Texas Attorney General Ken Paxton issued a legal opinion on March 2 that says it is illegal for state-licensed mental health care providers to “transition” children.

Texas passed Senate Bill 14 in 2023, which banned using “gender-affirming care” procedures such as puberty blockers, hormone therapy, and surgeries to treat gender dysphoria in minors.

In Paxton’s opinion, he writes that because SB 14 made it illegal for health care providers to transition children, the law also applies to mental health care providers licensed by the Texas Behavioral Health Council.

He said mental health professionals are defined as health care providers in this sense “for good reason, as the path to kids being ’transitioned‘ often starts with unethical indoctrination by activists providing mental ’health care' designed to confuse children about their gender.”

The opinion states that SB 14 not only applies to persons or entities that “provide” medical interventions but also to those that “facilitate” medical interventions.

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

Paxton issued the opinion in response to an inquiry by Darrel Spinks, executive director of the Texas Behavioral Health Executive Council.

In it, the Texas attorney general says that the “multidisciplinary path to medically transitioning children often starts with mental ‘health care.’”

After SB 14 went into effect in 2023, multiple parents of children diagnosed with gender dysphoria and physicians and groups affected by the law sued the state, arguing that it was unconstitutional.

“Trans Texans, like all Texans, have the right to get the medical care they need. SB 14 is an unconstitutional law that overrides the judgment of patients, parents, and medical providers by banning life-saving medical care for transgender youth,” the Texas American Civil Liberties Union (ACLU), which represented plaintiffs in the case, wrote in a 2023 statement.

Although a trial court ruled that the law likely violated the state’s constitution, the Texas Supreme Court upheld the law.

Proponents of statewide bans on transgender procedures for minors, including Paxton in his legal opinion on March 2, argue that these health care interventions permanently alter children. They often highlight the irreversible aspects of sex reassignment surgeries.

A July 2024 study by Harvard was unable to find any instances in which a U.S. minor under the age of 12 received gender-related surgical procedures and determined that these interventions are rare in minors older than 12, usually limited to chest-related surgeries.

The Mayo Clinic said in January that using puberty blockers on transgender-identifying children might improve “mental well-being, ease depression and anxiety, improve social interactions with others, lower the need for future surgeries, [and] ease thoughts or actions of self-harm.”

“Taking puberty blockers alone, however, without other medical or behavioral treatment, might not be enough to ease gender dysphoria,” the clinic stated.