FILE - Demonstrators gather on the steps to the Texas Capitol to speak against transgender-related legislation bills being considered in the Texas Senate and House, May 20, 2021, in Austin, Texas. The Texas Supreme Court will allow the new state law banning gender-affirming care for minors to take effect on Friday, Sept. 1, 2023, setting up Texas to be the most populous state with such restrictions on transgender children. (AP Photo/Eric Gay, File)
CNN  — 

The Texas Supreme Court heard oral arguments Tuesday on the challenge to the state’s near-total ban on gender-affirming care for minors.

Senate Bill 14, which went into effect last September, bars Texas health care providers from giving gender-transition surgeries, puberty-blocking medication or hormone therapies to those under 18, with violators at risk of losing their licenses.


Gender-affirming care is endorsed by the American Medical Association, the American Psychiatric Association and the American Academy of Pediatrics, among other major medical groups, as clinically appropriate for children and adults with gender dysphoria, a psychological distress that may result when a person’s gender identity and sex assigned at birth do not align.

Last year, a district court judge issued a stay on the law before it went into effect. At the time, the Texas Attorney General’s office filed an appeal to the Texas Supreme Court, which allowed the ban to take effect, CNN previously reported.

On Tuesday, Texas Assistant Solicitor General Natalie Thompson defended the state law, arguing the plaintiffs’ claims have no merit.

“First, parental liberty interests are not in conflict with the state’s well recognized authority to regulate the practice of medicine. Second, a statute that distinguishes between medical conditions is not discrimination on the basis of sex, and this court should not recognize transgender individuals as the first ever suspect class that is mentioned nowhere in the Texas Constitution’s text. Third, physicians do not have a constitutional right to perform gender transitioning procedures on children,” Thompson said.

“The statute is narrowly tailored to protecting children from interventions that interfere with their growth and development and have irreversible physical effects all without proven mental health benefit. The court should vacate the temporary injunction and reverse,” Thompson added.

Major medical associations – including the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry – agree that gender-affirming care is clinically appropriate for children with gender dysphoria.

Research shows that gender-affirming care can greatly improve a person’s mental health and well-being, CNN previously reported.

Several justices pressed Thompson on her argument that the law does not interfere with parents’ decisions.

“How is it not an interference when that parent has made that decision based upon his or her consultation with medical professionals based upon medically sound guidelines that have been accepted by the American Medical Association, the American Psychological Psychiatric Association … Pediatric Association?” Justice Debra Lehrmann asked.

Thompson argued that the state legislature had “evidence that the organizations your honor mentioned have been ideologically captured. The evidence to support these interventions is questionable at best.”

Thompson also pointed out that parents “do not have a constitutional right to obtain procedures that are otherwise unlawful. If an adult wouldn’t have a right to obtain a medical procedure because it’s made unlawful, then parents don’t get to veto those same laws on behalf of their children,” she said, referring to medical treatments in general.

SB 14 in the Courts

-June: Texas GOP Gov. Greg Abbott signs SB 14 into law, to take effect September 1
-July: Families, doctors and advocates of transgender youth sue state officials, claiming the law violates the state constitution
-August: A state district court judge temporarily blocks the law, ruling in favor of the families. But the state attorney general appeals, allowing the law to take effect as scheduled
-Tuesday: The state Supreme Court heard oral arguments in the case

Attorney Kennon Wooten spoke on behalf of the parents, doctors and advocates challenging the law. She argued that SB 14 “usurp(s) the fundamental right of parents to make medical decisions for their children, deprives transgender youth of equal rights and equal protection. It deprives the doctors of their vested property interests in their medical license without due course of law, and then infringes on all healthcare providers’ occupational liberty again, without due course of law.”

“The state has disregarded widely recognized benefits of the care that SB 14 bans in the risk of doing nothing to treat gender dysphoria,” Wooten said.

During the hearing, several justices asked Wooten about who should have the right to decide whether a person has access to medical care or medical decisions impacting children.

“Does the legislature have any role in regulating what is on offer in terms of medical care to minors?,” Justice Jane Bland asked. Bland added that there have been different kinds of mental health treatments that “we have seen through decades of medical practice.”

“They can do that, but they can’t do it in a way that crosses the bounds of constitutionality,” Wooten said.

As they ended their oral arguments Texas Assistant Solicitor General Thompson said she would like the court to decide the future of SB 14.

Meanwhile, Wooten said her clients are hoping to go to trial.