Texas has one of the country’s most restrictive sets of laws affecting transgender residents. Since 2021, the state has banned gender-affirming medical care for minors, required bathrooms in government buildings to be used according to biological sex, limited school and college sports participation to teams matching sex at birth, cut off administrative routes to change sex markers on state IDs, and written a biological definition of sex into the statute books. The Texas anti-trans laws now in force reach healthcare, schools, identification, public facilities, and certain performances, and they interact with federal rules that have themselves narrowed in the past two years.
Ban on Gender-Affirming Care for Minors
Senate Bill 14 took effect in September 2023 and prohibits doctors and other healthcare providers from performing gender-transition procedures or prescribing transition-related medications to anyone under 18.1State of Texas. Texas Health and Safety Code 161.702 – Prohibited Provision of Gender Transitioning or Gender Reassignment Procedures and Treatments to Certain Children The ban covers surgery, puberty blockers, and hormones such as testosterone and estrogen when prescribed to transition a minor’s biological sex or affirm a gender identity different from their sex at birth.
The law carves out narrow exceptions. Puberty blockers may still be prescribed to treat precocious puberty, and medically necessary treatment is permitted for children born with genetic disorders of sex development, including chromosomal variations and ambiguous reproductive anatomy.2State of Texas. Texas Health and Safety Code 161.703 – Exceptions Minors who had already begun a course of medication before June 1, 2023, were allowed to continue temporarily but must wean off the drugs in a medically safe manner. No minor in that group may switch to a different prohibited treatment.
The penalties for providers are mandatory. The Texas Medical Board must revoke the license of any physician found to have provided a prohibited treatment and must refuse to issue or renew a license for anyone who has committed a violation.3Texas Legislature Online. Texas Senate Bill 14 – Enrolled The Texas Attorney General can also go to court to stop a provider from continuing or repeating a violation.
SB 14 also closes off public funding. No state money may pay for, reimburse, or subsidize a prohibited procedure or treatment for a minor, which includes Medicaid and the state’s Children’s Health Insurance Program (CHIP).3Texas Legislature Online. Texas Senate Bill 14 – Enrolled The funding ban reaches grants to hospitals, medical schools, and any other entity that provides or facilitates the covered treatments.
Child Welfare Investigations
In February 2022, before SB 14 passed, Governor Greg Abbott directed the Texas Department of Family and Protective Services to investigate reported instances of minors receiving gender-transition procedures, characterizing them as child abuse under existing Texas law.4Office of the Texas Governor. Governor Abbott Directs DFPS to Investigate Gender-Transitioning Procedures as Child Abuse The directive relied on an Attorney General opinion arguing that certain medical interventions for minors qualify as abuse under the state’s Family Code.
The governor’s letter reminded licensed professionals who work with children, including doctors, nurses, and teachers, that they have a legal duty to report suspected abuse and face criminal penalties for failing to do so. Several families were investigated in the months that followed, and the directive remains in the background even after SB 14 took over the healthcare question through the legislature.
Legal Definition of Sex
House Bill 229, passed in the 2025 session, formally defines “sex,” “male,” “female,” “man,” and “woman” throughout Texas law. Under HB 229, “sex” means an individual’s biological sex, either male or female, and those definitions apply whenever another Texas statute uses the terms without providing its own.5Texas State Law Library. Guides – LGBT Law – Transgender Law The definitions set a uniform baseline that supports the state’s other transgender-related laws.
A companion from the same session, Senate Bill 1188, requires electronic health records to list a patient’s biological sex at birth. Providers may amend that designation only to correct a clerical error or to reflect a diagnosed disorder of sex development. The practical effect is that medical records in Texas reflect birth sex regardless of a patient’s gender identity or any transition undergone as an adult.
Bathrooms and Changing Rooms in Government Buildings
Senate Bill 8, the Texas Women’s Privacy Act, took effect in 2025 and requires multiple-occupancy restrooms, locker rooms, and changing areas in government-owned buildings to be designated for use by individuals of one biological sex only.5Texas State Law Library. Guides – LGBT Law – Transgender Law The law covers public schools and charter schools, public universities and junior colleges, state agency and local government buildings, correctional facilities, and certain domestic violence shelters.
SB 8 does not spell out how institutions should verify compliance, requiring only that they take “every reasonable step” to enforce the restrictions. Violations can lead to civil penalties or a lawsuit. The law replaced what had been a patchwork of district and agency policies with a single statewide standard tied to biological sex at birth.
School and College Sports
Student athletes in Texas must compete on teams matching their biological sex. House Bill 25, signed in 2021, covers public K-12 schools and open-enrollment charter schools, and ties eligibility for a male or female team to the sex listed on the birth certificate issued at or near the time of birth.6State of Texas. Texas Education Code 33.0834 – Interscholastic Athletic Competition Based on Biological Sex A later amendment does not count unless it corrected a clerical error. If the original birth certificate is unavailable, the school may use another government record.
Senate Bill 15, signed in 2023, extended the same framework to public colleges and universities. A student may not compete on a team designated for the opposite biological sex, and male students may not fill positions designated for female athletes in mixed-sex competitions.7State of Texas. Texas Education Code 51.980 – Intercollegiate Athletic Competition Based on Biological Sex Female students may compete on a men’s team when no women’s equivalent is available.8Texas Legislature Online. Texas Senate Bill 15 – Save Women’s Sports Act Anyone can seek a court injunction against a university that fails to follow the rules.
