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Breaking Down the Headlines: The Outcomes We Don't Hear About (Part Two)
- Jul 16
- 12 min read
In part one of The Outcomes We Don’t Hear About, we looked at the issue of legal actions against the transgender community, medical providers that serve them, and what happens when we only hear about the accusation of “wrongdoing” but don’t learn the outcome. We discussed strategic litigation, lawfare, and the chilling effect that legal actions have regardless of their outcomes. In part two, we are going to look at specific cases that were in the headlines, identify their status or outcome, and share resources to help you follow legal actions that are important to you.
One thing that may not be totally clear is the role that Texas, specifically the Texas Attorney General, has played in laying the groundwork for not just the fact that the legal actions are occurring, but also the reasoning behind the actions.
Texas has spent years serving as a proving ground for attacks on transgender people, and Attorney General Ken Paxton has been one of the leading figures behind that effort. Long before the federal government began issuing grand jury subpoenas to hospitals providing gender-affirming care, Texas was testing the limits of what was possible. Paxton's office advanced the false narrative that gender-affirming care is child abuse, pushed investigations into parents and healthcare providers, and worked to reframe accepted medical care as something suspicious or even criminal. These actions were never just about Texas. They were about building a roadmap, one that could be replicated by other states and, eventually, by the federal government.
That roadmap is now becoming easier to see. The latest federal actions, including the use of grand jury subpoenas and allegations of insurance fraud like we discussed in DOJ Subpoenas for Trans Care Records, follow a pattern Texans have witnessed for years: take a vulnerable community, create a moral panic around its existence, and then use the power of the government to investigate, intimidate, and isolate the people who support it. This has been the case for many vulnerable groups including immigrants, those impacted by environmental racism, and the LGBTQ+ community.
Texas has been the testing ground for these tactics, and Ken Paxton, the State Attorney General, has often appeared to be the lead scientist, developing new theories, refining old ones, and measuring their success by how effectively they discourage people from accessing care. What starts in Texas rarely stays in Texas. And as these strategies spread across the country, transgender people continue to pay the price, not because they have done anything wrong, but because their lives have become a political experiment.
Understanding today's federal investigations requires looking back at where many of these efforts began. The current moment did not appear overnight, nor is it the result of a single lawsuit or subpoena. It is the culmination of years of coordinated legal, political, and administrative actions designed to challenge the legitimacy of transgender people's lives and the healthcare they receive. Beginning in 2022, Texas accelerated these efforts through attorney general opinions, executive directives, investigations, and litigation that would become a model for others to follow. The timeline below illustrates how Texas helped shape the playbook now being used across the country, and how each action built upon the last, bringing us to the present day.
Between 2022 and 2023, Texas built a legal and policy framework around gender-affirming care for minors. This period is important because it shows how quickly a single legal opinion can expand into investigations, executive action, and ultimately statewide legislation. It also shows something else: how many different parts of government can be used at the same time, executive agencies, courts, legislatures, and attorneys general, to create a sustained legal environment around a single issue.
We’re going to take a look at some of the headlines during this time and follow what happened after. The goal in doing this is to demonstrate that the first headline is only the beginning, and to hopefully clearly show how each of these separate actions have worked together to create the legal landscape targeting transgender people and providers who care for them that we see across the country. We’ll examine this in three phases:
Phase One: 2022 The Legal Foundation Is Set
Phase Two: 2023 Lawmaking Replaces Executive Action
Phase Three: 2024 to Present Targeting Providers Directly
I’ve organized this into charts to hopefully make reading easier. If you prefer to read this without the chart and with more detail, check out the PDF linked below.
