Psychologists, counselors, and social workers in Texas can be penalized just like doctors for helping facilitate children&#8217;s sex changes, according to an opinion clarifying the state&#8217;s ban on sex-rejecting interventions.
The Texas Behavioral Health Executive Council (TBHEC) asked Republican Attorney General Ken Paxton if mental health providers met the criteria of “health care provider” described in the state&#8217;s child sex-rejection ban, <a href="https://legiscan.com/TX/text/SB14/id/2756089">S.B. 14</a>, suggesting the care provided by mental health professionals fell outside the outlawed interventions.
“The agency respectfully seeks clarification as to how such providers are impacted by S.B. 14, given that the prohibited activities and services are exclusively medical in nature and fall outside the scope of practice for mental health professionals,” the council wrote in a July 2025 <a href="https://www.texasattorneygeneral.gov/sites/default/files/request-files/request/2025/RQ0605KP.pdf">letter</a>. 
“Any radical facilitating the ‘transitioning’ of our kids is committing child abuse. The law is clear that these radical procedures are illegal and in no world should Texans’ tax dollars be used to permanently harm children,” Paxton told The Daily Wire. &#8220;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.”
The <a href="https://bhec.texas.gov/">TBHEC</a> helps regulate and uphold professional standards within the state&#8217;s behavioral health and social service professions.
Paxton unequivocally said mental health professionals fell within the criteria of the ban in an <a href="https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/2026/kp-0518.pdf">opinion</a> published on February 27, 2026.
“The unambiguous definition of ‘health care provider’ does not require a prescription pad or scalpel,” Paxton stated in the opinion. “S.B. 14 codified more than a prohibition on providing certain surgeries and prescriptions.” 
Paxton further clarified that the Texas <a href="https://legiscan.com/TX/text/SB14/id/2756089">ban</a> on child sex-rejection forbids the use of public money to fund any individual or organization that “provides or facilitates” the gender transition of minors.
The TBHEC told The Daily Wire the professionals they help regulate are “expected to comply fully with Texas law.” 
“S.B. 14 prohibits certain medical procedures for minors in Texas. The question before us was whether the technical statutory definition of ‘health care provider’ included behavioral health professionals,” Darrel Spinks, Executive Director of the Texas Behavioral Health Executive Council, told The Daily Wire. 
“Out of deference to the statutory framework and the Attorney General’s role in interpreting state law, we sought formal clarification to remove any ambiguity. The opinion confirms what many would reasonably assume; that licensed mental health professionals are health care providers under the statute. This does not change the law or our responsibilities. Our licensees are expected to comply fully with Texas law,” Spinks stated. 
The council&#8217;s letter mentioned the pending Supreme Court case, <a href="https://www.dailywire.com/news/scotus-to-hear-challenge-to-colorados-gender-identity-censorship-law">Chiles v. Salazar</a>, where Christian counselor Kaley Chiles is challenging Colorado’s law banning so-called conversion therapy. The Colorado <a href="https://content.leg.colorado.gov/sites/default/files/2019a_1129_signed.pdf">law</a> prohibits counselors from “attempts or purports to change an individual’s sexual orientation or gender identity,” which Chiles argues violates her freedom of speech and pushes children towards sex-rejecting medical interventions. 
“The court is examining whether the regulated practice of mental health counseling is conduct or speech,” wrote the TBHEC. “Circuit courts are split, as the Third and Eleventh Circuits treat mental health counseling as speech and not conduct, while the Ninth and Tenth Circuits treat it as conduct and not speech. Given the significance of the question before the court, which may have far reaching implications, this case may be something you want to consider in your opinion.” 
Paxton addressed these concerns in the opinion footnotes, writing, “You also imply that your questions may intersect with the First Amendment, referencing Chiles v. Salazar … But Chiles concerns a statute that is markedly different from the framework at issue in your request.”   
However, Paxton wrote his office generally did not comment on pending litigation and would offer “no speculation on the scope of the Court’s eventual holding in Chiles.” 
Mental health providers play a pivotal role in the sex-rejecting medical intervention pipeline by providing psychological assessments that are often required to obtain sex change surgeries, such as a double mastectomy, the opinion noted. 
