Why Texas Senate Bill 1257 should be a model for the nation.
In May 2025, Texas passed Senate Bill 1257 (SB 1257) with an 87-58 vote in the House. This law requires insurance providers covering sex-trait modification treatments, such as hormone therapy or surgeries, must also fund complications, reconstructions, and recovery care. Genspect has worked on this bill since 2022, and we believe it should inspire similar legislation across the nation and the world. Why is this significant? How will it reshape Texas and potentially influence other regions? Let us explore.
So called gender transition treatments and procedures—hormone therapy, surgeries, and related interventions—are often promoted as solutions for distress by organizations like WPATH, the American Academy of Pediatrics, and the Endocrine Society. However, recent findings, including the HHS report and the Cass Review, reveal weak evidence for the safety and efficacy of these treatments. President Trump’s Executive Orders on gender, which cut funding for institutions offering such procedures, will likely reduce their prevalence. Yet, as long as insurance providers and Medicaid cover these interventions, they will persist.
While insurance often funds medicalized sex trait alterations, it often excludes costs for addressing complications, reconstructions and on-going health monitoring. This gap is not merely a practical issue for tens of thousands of individuals; it conceals the crisis of iatrogenic harm caused by these procedures.
Proponents of sex-trait modification treatments have long dismissed detransition as a myth and claimed complications are rare. They sustain this narrative partly because the system operates like a conveyor belt: when initial interventions fail to deliver desired outcomes, further procedures are presented as solutions. For those seeking to reverse course, returning to the practitioner who initiated their path is often the last thing they want to do. Additionally, the medical system lacks diagnostic and billing codes for unique complications—like vaginal atrophy in a 25-year-old masculinized woman or fistulas in a surgically constructed anatomy—rendering these adverse effects invisible.
Senate Bill 1257 addresses this issue directly. It requires insurance providers covering such procedures to also fund care for complications or reconstruction and on-going health monitoring. Imagine undergoing surgery only to discover that insurance will not cover follow-up care if healing falters—that is a crushing burden. This bill prevents such scenarios, offering critical support for individuals who detransition, a group gaining increasing recognition. It ensures assistance is available, regardless of the path chosen.
How will this change the landscape? The legislation will likely encourage greater caution among physicians and insurers. Doctors may perform more rigorous evaluations before recommending medicalized sex alteration, ensuring patients understand the risks. Insurers may become more discerning about what they cover; however, they must continue to care for those who have already undergone these treatments. The bill will also reveal the true scope of post-medicalization complications, reducing cases of individuals facing unaffordable bills after procedures go wrong. Furthermore, it may foster more transparent discussions about the risks and benefits of these interventions, benefiting all involved.
What can we expect in Texas and beyond? In Texas, Senate Bill 1257 aligns with existing policies, such as Senate Bill 14 (2023), which restricts sex-trait modification treatments for minors. This new law extends some protection to adults, addressing a critical gap.
Could this approach spread? We hope so. Other regions, particularly those with similar healthcare perspectives, are observing Texas closely. If Senate Bill 1257 proves effective, other states may adopt comparable measures. Unfortunately, most insurance plans are regulated federally. To ensure protection for all citizens, similar policies must be adopted in Washington.
Ultimately, Senate Bill 1257 ensures individuals facing challenges are not abandoned. Though not flawless and likely to face opposition, it marks a vital step toward a healthcare system that supports people navigating gender distress.