Texas Supreme Court Revives Detransitioner Lawsuit

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The Texas Supreme Court has revived one of the most closely watched healthcare liability lawsuits in Texas, unanimously holding that detransitioner Soren Aldaco’s medical malpractice lawsuit may proceed against the therapist whose recommendation helped facilitate her gender transition surgery.

Aldaco, who identifies as a detransitioner, alleges that therapist Barbara Rose Wood authored a recommendation letter containing material misrepresentations that enabled her to obtain an elective double mastectomy in 2021. According to her lawsuit, the procedure left her with permanent physical injuries, emotional trauma, and lifelong regret. She contends that Wood’s actions fell below the applicable standard of care and constituted both negligence and fraud.

The lawsuit was initially dismissed before those allegations could ever be considered. Both the trial court and the Fort Worth Court of Appeals concluded that Aldaco filed her claims too late under the Texas Medical Liability Act (TMLA) because the two-year statute of limitations began when Wood signed the recommendation letter on February 22, 2021, rather than when her treatment ended or when the surgery occurred.

The Texas Supreme Court unanimously reversed that conclusion.

In a decision supported by all nine justices in the judgment, the Court held that Aldaco’s lawsuit was timely under the TMLA and returned the case to the trial court for consideration on its merits. While the justices did not all join every part of the Court’s reasoning, they unanimously agreed that the Fort Worth Court of Appeals should be reversed.

Background of the Soren Aldaco Detransitioner Lawsuit

According to the Texas Supreme Court’s opinion, Aldaco struggled with gender identity as a teenager before seeking a double mastectomy from the Crane Clinic in 2021. Because the clinic required a recommendation letter before performing the procedure, staff provided her with both a template and a list of practitioners who could authorize the surgery. Instead, Aldaco sought the recommendation from Barbara Rose Wood, a therapist with whom she had been conducting telehealth counseling sessions regarding relationship issues.

On February 22, 2021, Wood signed a letter endorsing what was described as “top surgery.” Their counseling relationship ended on May 14, 2021, after Aldaco missed an appointment, failed to pay a no-show fee, and discontinued therapy. Less than a month later, on June 11, 2021, Aldaco underwent the double mastectomy.

According to Aldaco’s lawsuit, the surgery did not resolve the issues she hoped it would address. Instead, she experienced post-surgical complications requiring emergency medical care and eventually came to regret the irreversible procedure after further research and personal reflection. In 2023, she filed suit against multiple healthcare providers, including Wood and Wood’s employer, Thriveworks, alleging negligence, fraud, and other claims arising from the recommendation that facilitated the surgery.

Before those allegations could be litigated, however, the courts first had to answer a threshold legal question: Was the lawsuit filed before the statute of limitations expired?

Texas Supreme Court Clarifies Statute of Limitations

The legal dispute centered on Section 74.251 of the TMLA, which establishes when healthcare liability claims must be filed. The trial court answered that question by concluding the limitations period began on February 22, 2021, when Wood signed the recommendation letter.

The Fort Worth Court of Appeals affirmed.

Relying on decades of Texas precedent, including Shah v. Moss, the court concluded that when the allegedly negligent act occurs on a specific, identifiable date, that date controls the statute of limitations. Because Wood’s recommendation letter was written on a clearly ascertainable date, the court held that the statute began running immediately, regardless of when the surgery occurred or when the counseling relationship ended.

Under that interpretation, Aldaco’s May 2023 pre-suit notice came too late, and her claims were dismissed without ever reaching the merits. The Texas Supreme Court rejected that analysis. Rather than simply disagreeing with the outcome, the Court rejected the legal framework used by the Court of Appeals.

First, the Court emphasized that Section 74.251 uses the disjunctive word “or” when describing the events that may trigger the statute of limitations. One of those triggering events is the completion of treatment. Because Wood’s psychotherapy concluded on May 14, 2021, Aldaco’s May 9, 2023, pre-suit notice was timely under that provision.

Second, the Court concluded that even if the statute were interpreted differently, Aldaco’s claims remained timely because the alleged tort had not yet occurred when the recommendation letter was written.

The Court explained that negligence and fraud claims require an actual injury. According to the Court, Aldaco suffered no legally cognizable injury until the surgery was performed on June 11, 2021. Had she attempted to sue before undergoing the operation, her negligence and fraud claims would have failed because no injury had yet occurred. Since her pre-suit notice was provided before June 11, 2023, the lawsuit was timely under that analysis as well.

Why the Court Reversed

One of the most significant aspects of the opinion is not simply that the Texas Supreme Court reached a different conclusion. It is why.

The Fort Worth Court of Appeals believed it was faithfully applying decades of existing precedent interpreting the Texas Medical Liability Act. It concluded that because Wood’s allegedly negligent recommendation letter was written on a specific date, earlier Texas Supreme Court cases required the statute of limitations to begin running on that date.

The Texas Supreme Court distinguished those earlier cases instead of overruling them.

According to the Court, every case relied upon by the Court of Appeals involved plaintiffs who suffered an injury during treatment or hospitalization. Aldaco’s case was fundamentally different because the alleged injury did not occur until after Wood’s counseling relationship had already ended and the surgery was later performed. Therefore, the earlier precedents did not control the outcome.

The Court also criticized the Court of Appeals for overlooking important statutory context.