The NCAA updated its own policy in February 2025 to bar student athletes assigned male at birth from competing on NCAA women’s teams, though they may still practice with women’s teams and receive benefits such as medical care.9NCAA.org. NCAA Announces Transgender Student-Athlete Participation Policy Change NCAA rules also note that state and federal laws supersede NCAA policy where applicable, so transgender athletes at Texas schools are subject to both the state restrictions and the national association’s rules.
Changing Sex Markers on IDs
Changing the sex marker on a Texas driver’s license or state ID to reflect a gender transition is no longer possible. In 2024, the Texas Department of Public Safety stopped accepting court orders that change an individual’s sex designation. A judge’s decree will not produce an updated license.10Texas State Law Library. Correcting Errors – Identity Documents The agency also rejects combined orders that bundle a name change with a sex marker change in one document.
Birth certificates face similar barriers. The Texas Department of State Health Services is no longer processing amendments to gender markers on birth certificates, and even where lower courts have ordered a change, state agencies have refused to carry it out. The result is that core identity documents in Texas reflect sex at birth with no administrative path to change them.
Federal documents have also become more restrictive. Following a November 2025 Supreme Court decision, the State Department requires all new, renewed, and replacement passports to show the holder’s sex assigned at birth. The “X” gender marker option has been eliminated for new applications, though previously issued passports with an “X” or a marker reflecting the holder’s gender identity remain valid until they expire. The Social Security Administration similarly no longer permits updates to the sex designation on Social Security records. The Social Security card itself does not display a sex marker, but the underlying record links to credit reports, medical records, federal student aid, and background checks.
Sexually Oriented Performances
Senate Bill 12 created criminal and civil penalties for performances the state classifies as “sexually oriented” when they take place on public property or in front of someone under 18. The law targets performances that combine accessories or prosthetics exaggerating sexual characteristics with sexual conduct.11State of Texas. Texas Penal Code 43.28 – Certain Sexually Oriented Performances Prohibited A performer who violates the law commits a Class A misdemeanor, punishable by up to a year in jail, a fine of up to $4,000, or both.12State of Texas. Texas Penal Code 12.21 – Class A Misdemeanor A business owner who allows such a performance in front of a minor on their premises faces a separate civil penalty of up to $10,000 per violation.13Texas Legislature Online. Texas Senate Bill 12 Cities and counties cannot authorize these performances on public property or anywhere a minor might be present.
SB 12 was tied up in court for years. In February 2026, a three-judge panel of the Fifth Circuit cleared it to take effect in March 2026, noting that a performance must appeal to a “prurient interest in sex” to qualify as “sexually oriented” under the statute. The panel also found that most of the plaintiffs had not shown their own performances met that threshold. The case has been sent back to a lower court for further proceedings on some enforcement questions, so the exact boundaries of the law may continue to shift.
Federal Protections That Still Apply
Federal law offers some remaining protection, though its scope has narrowed. In 2020, the U.S. Supreme Court ruled in Bostock v. Clayton County that firing someone for being transgender violates Title VII of the Civil Rights Act, because it amounts to discrimination based on sex.14Supreme Court of the United States. Bostock v. Clayton County, Georgia A Texas employer who terminates or refuses to hire someone specifically because they are transgender can be sued under federal law regardless of what state law says.
How far Bostock reaches beyond hiring and firing is less settled. In January 2026, the EEOC rescinded its 2024 workplace harassment guidance, which had addressed pronoun usage and restroom access for transgender employees. Repeated and deliberate misgendering combined with hostile behavior could still support a harassment claim under general Title VII principles, but the bar for proving a hostile work environment remains high.
Healthcare and education protections have shifted as well. In June 2025, the Supreme Court ruled 6-3 in United States v. Skrmetti that state bans on gender-affirming care for minors are constitutional.15Supreme Court of the United States. United States v. Skrmetti The Court applied rational-basis review, which removed the most promising federal constitutional avenue for challenging laws like SB 14.
On the education side, the 2024 Title IX rule that would have explicitly protected students from discrimination based on gender identity was blocked nationwide by a federal court order in early 2025. The U.S. Department of Education is enforcing the older 2020 Title IX regulations, which do not include explicit gender-identity protections. Title IX still prohibits sex discrimination, and some courts have interpreted that to cover gender identity, but no binding federal regulation currently requires schools to do so. HHS has also rescinded guidance extending the Affordable Care Act’s nondiscrimination protections to gender identity in healthcare settings, and a nationwide injunction blocks enforcement of the 2024 rule that attempted to codify those protections.
Seeking Care Out of State
Families looking for gender-affirming care for a minor sometimes consider other states where the treatments remain legal. About 21 states have enacted “shield laws” designed to protect people who provide, receive, or help someone access gender-affirming care from legal retaliation by states that have banned it. These laws vary, but commonly block state officials from cooperating with out-of-state investigations, prevent enforcement of out-of-state civil judgments, and protect healthcare providers from losing their licenses over care they legally provided within their own state. Some shield states also let individuals targeted for seeking care bring their own lawsuits.
The protections have real limits. They apply only within the shield state’s jurisdiction and do not prevent Texas from pursuing its own enforcement actions at home. Shield laws protect the provider in the other state but do not necessarily shield a Texas family from action by state authorities after they return. The interaction between SB 14, the DFPS investigation directive, and another state’s shield law creates a legal gray area that families should work through with a lawyer before starting treatment.