicians — are prohibited from facilitating gender transition procedures for minors under Senate Bill 14. The opinion makes clear that therapists and counselors are now squarely in the crosshairs, not just surgeons and endocrinologists.
The Law and What It Actually Says
S.B. 14 took effect on September 1, 2023, banning gender-affirming treatments like puberty blockers and hormone therapy for minors across Texas. There are narrow exceptions — some patients already on treatment before the law’s passage were allowed to continue, but only for the purpose of weaning off, as detailed by KERA News. That’s a tight window. And Paxton is now arguing it’s one that several providers blew right past.
The March opinion doesn’t mince words. Its summary states: “Any licensee that facilitates the provision of unlawful procedures or treatments that aim to transition a child’s sex are thus forbidden from receiving public money in support of those efforts and, separately, risk revocation of their licenses to practice.” That’s a two-pronged threat — cut off the funding, pull the license. For any provider still operating in a gray area, the message is unambiguous.
Lawsuits Already Filed — and One Doctor Gone
Paxton isn’t waiting around. In February 2026, his office filed suit against Children’s Health System of Texas and Dr. Jason Jarin, alleging that the hospital system provided puberty blockers, hormone replacement therapy, or surgery to 19 transgender youth in violation of S.B. 14. The lawsuit also includes allegations of fraudulent Medicaid billing — a charge that Paxton has leaned into hard. “This criminal extremist not only permanently harmed children, but he also then defrauded Medicaid and stuck Texas taxpayers with the bill for this insanity,” Paxton wrote in a statement. “Experimental ‘transition’ procedures on minors are illegal, unethical, and will not be tolerated in Texas.”
Then there’s the case of Dr. May Lau. Paxton sued her for allegedly prescribing testosterone to at least 21 minors. By early October 2025, she had surrendered her Texas medical license and relocated to Oregon. Paxton called her departure a victory, not a quiet resolution. “Doctors who permanently hurt kids by giving them experimental drugs are nothing more than disturbed left-wing activists who have no business being in the medical field,” he said. “We will not relent in holding anyone who tries to ‘transition’ kids accountable.”
Supporters Say It’s About Protection
Not everyone sees this as overreach. Jonathan Covey, policy director of Texas Values, praised the action against Dr. Lau specifically. “We’re grateful for the Texas Attorney General’s leadership in protecting kids from these harmful treatments and procedures,” Covey noted. For conservative advocacy groups in Texas, the enforcement wave is exactly what the law was designed to produce — consequences, not just statutes.
Paxton himself has made no effort to soften his framing. In a statement tied to the March legal opinion, he called providers who continue offering transition-related services to minors participants in child abuse — full stop. “Any radical facilitating the ‘transitioning’ of our kids is committing child abuse,” he declared. “The law is clear that these radical procedures are illegal and in no world should Texans’ tax dollars be used to permanently harm children.”
A Chilling Effect — By Design
Here’s the thing about legal opinions: they don’t have the force of a court ruling, but in practice, they often don’t need to. When a state attorney general tells licensed professionals that their credentials are on the line and their public funding could be yanked, many providers don’t wait for a judge to weigh in. They stop. They move. Or they never start.
Still, the legal battles are far from settled. Lawsuits against major health systems take time, and courts have previously scrutinized the scope of S.B. 14 — including what “facilitating” actually means when applied to counselors and therapists rather than prescribing physicians. The March opinion may widen the law’s reach on paper, but whether it holds up under challenge is a separate question entirely.
What’s not in question is the direction Texas is moving — and the speed at which it’s getting there. One doctor has already left the state. A major children’s hospital is facing litigation. And now the mental health community is being told it’s next in line. For the providers who remain, the warning has been delivered loud, in writing, and with Paxton’s name on it.
Whether that’s justice or intimidation likely depends on which side of the exam room door you’re standing on.