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Phase One (2022): The Legal Foundation Is Set
Headline / Issue | Action Taken | What Happened After the Headline |
Attorney General Ken Paxton issued Opinion KP-0401 stating that certain forms of gender-affirming care could constitute child abuse. | This opinion was not a law and not binding on courts, but it carried significant weight in how state agencies interpreted their authority. The chilling effect. It became the legal foundation for what followed not just in Texas, but across the country. | |
Gov. Greg Abbott orders investigations of gender-affirming care (Feb. 22, 2022) | Abbott directed DFPS to investigate families supporting transgender children accessing care. | The directive was an administrative command—not legislation—and prompted immediate legal challenges from families and advocacy organizations. |
Doe v. Abbott & PFLAG v. Abbott (March 2022) | Families, providers, and advocates sued Texas, arguing the state lacked authority to redefine child abuse and investigate families. | Courts issued temporary orders blocking or limiting investigations while litigation continued, creating years of uncertainty for families and providers. |
Texas courts intervene (Spring–Summer 2022) | Multiple courts issued, modified, and narrowed injunctions. | Investigations were repeatedly announced, blocked, paused, and narrowed, demonstrating how legal uncertainty itself can alter behavior. |
Texas Supreme Court ends injunctions (May 29, 2026) | The Court dissolved remaining injunctions after DFPS testified investigations had permanently ended. | The Court reaffirmed that Attorney General opinions and gubernatorial directives cannot change Texas law. DFPS stated it would not reopen investigations because SB 14 now prohibits the care. |
Key Takeaway:
Phase One transformed a legal opinion into state action, lawsuits, and years of uncertainty, even though the original opinion was never legally binding.
Phase Two (2023–2024): Lawmaking Replaces Executive Action
Headline / Issue | Action Taken | What Happened After the Headline |
SB 14 introduced (March–May 2023) | Texas lawmakers introduced legislation banning gender-affirming medical care for minors. | The legal question shifted from, "Can the state investigate this?" to "Can the state prohibit this care altogether?" |
Gov. Abbott signs SB 14 into law (June 2, 2023) | SB 14 prohibited puberty blockers, hormone therapy, and most surgical interventions for minors while creating enforcement mechanisms. Texas moved from opinion → directive → investigations → legislation, fundamentally changing the legal landscape. | Lawsuit is filed. See Loe v. Texas and the subsequent actions below. |
Loe v. Texas filed (July 2023) | Families and physicians challenged SB 14, arguing it violated parental rights, discriminated against transgender youth, and interfered with medical judgment. | The issue entered constitutional litigation, with advocates seeking to prevent statewide enforcement. |
Temporary injunction, then stay (Summer 2023) | A lower court temporarily blocked SB 14. | The Texas Supreme Court later stayed the injunction, allowing the law to take effect while litigation continued. |
SB 14 takes effect statewide (Sept. 1, 2023) | Texas began enforcing its ban on gender-affirming care for minors. | Texas became one of the largest states to enact such a ban while legal challenges remained unresolved. |
Texas Supreme Court upholds SB 14 (June 28, 2024) | In State of Texas v. Loe, the Court upheld the law in an 8–1 decision. | The ruling rejected challenges related to parental rights, equal protection, and physician rights, permanently clearing the way for enforcement and influencing legal efforts nationwide. |
Key Takeaway:
Phase Two transformed administrative actions into enforceable law, creating a legal framework that has since been cited and replicated across the United States.
The Framework Texas Created in Phase One and Phase Two
It is important to point out that while Texas wasn’t the first to use legal and administrative actions to disrupt gender affirming care for minors (Arkansas and Florida were the first states to do so), the sequence of events in Texas ended up paving the way for those previous actions in Arkansas and Florida to go into effect, inspired other states to pursue similar actions, and influenced a US Supreme Court decision.
Prior to Texas issuing its directive to investigate families in February 2022, Arkansas and Florida utilized administrative actions and legal opinions to disrupt or block gender-affirming care for minors.
Key state actions prior to 2022:
Florida- In 2021 and 2022, state officials increasingly used administrative mechanisms and legal guidance. The Florida Agency for Health Care Administration issued a regulation barring Medicaid coverage for gender-affirming care, and the Florida Department of Health issued guidance aiming to discourage such care. [1, 2]. What we frequently observe in anti-LGBTQ+ legal actions or state administrative actions is that what originates in Florida hits Texas next, and vice versa.
