Gender transitions at issue in court

In 2003, Texas Republicans championed sweeping medical malpractice reforms aimed at protecting doctors from frivolous lawsuits. The changes capped most malpractice damage awards at $250,000 and required patients to file lawsuits within two years, making it significantly harder to bring such claims before a judge.

Two decades later, the party is now asking the Texas Supreme Court to make an exception to that strict two-year deadline for one specific group: people who say they were harmed by gender-transition procedures. And on Wednesday, the court signaled it's seriously considering doing so.

During oral arguments in the case, Chief Justice Jimmy Blacklock seemed poised to agree that gender-modification care causes particular harm to patients, even when those patients are adults.

"The claim (the plaintiff is making) is essentially, 'you told me to go hurt myself,'" Blacklock said on the bench. "I'm also struggling with why there wouldn't be an ongoing legal duty to withdraw advice of that nature."

More than 60 Texas House Republicans penned a statement this month urging the high court to allow detransition activist Soren Aldaco, 23, to sue the therapist who helped her transition when she was 19. Aldaco did not sue until more than two years after her therapist referred her for breast-removal surgery, but within two years from the surgery date itself.

"I am, as a physician lawmaker, I am a big fan of tort reform," state Rep. Tom Oliverson, R-Cypress, said in a news conference on Wednesday morning.

But, he added, "This is not about frivolous lawsuits. This is about somebody who is steered down a path before the age of consent, before they could vote, before they could drive, in some cases, before they could even sign a legal document."

The lawmakers also pledged to work on carving gender-modification care out of the state's strict malpractice lawsuit limitations, a change that could make Texas doctors more likely to face legal action when helping adults transition. LGBTQ rights groups have warned that GOP lawmakers could target transgender care for adults eventually, even as proponents in the Legislature have insisted that their efforts are solely about protecting children.

Aldaco says the therapist helped her obtain a referral for a double mastectomy -- the surgical removal of both breasts. She did not formally file her lawsuit until more than two years after the referral was issued, which lower courts ruled was too late under Texas law.

The high court's consideration is striking given its conservative majority has historically sided with doctors and businesses in malpractice and injury cases. If the justices rule in Aldaco's favor, it could make it easier to sue providers of transgender care in Texas, and likely make it harder to seek out that care.

Several of the lawmakers who signed the letter have previously supported tort reform efforts, including measures backed by Texans for Lawsuit Reform, a powerful group that advocates for limits on lawsuits. The group told Hearst Newspapers that it was "monitoring the case and will refrain from commenting until the court has rendered its decision."

The lawsuit also comes at an inflection point in the debate over gender-affirming care, and amid a hostile political climate for transgender Texans. Texas banned medical gender transition procedures for minors in 2023 and has sought to investigate parents who seek out such treatment for child abuse, drawing rebuke from LGBTQ+ rights groups.

Earlier this month, two major medical groups changed their stances and asserted that children should not generally undergo hormone replacement therapy, breast removal and other procedures until they are adults. They have not publicly opposed surgeries for adults.

Transition, lawsuit

Aldaco had "played with the idea of living as the opposite sex" since she was 11, she wrote in a Dallas Morning News op-ed in 2023. Dressing in boys' clothing, cutting her hair short and binding her chest "felt like a weight lifted off (her) shoulders." She joined a support group for trans youth, then began receiving masculinizing hormone replacement therapy at 17.

In February 2021, she received a referral for double mastectomy surgery that she had requested from Barbara Rose Wood, a licensed clinical social worker with a counseling group in West Lake Hills whom Aldaco consulted with via telehealth.

The surgery took place in June 2021. Aldaco later said she experienced complications and regretted the procedure. In 2023, she sued Wood and other medical providers involved in her transition.

Aldaco said Wednesday that she was "taken advantage of by a series of medical providers who prioritized ideology, conveniently simplistic explanations and profit over helping me uncover and work through a liturgy of pain."

Tarrant County trial courts dismissed the lawsuits, ruling that Aldaco had missed the two-year filing deadline. She formally notified providers of her intent to sue in May 2023 and filed her complaint in July 2023, more than two years after the February 2021 referral letter that forms the basis of her malpractice claim.

Her attorneys argue that the two-year clock should have started on the date of the surgery, June 11, 2021, when they say she suffered "irreversible, grievous injuries." The Dallas-based law firm representing Aldaco focuses exclusively on cases brought by people who have detransitioned.

Gender dysphoria "is the only psychological condition for which surgery is a recommended treatment," lawyer John Ramer said Wednesday, arguing that referrals for gender modification care cause harm that endures long afterward.

Meanwhile, Wood's attorney William Newman said a ruling in Aldaco's favor would open the floodgates for other kinds of medical malpractice lawsuits and mark a "radical change" from the court's historical approach to torts. He contended gender-affirming surgery is not significantly different from other kinds of cosmetic surgery that could cause harm.

Political fight

Aldaco, who now identifies as a woman, has said she felt she "essentially traded mental anguish for physical anguish" during her transition and that her distress did not disappear. She has also argued that her earlier understanding of womanhood was shaped more by cultural expectations than by biology.

Regardless of how the court rules, the issue may soon return to the Texas Legislature.

The Republican lawmakers who signed the letter also pledged to pursue legislation that would extend the statute of limitations for malpractice claims filed by detransitioners who say they were harmed by negligent providers.

Similar bills failed to gain traction in 2023 and 2025, but with the public support of 60 House Republicans, the proposal could gain momentum in the next legislative session.

"I am not for repealing (Texas' medical malpractice liability restrictions)," Oliverson said Wednesday. "But I am for creating a special pathway so that these young people, who are scarred for life before they were even old enough to vote, have the ability to seek justice and to be made whole to the best of our ability to make them whole."

Oliverson denied, however, that such a reform would have broader implications for Texas' legal landscape.

Asked by Hearst Newspapers whether he believes all minors harmed by medical malpractice should be given a longer timeline to do so, Oliverson said he's focused narrowly on gender transition. He asserted the medical industry perpetrated a "systemic failure" in that area.

"The issue before us is whether to allow an exception for this particular issue," he said in an interview. "Hypotheticals are hypotheticals, but I think in this case, you can clearly articulate that these people were pushed down a pathway, often without even a proper diagnosis, and just pushed into a course of irreversible treatment."

Equality Texas, an LGBTQ advocacy group, said it opposes expanding legal liability for gender transition treatments because it "makes it riskier for doctors to provide the care and for insurers to cover it."

"We oppose any and all legislation that would create more regulations for trans folks, who are just trying to take care of their health while navigating an unusually complex system," Jonathan Gooch, a spokesperson for Equality Texas, told Hearst Newspapers in an email Wednesday.