Hospitals and clinics across Texas have been withdrawing from trans-affirming care under sustained political pressure, accelerated by Governor Greg Abbott's appointments and legislation targeting gender-diverse young people. The retreat is not driven by medical evidence: it is driven by fear, and the people paying the price are trans Texans who need care.
What has been happening to trans healthcare in Texas?
Over recent years, Texas has become one of the most hostile environments in the world for trans-affirming medical care. What was once a patchwork of providers offering gender-affirming services, including hormone therapy, puberty-pausing medications, and psychological support, has been systematically dismantled through legislation, executive orders, and institutional pressure.
The pattern is consistent. A provider announces they are pausing or permanently ending gender-affirming services. They cite the legal climate, institutional risk, or regulatory uncertainty. Sometimes they say nothing at all, and patients simply find that appointments stop being available. The clinicians who wanted to provide that care often remain employed at those institutions, but they are no longer permitted to do the work.
This is what provider retreat looks like from the inside: not a loud, dramatic announcement, but a series of quiet closures that leave patients stranded without warning, transition, or referral to anywhere that can help.
What legislation is driving this?
Texas Senate Bill 14, which passed in 2023, banned gender-affirming medical care for trans minors, including puberty blockers and hormone therapy. It placed the threat of professional discipline on any provider who continued, and opened institutions to legal liability. The effect was immediate: major hospital systems that had been providing care announced they were stopping.
The legal challenge to that bill has continued through the courts, but in the meantime, care has stopped. The families who needed it most, those without the means to travel to another state, have been left without options. Puberty does not pause while a legal process runs its course, and every month of an unwanted one is a permanent physical change that no court ruling can reverse.
For adults, the legislative picture has been somewhat different, but the chilling effect has been real. Providers who serve adults have watched what happened to those serving young people and drawn their own conclusions about what comes next. Some have pre-emptively withdrawn. Others have made their services harder to access without formally stopping them.
Who is Shawn Thierry, and why does this matter?
Shawn Thierry served as a Democratic state representative in Texas. Her appointment by Governor Greg Abbott, a Republican who has made opposition to trans healthcare a central part of his political identity, was widely read as a significant and deliberate move. Thierry had broken with her party on trans-related legislation, aligning herself with positions more closely associated with the Republican majority, particularly on restrictions affecting trans young people.
Abbott's appointment of Thierry to lead a state body sent a clear signal: those willing to cross the aisle on trans issues would be rewarded with institutional power. That dynamic matters not just symbolically. The bodies that shape healthcare policy, professional standards, and regulatory enforcement in Texas are staffed and led by people making consequential decisions every day. When those positions are filled by people who have demonstrated a willingness to restrict trans care, the institutional environment becomes correspondingly more hostile.
This is how political backlash operates at scale. It is not only about the laws that pass. It is about who controls the machinery that interprets and enforces them.
What does the medical evidence actually say?
The medical case for gender-affirming care is not contested by the organisations that set international clinical standards. The World Health Organisation, the American Medical Association, the Endocrine Society, and WPATH (the World Professional Association for Transgender Health) all support access to gender-affirming care, including for adolescents where clinically appropriate. These are not fringe positions: they represent decades of clinical experience and research.
Gender-affirming hormones are typically bio-identical, meaning they are the same hormones the body would produce naturally. Puberty-pausing medications, often called puberty blockers, have been used for decades in the treatment of conditions such as precocious puberty. Their use in gender-affirming care is an extension of established practice, not an experimental departure from it.
The case against, in Texas and elsewhere, does not rest primarily on medical evidence. It rests on political and moral objections to trans identity itself, translated into the language of child protection. Describing it as anything else would be inaccurate.
Who is being harmed?
The harm is falling most heavily on trans young people and their families. Young people who were mid-treatment have had medications withdrawn. Families who had been working within the healthcare system have found themselves without providers, without prescriptions, and without any clear path forward. Some have moved out of Texas. Others cannot.
Trans adults in Texas have also experienced the chilling effect, particularly those in the earlier stages of their journey. Finding a provider willing to initiate hormone therapy has become harder. Waiting times have extended. Some clinicians who were willing to provide care have left the state or the field entirely.
The harm is not abstract. People I hear from in situations like this describe a particular kind of despair: not just about the care they cannot access, but about the message that withdrawal sends. When a hospital system removes your care from its list of services, it does something to how you understand your own legitimacy in the world. That is a harm too, and it should be named.
What can trans Texans do?
The options are limited, but there are some.
Interstate travel for care remains legal for adults, and for families of trans young people in states that have passed protective legislation. Several states have enacted shield laws that protect providers from out-of-state legal action and protect families who travel for care. Knowing which states offer that protection is worth understanding if travel is possible.
Online and telemedicine providers operating from states with legal protection have continued to serve trans people in restricted states. The legal picture is complex and changes frequently, but access through this route has remained possible for some. For practical medical care including hormones and ongoing prescribing, GenderGP works with people in difficult access situations and can help you understand what is available to you.
Community networks and legal support organisations have been documenting what is happening and providing practical guidance to families navigating the withdrawal of care. If you are in Texas and have lost access to a provider, you are not navigating this alone, even when it feels that way.
Is this happening only in Texas?
No. Texas has been among the most aggressive states in its approach, but the pattern of legislative restriction followed by provider retreat has appeared across the United States, and echoes of it can be found in the UK and elsewhere. The mechanism is similar wherever it occurs: legislation or regulatory pressure raises the risk of providing care, institutions respond by withdrawing from it, and the burden falls on the individuals who needed that care most.
What is distinctive about Texas is the scale, the speed, and the explicit use of state power, including in appointments like Thierry's, to shape the institutions responsible for healthcare policy. That combination makes Texas a useful case study in how political backlash against trans people operates in practice, not just in principle.
What does this mean for the future of trans care in the US?
The short answer is that the legal and political battles are continuing, and the outcomes are genuinely uncertain. Federal and state court decisions have pulled in different directions. The political environment at the federal level has shifted in ways that affect what protections trans people can rely on.
What is not uncertain is the medical case. The evidence supporting gender-affirming care has not changed because of legislation in Texas. Trans people exist, they always have, and the care that helps them live better lives remains what it has always been. The question is access, and access is a political question, not a medical one.
That distinction matters. The fight for access is worth having, and it is a fight that trans people and their allies have been winning in important ways even while losing ground in others. Provider retreat is real, and so is the community that refuses to accept it as the final word.
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Dr Helen Webberley is a Gender Specialist, Medical Educator, writer, and advocate, and the founder of GenderGP. She works full-time in advocacy, education, and public engagement, promoting understanding and equality for gender-diverse people around the world.
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