On March 2, the viciously anti-trans attorney general of Texas, Ken Paxton, released an opinion saying it’s illegal for mental health care providers in the state to affirm trans youth. He said the gender-affirming care ban already in place in the state applies to mental health care, too, going so far as to call it “child abuse” to affirm trans youth who confide in trusted adults.

“This opinion should send a clear warning,” Paxton said in a statement at the time, “there will be consequences for any medical professional, whether a doctor or a therapist, who is illegally ‘transitioning’ Texas kids.”

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But here’s the wrench in Paxton’s nefarious threat: His opinion – even when issued with an official seal – doesn’t actually change the law.

“People are taking this opinion as fact, as Ken Paxton altering the law or reinterpreting the law to suit his whims,” Naveen Farrani, strategic Communications Manager for Equality Texas, told LGBTQ Nation. “He does not have the jurisdiction to do that.”

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Of course, most lay people (including journalists) can’t always grasp the nuances of political bureaucracy and parse the difference between an opinion, a law, a ruling, and the like. The opinion has thus caused a fury of confusion, fear, and misinformation, which is more than likely exactly what Paxton wanted.

“He has an agenda against trans folks… This is just an opportunity for him to make a political position to frighten people.”

And it’s working. Farrani said frantic mental health care providers have reached out to Equality Texas to ask whether they are still allowed to support their trans patients. They know of one therapist who has already dropped a trans patient rather than risk legal repercussions.

People are “complying in advance,” Farrani emphasized.  

Will Francis, executive director of the Texas, Louisiana, and Oklahoma chapters of the National Association of Social Workers (NASW), said folks have similarly reached out to his organization asking if they can even use trans patients’ preferred pronouns anymore, let alone treat them for gender dysphoria.

“We very quickly said yes, 100%,” he told LGBTQ Nation. “The legislation itself is purely focused on medical transitioning, which is unfortunately illegal in Texas… but [it] is the law. To be in any way connected to that, you would have to be part of a treatment plan.”

“It’s just an opinion,” Francis re-stated, “so no rules or laws are changed by what he says.”

Why gender-affirming therapy matters

For those who have fallen prey to the anti-trans hysteria currently sweeping the nation, the idea of gender-affirming mental health care might conjure images of crunchy, purple-haired, androgynous therapists evilly tenting their fingers while planting ideas in children’s heads, urging them to medically transition.

That’s not what happens.

In reality, therapists provide a space for young people to explore feelings they are already experiencing. “They’re gonna give them the opportunity to explore and then move to a medical space should they choose,” Francis said, adding that “therapists don’t start ideas in people’s minds that they then push towards medical treatment.”

He said therapy provides a space for trans youth to share things they may not be comfortable talking about at home and to explore different facets of their identities. A therapist’s job, he clarified, is not to tell a patient if they do or don’t need medical interventions.

Farrani said that coming to terms with one’s trans identity can be “profoundly isolating,” and having a therapist to help navigate it all is critical, especially for youth who don’t feel safe opening up to anyone else.

“It’s really, really hard to be different and feel confident in that difference when everything is telling you to conform in order to survive and to make friends… a lot of people are only able to really access and gain that confidence with the help and guidance of a mental health practitioner. It’s really hard when all of the people that you know of in positions of power are saying, you’re wrong, actually, I don’t think you should exist.”

2025 data from the Trevor Project found that out of LGBTQ+ people ages 13 to 17, trans, nonbinary, and gender-questioning youth have the poorest mental health outcomes and the highest risk of suicide. The organization’s 2024 survey also found that the risk of suicide decreases when these youth have access to affirming spaces.

“I think the youth themselves are the most minimized piece of the whole thing, and the most at risk,” Francis said. “We know the outcomes for trans youth can be challenging. We know the higher rates of suicide. We know they often retain things because of fear and shame. So you want them in a place where they’re safe. You want them talking to someone who they feel is safest… And in the therapeutic space, they often have the ability to explore in a deeper way.”

But Paxton’s opinion could make kids feel scared that they’ll get a therapist in trouble if they mention anything about gender identity. As such, Francis said NASW’s main message to therapists is that they “can potentially do more harm” by telling young people that there are things they can’t share with their therapist.

“We’re asking folks to not only put aside their fears about this, which are, I think, unjustified… but also think very strongly about how they can support youth in these spaces.”

The opinion versus the law

Texas banned gender-affirming care for trans youth in 2023.