“The multidisciplinary path to medically transitioning children often starts with mental ‘health care,’” the opinion states. “Mental health professionals serve as the ‘clinical gatekeepers whose assessments and recommendations initiate the interventions’ prohibited by S.B. 14.”
Many insurance companies and surgeons require a recent mental health assessment and surgery recommendation <a href="https://transcare.ucsf.edu/surgery-referral-assessment-requirements">letter</a> in order to move forward with sex-rejecting surgery.
The quality and clinical practice surrounding these assessments were heavily criticized in the Department of Health and Human Services (HHS) 2025 <a href="https://opa.hhs.gov/sites/default/files/2025-11/gender-dysphoria-report.pdf">report</a> on the treatment of gender dysphoria. 
Leor Sapir, PhD, a Senior Fellow at the Manhattan Institute and co-author of the HHS report, explained how gender clinician assessments often focus on achieving teens&#8217; sex-rejection goals rather than examining their gender dysphoria. 
“Gender clinicians have abandoned the assessment model pioneered by the Dutch and replaced it with ‘readiness assessments’ designed to help kids clarify and pursue their ‘embodiment goals,’” Sapir told The Daily Wire.   
“Importantly, gender clinicians freely acknowledge that these goals can shift, with some claiming that this is not a failure of treatment but rather part of a teen&#8217;s ‘gender journey.’ And increasingly, the gender-focused specialists in the mental health field have come to view assessment in the traditional sense as a form of harmful gatekeeping, or even ‘conversion therapy.’ “ 
<blockquote class="twitter-tweet">
TODAY: The Texas Supreme Court will hear oral arguments in the case of <a href="https://twitter.com/SorenAldaco?ref_src=twsrc%5Etfw">@SorenAldaco</a>, an Independent Women ambassador &amp; detransitioner seeking justice for what she says is medical malpractice that led to her double mastectomy at age 19. 
🧵 <a href="https://t.co/EQc7rtsaua">pic.twitter.com/EQc7rtsaua</a>
— Independent Women (@IWF) <a href="https://twitter.com/IWF/status/2021629602805035171?ref_src=twsrc%5Etfw">February 11, 2026</a></blockquote>
Mental health assessments performed by gender clinicians have recently been scrutinized in detransitioners&#8217; lawsuits. 
Fox Varian, a female detransitioner, successfully sued her psychologist and surgeon and was <a href="https://www.dailywire.com/news/shocking-details-emerge-in-landmark-2-million-trans-malpractice-judgment">awarded $2 million</a> for harm caused by a double mastectomy she received at age 16.  Psychologist Dr. Kenneth Einhorn recommended and pressured Varian’s mother to sign off on the surgery, saying the gender-confused teen would commit suicide without it, according to reporting from independent journalist Benjamin Ryan for the <a href="https://www.thefp.com/p/a-legal-first-that-could-change-gender">Free Press</a>.
Arguments in the case centered around a letter sent by Einhorn to Varian’s surgeon recommending she receive the double mastectomy, which Varian’s legal team argued was inaccurate and improper, according to reporting from <a href="https://www.theepochtimes.com/us/surgeon-psychologist-defend-approval-of-teen-gender-surgery-at-trial-5971471?lwpw=k_3a6luJl_-CKlybsxi5TcsF1XMIfeLvxAWJ_opV_QjuH3SoPr-dweybn_1R_4jnUcku1lvvVrkIBDi4KGrrtXa48JW6iWemlCp6rSMUQ0lVHv3817gNdnxMqZTK8d2Nmvvm64G934EWxturDVNPiSs7aFEUdDDgJsypHaol">The Epoch Times</a>.
<a href="https://www.dailywire.com/news/texas-supreme-court-case-could-help-destransitioners-seek-justice">Soren Aldaco</a>, a woman who struggled with gender confusion throughout her adolescence and underwent a double mastectomy at 19 that she later regretted, sued her mental health providers, alleging they negligently wrote a surgical recommendation that granted her access to the mastectomy, <a href="https://law.justia.com/cases/texas/second-court-of-appeals/2024/02-24-00217-cv.html">court documents</a> show.

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Texas Therapists Will No Longer Get Away With Pushing Kids Toward Sex Changes