Today, the US Supreme Court will finish its term with the release of two rulings in cases involving transgender athletes, along with a much-anticipated decision about birthright citizenship. Both West Virginia v. B.P.J. and Little v. Hecox will ignite plenty of commentary and likely result in binding precedent.
Before we get to that, however, the Texas Supreme Court quietly made its own impact on trans issues. In a ruling on Friday, the court made a significant adjustment to the statute of limitations in malpractice lawsuits for those detransitioning from pediatric sex-change surgeries and therapies. Soren Aldaco had a double mastectomy at 17 while dealing with abuse and mental issues that she alleges her doctors and nurses all but ignored. The surgery resulted in ongoing medical complications even apart from its sex-change purpose, but Aldaco wants to hold her doctor and clinic responsible as well.
Lower courts dismissed Aldaco's case based on the statute of limitations, but a unanimous decision by the state supreme court redefined the timeline. The key, the court ruled, is when the patient ascertains the injury:
We needn’t reconsider Shah, Husain, and Kimball today because those cases are distinguishable. Unlike Aldaco, the plaintiffs in those cases all suffered bodily injury on some ascertainable date before completion of their treatment or hospitalization. The plaintiff in Kimball had no “difficulty ascertaining a precise date on which his injury occurred” because the anesthesiologist whose failed intubation caused his respiratory failure had treated him only on the fifth day of his eleven-day hospitalization. 741 S.W.2d at 372. So too for the plaintiffs in Husain and Bala, whose doctors misdiagnosed cancer during examinations on specific days before the diseases were eventually spotted. Husain, 964 S.W.2d at 919–20; Bala, 909 S.W.2d at 891–92. And the same goes for the plaintiff in Shah, whose surgeon caused a detached retina by removing a scleral buckle from his eyeball on a known date and then continued to provide follow-up treatment. 67 S.W.3d at 842–43.
By contrast, Aldaco couldn’t ascertain any bodily injury until after completion of her treatment. Wood terminated psychotherapy on May 14, 2021, but the double mastectomy wasn’t performed until June 11, 2021. At any time during the course of treatment, Wood could’ve (and perhaps should’ve) withdrawn her allegedly negligent and fraudulent letter of February 22, 2021. As the court of appeals acknowledged, Aldaco “characterize[s] her claims as being rooted in Wood’s course of treatment[,] emphasizing that Wood had an ongoing obligation to withdraw the recommendation letter and that her counseling was flawed overall.” 727 S.W.3d at 219–20. Aldaco thus claims at least 82 days of continuing negligence, from February 22 through May 14, 2021. Wood’s alleged negligence posed the same risk on the last day of treatment as it did on the day she wrote the letter— namely, that Aldaco would act on the surgery recommendation that was never withdrawn. Under that theory of the case, even if we ignore Section 74.251(a)’s disjunctive “or” and give priority to the ascertainable date of the alleged negligence under the precedents quoted above, we’re left with a range of dates extending at least to May 14, 2021. Within that timeframe, there’s no ascertainable date of injury on which Aldaco’s limitations period began to run under Shah and its ilk. By giving presuit notice within two years of Wood’s completion of treatment, therefore, Aldaco satisfied the statute of limitations.
This may seem very technical and not of much import for anyone other than Aldaco and her particular set of circumstances. However, this has more impact than it might seem. It doesn't change the statute of limitations' time range, but it does define the moment it starts more rationally. Those undergoing sex-change therapies usually put surgery off to the end of the process. If the clock starts at the beginning of the therapy, as the lower courts held, then most detransitioners may be almost out of the window by the time surgery happens, and certainly won't get any time to regret before losing access to legal avenues for redress.
The decision in Aldaco v Wood et al may not be revolutionary change, but it's still significant enough to matter. Even more, the case and the ruling have caught the attention of the Texas state legislature, which will soon debate a bill to formally widen the window for those who want justice for pediatric sex change surgeries and therapies. The Free Press mentions this in its profile of Soren Aldaco:
But the ruling sent a clear message to the Texas legislature: If detransitioners are going to get a real shot at pursuing legal claims against their care providers, laws are going to have to change. Some lawmakers are already trying to do just that.'
In response to the ruling, Texas House member Shelby Slawson said that she will refile HB 1088—a bill that would give patients until their 25th birthday to file claims related to gender transition procedures performed on them as minors. The next legislative session begins in January, and 60 Republicans in the Texas House signed a letter earlier this year in support of HB 1088. Jeff Leach, one of the signatories, said Friday’s ruling only strengthened his resolve. “I want to blow the doors to the courthouse wide open for detransitioners,” he told The Free Press.
But the bill has limits. It would apply only to minors and is not retroactive, meaning it would not help detransitioners whose procedures predate the bill’s effective date or those who were adults when they were treated.
Meanwhile, Aldaco has helped win passage of a bill requiring insurance companies that cover gender-affirming care in Texas to also cover detransition care and follow-up procedures. It was the first bill of its kind in the U.S., and was signed into law by Governor Greg Abbott in 2025.
The limits on Slawson's bill are rational, if not exactly bold. Adults who put themselves through sex changes clearly have more agency than children, but it's still arguable that they have also been victimized by manipulative doctors and health-care facilities. They could still sue even when Slawson's bill passes, but only under the current statute of limitations. Retroactive application would allow for justice for those who have already been harmed, but it might create problems in keeping the statute from being struck down later. However, its passage will have a major impact on the Texas sex-change industry in regard to minors, heightening the long-term risks of pushing sex changes onto confused and troubled teens rather than treating their underlying issues directly.
That is what happened to Soren Aldaco, and to many other teens in this pernicious practice, and that is what Slawson's bill aims to stop. The Free Press profile of Aldaco is heartbreaking, but at least she now has the chance to make her case in court. The most heartbreaking part of the Free Press profile is the story of another pediatric sex-change detransitioner, Claire Abernathy, who also got "top surgery" at 14. She will never get to take her case to court, so she is pushing hard for changes to the law to let other victims make their cases:
One detransitioner who has had to accept that justice is out of reach for her is 21-year-old Claire Abernathy. She was just 14 when she underwent a double mastectomy in Texas; she had been prescribed testosterone just eight months earlier. “Even once someone recognizes that transition was wrong for them,” she told The Free Press, “that does not necessarily mean that they recognize that their doctors harmed them.” For her, it was three or four years into detransitioning before she began making those connections.
“I want a public trial,” Abernathy said. “I want the inner workings of these clinics, the reality of the experiences of the patients to be made bare in public, and for the doctors who have mistreated their patients to be held to account.” But she is unable to move forward with legal action. For Aldaco, though, it is not too late.
The Texas Supreme Court has given Aldaco a lifeline for her bid to impose accountability for abuse and malpractice. It's time for the Texas legislature to fix the statutes so that all of the victims can do the same.
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