In Texas, cases are mounting against physicians who broke state law by prescribing puberty blockers and hormones to minors under the guise of “gender affirming care.”

On Oct. 17, Texas Attorney General Ken Paxton filed a lawsuit against Dr. May Lau, a pediatrician and professor at the University of Texas Southwestern Medical Center. The suit claims that Lau treated 21 children with hormone blockers after the practice became illegal in the state and then “falsified” medical and billing records and prescriptions to manipulate the appearance of the care she provided.

Less than two weeks later, Paxton filed another suit accusing Dr. Hector Granados, an El Paso-area pediatric endocrinologist and known “gender care” provider, of “harming the health and safety of Texas children.” Paxton’s suit against Granados alleges the physician falsified medical records, prescriptions, and billing records to “intentionally conceal the unlawful conduct in violation” of Texas law. 

On Nov. 4 Paxton named a third physician, Dr. M. Brett Cooper, in a lawsuit for allegedly providing “gender transition” drugs to minors after Texas law forbade it.

In a statement, Paxton said that Texas is “cracking down” on physicians who continue to illegally prescribe such drugs to minors and “will be prosecuted to the full extent of the law.”

Paxton has strong legal backing. Both suits hinge on recently passed Texas law SB 14, upheld by the Texas Supreme Court in June 2024. The law states that healthcare providers may not “affirm the child’s perception of the child’s sex if that perception is inconsistent with the child’s biological sex.” Providers may not prescribe puberty blockers and cross-sex hormones to children with the intent of altering their expression of gender. If found guilty, physicians face loss of licensure and a potential $1 million fine.  

Power of the States

The U.S. medical system is structured so that states and state medical boards, not the federal government, largely decide licensure and regulate practice. But state medical boards are failing to protect the public. 

The Texas Medical Board would not comment on Lau’s or Granados’ case.

“As the regulatory agency overseeing the licensing and discipline of physicians, TMB plays a vital role in ensuring the quality of healthcare in Texas,” said Spencer Miller-Payne, communications officer at the Texas Medical Board, in response to emailed questions. “The board’s primary responsibility is to protect public health and safety by enforcing standards that physicians and other licensed professionals must meet to practice in the state.”

Complaints received by the board receive due process and follow standard procedures for determining violation of the Medical Practice Act, he said. If a licensee is found in violation of Texas law, the board is required to revoke their license. 

“Now that gender affirming care has been publicized as a ‘gold standard’ by the AAP [the American Academy of Pediatrics] and Endocrine Society, you need judges that are willing to go against a group of doctors,” explains Dr. Jill Simons, executive director of the American College of Pediatricians, an alternative medical board that has spoken out against the practice of gender transitioning. 

Resistance to Convincing Data

The Cass Review, leaked World Professional Association for Transgender Health files, and an increasing number of studies have contributed to bans on “gender transition care” in some Western nations, yet major American medical boards have announced a determination to not change course. 

Lawsuits and court cases are therefore the most effective route to end these practices, said Merrill Matthews, a health policy expert who serves on the Texas Advisory Committee of the U.S. Commission on Civil Rights. State lawsuits have the potential to reduce transgender treatments, but as long as some states still allow it, minors could still cross state lines. “It is a necessary, but not sufficient step,” Matthews said.

Civil lawsuits, filed by people who were minors at the time of the gender-affirming care, will be the most effective way to stop these practices, Matthews said. “When individuals who underwent this ‘care’ as minors explain to juries the lifelong medical challenges they now face and how they believe they and their parents were [deceived] into transitioning, those juries will be delivering hefty awards.”

For transgender care centers and physicians, those penalties could amount to millions of dollars, Matthews said. “Malpractice insurance would then stop covering the centers and the practices. And with the profit factor removed and jury awards piling up, health care providers will have to stop.”

Small plaintiffs’ law firms, such as Campbell Miller Payne in Dallas, are already specializing in these cases. Attorney Jordan Campbell said the firm has heard from roughly 125 potential plaintiffs and have trial dates set in several cases; other cases have dates pending and more will soon be filed. 

If several are decided for plaintiffs and actual and punitive damages stretch into the millions of dollars, more suits will follow, Matthews said. 

Federal Intervention

Historically, physicians have regulated themselves within the profession, Simons said. “That is what actually should happen; if something is new or not working, we come together within our organizations and discuss,” she said. “Unfortunately, that is no longer happening, so now it is going to the courts.”

President-elect Donald Trump has outlined a plan to support legislation allowing individuals who underwent “gender transition” procedures as minors to sue the doctors involved. His plan would also revoke gender-affirming care policies, ban federal support for gender transition, deny Medicare and Medicaid certification to providers involved in gender treatment for minors, and investigate pharmaceutical companies and providers who have used these treatments. 

Under a Trump administration Department of Health and Human Services, “the agency might seek to issue guidance or regulations that would effectively ban the practice [of giving children transgender hormones and surgeries],” Matthews said. “A GOP-controlled House and Senate may prepare legislation to stop the practice. And Trump would likely sign it.”