Arkansas- In 2021, Arkansas became the first state to pass a law banning gender-affirming medical care for minors. Its enforcement was blocked by a federal court. After years in the judicial system and multiple blocks, the law went into effect in 2025 after the 8th Circuit Court rejected the challenge to the law. This decision came following the US Supreme Court ruling in the Skrmetti case, which upheld Tennessee’s 2023 ban on gender affirming care for minors (the same year Texas enacted SB 14). And cited as precedent in that US Supreme Court Case: Texas’ SB 14, and the Texas Supreme Court decision which upheld the law’s constitutionality.
This Texas State Supreme Court ruling on SB 14, bolstered by the years of legal opinions, administrative commands, and political influencing that came before it, permanently cleared the way for not just Texas to enforce its ban on gender affirming care for minors, but all states, and created a political formula for more states to follow…and they have followed. And so has the federal government with Executive Orders and the resulting policy revisions (administrative commands), and subpoenas against providers
Phase Three (2023–Present): Targeting Providers Directly
Headline / Issue | Action Taken | What Happened After the Headline |
Texas investigates Dell Children's & Texas Children's Hospitals (May 2023) | The Texas Attorney General opened investigations months before SB 14 took effect. | Both hospitals settled. Dell Children's Medical Center in Austin avoided a formal lawsuit by entering into an investigation with the Texas Attorney General in May 2023. In response to the probe, the hospital announced it “prohibits pediatric hormone therapy and surgeries for gender dysphoria” (which was set to become illegal in September with SB 14), prompting the entire adolescent medicine clinic staff to leave. No wrongdoing was demonstrated. Texas Children's settled for more than $10 million, ended pediatric services, agreed to open a detransition clinic. No wrongdoing was demonstrated. |
Seattle Children's subpoenaed (Nov. 2023) | Texas demanded records related to transgender patients from Texas. | Seattle Children's sued. The parties settled in 2024, Texas dropped its records request, and no wrongdoing was established. |
Paxton demands PFLAG records (2024) | Texas sought communications, documents, and referral information concerning families seeking care outside the state. | PFLAG sued to block the demand. In 2026, the Texas Supreme Court allowed portions of the request to proceed, but allowed documents to redact identities of trans individuals. Litigation remains ongoing. |
Texas filed lawsuits against Drs. May Lau, Brett Cooper, and Hector Granados for allegedly violating SB 14. |
This marked the first known use of Medicaid fraud laws against providers of gender-affirming care, and laid the groundwork for subpoenas against hospitals in Rhode Island and New York we discussed in a previous blog which use the same strategy. · The lawsuits against Dr. Lau and Dr. Cooper are ongoing, with Dr. Cooper set for trial in the 493rd Judicial District Court of Collin County, Texas, a conservative court often preferred by the Texas Attorney General (forum shopping). | |
Children's Health lawsuit (Feb. 2026) | Texas sued Children's Health and Dr. Jason Jarin alleging prohibited care, Medicaid fraud, and false documentation. | The state seeks civil penalties exceeding $1 million. The litigation remains ongoing. |
Federal subpoenas issued (April–May 2026) | Federal prosecutors in Texas subpoenaed hospitals, including Rhode Island Hospital and NYU Langone, seeking records related to gender-affirming care. | Families sued to block disclosure. Federal judges have temporarily blocked enforcement of the subpoenas while litigation continues. |
FTC and Texas sue WPATH (June 2026) | The FTC and several states alleged deceptive practices related to pediatric gender-affirming care. | WPATH denies the allegations and continues to challenge the action in court. The case remains ongoing. |
Key Takeaway:
Phase Three marks a shift from targeting policies to targeting providers, hospitals, advocacy organizations, and national medical institutions directly. Many of these cases remain unresolved, while others concluded without findings of wrongdoing. This is where we can clearly begin to see the use of strategic litigation and lawfare that we discussed in part one. We see a pattern of settlement to avoid costly litigation that further jeopardizes a provider’s reputation, and perhaps most importantly, we can see a clear pattern of no wrongdoing.
Why This Timeline Matters
This timeline illustrates a clear evolution in Texas's legal strategy and how it has laid the groundwork for federal actions. Initial efforts in 2022 centered on administrative and child welfare enforcement through Attorney General opinions and DFPS investigations. Beginning in 2023, the focus shifted toward legislative restrictions with SB 14, followed by constitutional litigation over the law's validity. From late 2023 through 2026, enforcement increasingly relied on civil litigation, fraud allegations, Medicaid billing claims, consumer protection statutes, and coordinated state-federal investigations, reflecting an expansion from regulating medical practice to broader legal scrutiny of healthcare providers, hospitals, advocacy organizations, and professional medical associations.
