When Gina Goe talks about her 15-year-old son, Grayson, she beams with pride.
"I think Grayson is pretty amazing," Goe testified during a hearing at the Travis County District Court Tuesday. "He's smart."
Grayson is transgender, and has been taking testosterone for some time now. Goe — who is using a pseudonym — said it's helped Grayson regain confidence in himself and become more functional.
But a law set to go into effect next month would require Grayson to stop using his testosterone. The law, called Senate Bill 14 or SB 14, prohibits transgender minors from accessing gender-affirming care such as puberty blockers and hormone therapy. It also bans surgeries.
"If he doesn't continue on the testosterone I worry that ... the things that have changed for the better ... I'm afraid that that will be completely reversed," Goe said.
Under the law, minors who started gender-affirming care before June 1, and who have attended six months of counseling or psychotherapy before that date, will be able to wean off the treatment with the guidance of their physician.
Goe is one of multiple plaintiffs suing the state of Texas over the law, which is set to go into effect Sept. 1.
On Tuesday, Travis County District Court Judge Maria Cantú Hexsel held the first hearing on the lawsuit. She heard from the plaintiffs, medical experts and attorneys who asked the court to block the law from being implemented.
Karen Loewy, one of the attorneys representing the plaintiffs, said SB 14 violates the constitutional rights of the plaintiffs and their families.
"SB 14 threatens the health and wellbeing of transgender adolescents in Texas," Loewy said, adding it also violates parents' autonomy to choose what they consider the best medical treatment for their kids.
But during the hearing, attorneys for the state said SB 14 doesn't violate the constitution and that it's needed. "The law was enacted to protect minors from scientifically unsound treatment," said Heather Dyer, an assistant attorney general at the Office of the Attorney General of Texas.
She said the state has a "compelling interest" in safeguarding the well-being of minors.
What is gender-affirming care?
Gender-affirming care practices are endorsed by the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, the Pediatric Endocrine Society, the Texas Pediatric Society, and the American Board of Pediatrics as best practices for care.
That includes puberty blockers and hormone therapies, as well as surgeries — though they are rarely performed on minors.
But under the soon-to-be law, doctors who provide this type of care to transgender youth would have their licenses revoked.
Dr. Richard Ogden Roberts, a pediatric endocrinologist, said in court that if the law goes into effect it will make him "abandon patients with whom I have established relationships."
"I spent the last month telling people that I may in fact not be able to see them come Sept. 1," Roberts, who is a plaintiff in the lawsuit, said. "It would be heart wrenching to lose these patients."
Roberts said when he provides this type of care he follows adopted medical standards.
Dr. Aron Janssen, the vice chair of clinical affairs at the Pritzker Department of Psychiatry and Behavioral Health at the Lurie Children's Hospital of Chicago, said in court Tuesday that gender-affirming care creates multiple positive outcomes for transgender children.
"We see improvement in gender dysphoria, we see improvement in distress, we see improvement in mental health," Janssen said.
He said, when left untreated, gender dysphoria can increase the risk of suicidal ideation among transgender youth.
Supporters of SB 14 have heavily focused on the surgery aspect of care. That's despite medical experts, including Dr. Johanna Olson-Kennedy, pointing out that the procedures are uncommon.
Olson-Kennedy, who serves as the medical director of the Center for Transyouth Health and Development at Children's Hospital Los Angeles, said research does show that chest surgery has positive outcomes for the mental health of transgender people.
However, she stressed that more commonly used puberty blockers are life changing for transgender youth.
"For people who have access to puberty blockers, their life is just different because of that, and their mental health is intact because of that," Olson-Kennedy said.
She told the court she sees this in her clinic every day.
"We used to really celebrate when our patients graduated high school," Olson-Kennedy said. "Now I feel that because of access to services being more available, people are finishing college, they are going to grad school ... people are really thriving in their lives."
A second day of hearings is scheduled for Wednesday.
Last month, a federal judge lifted an injunction on Kentucky's ban on gender-affirming care for transgender minors.
Regardless of the judge's ruling, an appeal is expected to be filed. Twenty other states have banned medication and surgical treatments for transgender youth, according to the LGBTQ think tank Movement Advancement Project.
In Alabama, Florida, and Indiana, federal judges have either fully or partially blocked similar bans on transition-related care.