S.B. 14 banned doctors from prescribing hormones or puberty blockers and also from performing gender-affirming surgery (an already extremely rare treatment for trans youth). It required youth already receiving gender-affirming care in the state to wean off the treatments, essentially forcing them to detransition.

The legislation is very specific about which procedures and medications are banned. All of them are related to physical treatments of a child, rather than mental health care.

“Therapists are not giving somebody top surgery,” Farrani said. “Because they’re a therapist, not a surgeon. So therapists, as of right now… can still treat trans clients with gender dysphoria for anxiety and depression with talk therapy.”  

The word in the legislation that has caused confusion, Farrani added, is “facilitates.”

“Public money may not directly or indirectly be used, granted, paid, or distributed to any health care provider… that provides or facilitates the provision of a procedure or treatment to a child that is prohibited,” it says.

While the bill doesn’t define the word facilitate, Farrani says it would mean a therapist couldn’t, for example, write a letter of support for someone seeking hormone therapy. But because gender-affirming care is banned in Texas, anyway, there really isn’t a reason for a therapist to do that.

“So, it’s really about fear-mongering and causing panic,” they said.

A lengthy statement from NASW’s Sexual Orientation and Gender Identity and Expression (SOGIE) Committee echoed the same idea. “We want to stress that, since no minor can access gender affirming medical care in Texas, as S.B. 14 made that care illegal, it is not possible for social workers to ‘facilitate’ any ‘treatment or procedure.’”

Francis explained that Paxton’s opinion could ostensibly lead folks to accuse therapists of starting a discussion that ultimately leads someone to get medical care in another state.

“I think he would have zero leg to stand on,” Francis added, “but nobody wants to go to court.”

The SOGIE committee clarified, though, that “to facilitate medical transitioning in another state, you’d need to be connected to those professionals and part of the established or written plan.”

The committee also called attention to a statement from the Texas Behavioral Health Council saying that “Council licensees may not provide a course of treatment intended to affirm a child’s perception of sex that is inconsistent with the child’s biological sex when that course of treatment is intended to facilitate the medical transitioning of a child through a treatment or procedure prohibited” by the law.

“This statement, unfortunately, may cause social workers to fear providing even basic best practices to trans youth and their families, including linking clients and their families to appropriate resources,” the committee explained. “This was the goal of Ken Paxton’s opinion: to create more fear and spur overcompliance.”

“It is critical to note that this guidance does NOT prohibit you from ‘affirming a child’s perception of sex’ or gender that is not consistent with the sex or gender they were assigned at birth. It only prohibits you from doing so when your clinical care is specifically intended to ‘facilitate the medical transitioning of a child through a treatment or procedure prohibited under [Texas law].’”

Farrani nonetheless believes the opinion will have a chilling effect on therapists’ willingness to work with trans young people, even for reasons unrelated to gender dysphoria.  

“When I see my therapist, I am just trying to process the, the dumpster fire of the world, and if a non-binary teenager isn’t experiencing gender dysphoria and sees their therapist for other reasons, maybe to just process the state of the world, there’s a really good chance now that that therapist might just drop them because they’re nonbinary, and they’re just scared. So now that teenager just doesn’t have a therapist and is left high and dry to deal with the horrors that we all have to deal with.”

All that’s left

Farrani is devastated that Paxton’s opinion might limit access to affirming mental health care for youth, which is already hard enough to come by as it is. “Mental health care is really the only form of affirming care that trans young people in Texas have access to at all,” they lamented.

In addition to the gender-affirming care ban, Texas Gov. Greg Abbott (R) signed a Don’t Say Gay bill into law last year to bar discussion of LGBTQ+ identity in classrooms, ban LGBTQ+ student clubs, and prohibit school staff from acknowledging student identities that diverge from the binary, among other restrictive anti-LGBTQ+ measures.

It’s not an easy time, but Farrani wants trans kids to know that there are people fighting tooth and nail for them every day.  

“I know that at times, it really doesn’t seem like that because all of the bad news feels inescapable and is proliferating everywhere, but there are so many people whose entire jobs are to fight legislation, combat misinformation, and try to meaningfully change people’s minds and make the state a safer place.”  

“This is not the first time in modern history that there has been a concerted effort to erase queer and trans people,” Farrani added. “We’re still here; we’re not going away.”  

“Hang on,” they pleaded to Texas trans youth. “Hang on.”        

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