Gender Transition Care for Minors
Texas banned puberty blockers, hormones and surgeries for gender transition in minors in 2023, and courts have upheld the law. Medical groups and governments in the U.S. and abroad disagree about the evidence. Federal policy tightened in 2025 and 2026.
The basics
The words used are part of the debate. Supporters of access usually say 'gender-affirming care.' Recent federal documents use terms like 'sex-rejecting procedures'5. This page uses the neutral phrase 'medical transition treatments' for puberty blockers, cross-sex hormones and surgeries.
Texas Senate Bill 14 took effect September 1, 2023. It bars doctors from providing these treatments to minors for gender transition, lets the Attorney General enforce it in court, and required minors already on medication to wean off it1. The Supreme Court of Texas upheld the law on June 28, 20242.
On June 18, 2025, the U.S. Supreme Court upheld a similar Tennessee law in United States v. Skrmetti. It ruled the law does not classify by sex or transgender status in a way that triggers stricter review under the Equal Protection Clause3.
Federal agencies have acted too. The Department of Health and Human Services released a review of the evidence in May 2025, with peer-reviewed materials in November 20254. In August 2026, federal regulators finalized a rule barring federal Medicaid and CHIP money for these treatments for minors (under 18 in Medicaid, under 19 in CHIP), effective October 13, 2026. States may still pay with their own funds5. A separate proposal to bar hospitals that provide them from Medicare and Medicaid remains under review5.
Abroad, the United Kingdom made its ban on new puberty blocker prescriptions for gender dysphoria in under-18s indefinite starting January 1, 2025, citing expert advisers' finding of an unacceptable safety risk and an independent review that found weak evidence of benefit. Patients already on them may continue6. The American Academy of Pediatrics has said this care, provided carefully, is medically necessary and can be lifesaving7. In early 2026, the American Medical Association said surgery for minors should generally wait until adulthood while still supporting gender-affirming care, and the American Society of Plastic Surgeons recommended delaying these surgeries until age 198.
Key terms
- Gender dysphoria
- Distress caused by a mismatch between a person's sex and their gender identity.
- Puberty blockers
- Drugs that pause puberty. Texas bans their use for gender transition in minors1.
- Cross-sex hormones
- Testosterone or estrogen given to develop traits of the opposite sex. Texas bans them for this purpose in minors1.
- Rational basis review
- The easiest legal test for a law to pass. The Supreme Court applied it in Skrmetti3.
In Texas
The Texas law is settled for now: upheld by the state's highest court2, and a similar law was upheld by the U.S. Supreme Court3. The Texas Medical Board must revoke the license of a doctor who violates it, and the Attorney General can sue to stop violations1.
The remaining debate in Texas is mostly about whether to keep, strengthen or loosen the ban, and how state and federal agencies handle related health coverage.
How people see it
The strongest case for each view, in terms its supporters would recognize. We don't pick a side.
Ban for minors
Children cannot fully weigh decisions with permanent effects, such as infertility. Reviews in the U.S. and Europe have found the evidence of benefit weak. Until that changes, the state should protect minors and let adults decide for themselves.
Rare cases, strict limits
A small number of young people may benefit, but only after long, careful evaluation. Treatment should happen in research settings or with strict safeguards, not as a routine first step.
Leave it to families and doctors
Politicians should not make medical decisions for other people's children. Parents, working with doctors who know their child, are best placed to weigh risks and benefits case by case.
Protect access by law
Major U.S. medical groups say this care can be lifesaving for transgender youth at high risk of depression and suicide. Denying it harms kids and overrides parents. The law should guarantee access to care that doctors recommend.
Who decides
- Texas Legislature and Governor: Wrote and could change the state ban.
- Texas Attorney General (elected): Enforces the ban in court1.
- Texas Medical Board: Must revoke the license of a doctor who violates the law1.
- Congress, the President and HHS: Set federal health program rules, such as Medicaid coverage5.
- Courts: Decide whether laws on this issue are constitutional23.
Questions to ask a candidate
- Should the current Texas ban stay as is, be strengthened, or be loosened?
- Who should make these decisions for a minor: the state, parents, doctors, or some combination?
- What evidence would change your mind on this issue?
- Should public health programs like Medicaid pay for these treatments for minors?
Last reviewed 2026-09-26. Spotted something wrong? Every claim links to its source so you can check it yourself.
Sources
- Senate Bill 14, 88th Legislature (enrolled text)Texas Legislature Online
- Loe v. Texas case pageACLU of Texas
- United States v. Skrmetti: Supreme Court Affirms State Ban Against Certain Medical Treatments for Transgender Minors (LSB11329)Congressional Research Service
- Gender Dysphoria ReportHHS Office of Population Affairs
- CMS Final Rule Prohibits Federal Medicaid, CHIP Funding for Child Sex-Rejecting ProceduresHolland and Knight
- Ban on puberty blockers to be made indefinite on experts' adviceUK Department of Health and Social Care (GOV.UK)
- Why We Stand Up for Transgender Children and TeensAmerican Academy of Pediatrics
- What statements from medical societies mean for trans care for kidsSTAT