Section 74.251 contains both a two-year statute of limitations and a separate ten-year statute of repose. The Legislature used different language in each provision. The statute of repose begins with the “act or omission that gives rise to the claim,” while the statute of limitations begins with “the occurrence of the breach or tort.”

According to the Court, those different phrases carry different legal meanings. The Court of Appeals effectively treated them as interchangeable, while the Supreme Court concluded that doing so ignored the Legislature’s deliberate choice of words.

For that reason, the opinion represents more than a disagreement over one lawsuit. It provides new guidance for how Texas courts should interpret Chapter 74 of the Texas Medical Liability Act in future healthcare liability cases.

Why the Decision Matters

Although the underlying facts involve a detransitioner lawsuit, the Court’s reasoning reaches well beyond litigation involving gender transition procedures.

The opinion reinforces that Texas courts must closely adhere to the Legislature’s chosen statutory language. Rather than reading Section 74.251 in isolation, the Supreme Court examined the surrounding provisions of the TMLA and concluded that the Legislature intentionally used different language to describe the two-year statute of limitations and the ten-year statute of repose. Those textual differences ultimately drove the Court’s analysis.

That approach could affect future healthcare liability cases involving extended courses of treatment, counseling relationships, delayed injuries, or medical decisions that unfold over weeks or months before an injury occurs.

The opinion also serves as a reminder that procedural questions can determine whether a lawsuit is ever heard on its merits. Before the Supreme Court’s decision, Aldaco’s allegations had never been evaluated by a court because the case was dismissed solely on statute of limitations grounds. The Court’s ruling simply allows the litigation to move forward. It does not establish liability or determine whether any defendant committed malpractice.

Legislative Implications

Although the Supreme Court resolved this dispute through statutory interpretation, the Legislature has already considered whether Texas law should provide additional protections for certain healthcare liability claims involving gender transition procedures.

During the 89th Legislative Session (2025), State Rep. Shelby Slawson (R-Stephenville) filed House Bill 1088 (HB 1088), which proposed creating a separate statute of limitations for medical malpractice claims involving puberty blockers, cross-sex hormones, and gender transition procedures performed on minors. Rather than requiring those claims to proceed under the existing limitations framework, the legislation would have allowed a claimant who was a minor at the time the cause of action accrued to file suit until reaching their 25th birthday.

The legislation passed the House Judiciary and Civil Jurisprudence Committee but was never scheduled for consideration by the House Calendars Committee. As a result, HB 1088 never reached the House floor for debate or a vote by the full chamber.

Although the bill focused specifically on procedures performed on minors and therefore would not have directly applied to Aldaco’s lawsuit, it demonstrates that Texas lawmakers have already begun considering whether existing statutes of limitations adequately address claims arising from gender transition procedures.

The Supreme Court ultimately concluded that existing law was sufficient to permit Aldaco’s lawsuit to proceed. Nevertheless, the decision may renew legislative interest in whether Chapter 74 should be amended to provide greater certainty for future healthcare liability claims involving irreversible medical procedures.

Policy Implications Going Forward

The Aldaco decision raises policy questions that extend beyond this individual lawsuit.

One question is whether healthcare providers who recommend irreversible medical procedures should have continuing responsibilities after making those recommendations. In Aldaco’s case, the Supreme Court noted that her theory of liability included allegations that Wood had an ongoing obligation to withdraw the recommendation letter before surgery occurred. The Court did not determine whether that allegation was legally correct, but it recognized that it formed part of Aldaco’s theory of continuing negligence.

The decision also highlights the importance of precise statutory drafting.

Both the Fort Worth Court of Appeals and the Texas Supreme Court agreed that their role was to interpret the Legislature’s chosen language. Yet they reached opposite conclusions because they interpreted a handful of statutory phrases differently. That disagreement underscores how seemingly small differences in legislative wording can determine whether a lawsuit proceeds or is dismissed before any evidence is heard.

Finally, the opinion may encourage additional litigation involving detransitioners. As more individuals pursue malpractice claims related to gender transition procedures, Texas courts will likely continue addressing questions involving professional standards of care, informed consent, therapist responsibilities, causation, and damages. The Aldaco decision does not answer those substantive questions, but it establishes an important procedural precedent governing when such claims may be brought.

Final Thoughts

The Texas Supreme Court’s decision represents a significant development in Texas healthcare liability law. The Court did not determine that Barbara Rose Wood committed malpractice. It did not conclude that gender transition procedures constitute negligent medical care. Nor did it resolve the factual disputes surrounding Aldaco’s allegations.

Instead, the Court answered a narrower but critically important legal question.

The Court unanimously held that Soren Aldaco’s lawsuit was filed within the time permitted under the Texas Medical Liability Act and therefore deserves to be heard on its merits.

As the case returns to the trial court, the litigation will shift away from procedural deadlines and toward the substantive issues that have yet to be resolved. Those proceedings will ultimately determine whether the defendants met the applicable standard of care and whether they bear legal responsibility for Aldaco’s alleged injuries.

Regardless of the eventual outcome, the Texas Supreme Court’s decision has already established an important precedent for interpreting Chapter 74 of the Texas Medical Liability Act. It also signals that questions surrounding healthcare liability, informed consent, and gender transition procedures will likely remain active topics in both Texas courtrooms and the Texas Legislature for years to come.

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