This is where the connection becomes clear.
If someone only saw headlines from this period, they might see:
“Texas investigates parents of trans youth”
“Attorney General targets gender-affirming care”
“Texas bans transition care for minors”
“Lawsuit filed over transgender medical care”
Each of these headlines, when viewed on their own without following the trail forward creates a narrative that providers are acting illegally, and combined together create a social/political environment of fear of being “next” in line for legal consequences. But, we can see how many legal actions resulted in no wrongdoing being found. We can see that the recent legal actions against providers are tools of lawfare.
Does seeing the outcomes change how you view these legal actions?
This doesn’t mean that there isn’t legal risk for providers affirming transgender identities. It is clear that the Texas Attorney General and the federal government will continue to target providers even if their actions are frivolous and don’t have any merit. With their tactics of strategic litigation and lawfare, including forum shopping that frequently brings these cases to North Texas courts like the 493rd Judicial District Court of Collin County, Texas, there is risk of another provider in or out of Texas becoming the next headline. The hope is that just like with Dr. Granados, the cases fall apart because they have no merit, that Federal Judges continue to block subpoenas like in the cases of Rhode Island Hospital and NYU Langone, and that hospitals won’t prematurely comply with threats. With greater public understanding of these legal actions and the strategy behind them, we can lessen the impact of the chilling effect and not give these political actors the power to influence our behavior.
Resources For You
Below are resources to follow legal cases and also demystify legal terms to help you follow legal cases. Legal documents and the way they are written can be a major barrier to us better understanding the legal processes and tactics used. Our hope is that these resources and this blog help more people to not just understand the social, political, and legal landscape we are living in, but to change the trajectory of where we are going. We don’t have to let lawfare and targeted political attacks make us retreat into the shadows. We can understand them for what they are, see that they have very clear limitations, and not give them more power than they actually have. We don’t have to be passive bystanders as the Texas Attorney General, the federal government, or any entity make targeting vulnerable communities part of their driving mission.
Resources to Help You Follow Cases:
Lambda Legal- https://lambdalegal.org/litigation-library/
In Lambda Legal’s litigation library you can review details of all cases they are providing counsel on. You can also select specific topic areas, a specific state, and more to filter your search. You can read the case history, view records, and of course follow the outcome.
The ACLU’s in the courts resource page allows you to search for and read about cases in the US Supreme Court and State Supreme Courts. You can filter by court type, issue area, state, and you can also search by case name or key words.
The cases and advocacy page highlights the legal work of the National Center for LGBTQ+ Rights. You can filter by topic, outcome, type of case, and state.
Resources to Help You Understand Legal Terms:
Justia Legal Dictionary: Offers thousands of searchable terms with practical examples of how they are used in everyday legal settings.
NCSC Plain Language Glossary: Published by the National Center for State Courts, this translates complex legalese into clear writing to help everyday people understand court documents
United States Courts Glossary of Legal Terms: Find definitions of legal terms to help understand the federal court system. Enter legal term to search for definition.
General LGBTQ+ Law Related Resources:
The Library of Congress: LGBTQ+ Legal Resources: A Beginner’s Guide.
University of Oregon: LGBTQIA+ Legal Research Guide. This guide focuses on resources that primarily deal with laws in the areas gender identity and sexual orientation.
And Remember…
The next time a headline announces that someone has been sued, investigated, or subpoenaed, consider asking a few additional questions:
What exactly is being alleged?
What evidence has been presented so far?
Has a court actually ruled on the facts?
What happens after this stage of the case?
Will I follow the outcome as closely as I followed the headline?
Those questions won't always produce simple answers. But asking them can help us better understand the difference between an allegation and a legal finding, between publicity and proof, and between the beginning of a story and its conclusion.
We’ll be taking a break from our Breaking Down the Headlines Series next week, but stay with us for more soon.
