Overview

Soren Aldaco is a Texas woman who had a double mastectomy at 19 as part of a medical transition and later detransitioned. In July 2023 she sued several of the clinicians involved in Tarrant County, Texas. They included the therapist Barbara Rose Wood and Wood's employer, Three Oaks Counseling Group, LLC, which does business as Thriveworks. Aldaco alleges that Wood signed a surgery recommendation letter that contained false statements. The lower courts threw out her claims against Wood as filed too late. On 26 June 2026 the Supreme Court of Texas unanimously reversed that ruling in Aldaco v. Wood, No. 24-1069, and sent the claims back to the trial court (Supreme Court of Texas 2026).

The ruling is not about whether transition care was appropriate. It answers a narrower question about timing: when does the two-year deadline for a medical-liability claim start running if a mental-health professional's letter leads to surgery weeks or months later? Many detransitioners only recognise the harm years after treatment, and in many cases the deadline is what decides whether they can sue at all. That makes the answer important beyond this one case. For the wider picture, see detransitioner lawsuits.

Background

The account below comes from Aldaco's own court filings and interviews. The defendants have not admitted these facts, and no court has found them true.

According to her 2023 original petition, Aldaco struggled with depression and anxiety as a teenager. At 15 she was admitted to a psychiatric hospital after what the petition calls a manic episode. She was later diagnosed with major depressive disorder, ADHD and autism spectrum disorder (Aldaco original petition 2023). The petition says she began testosterone at 17 after a short first appointment with a nurse practitioner. It also says that from July 2020 she had telehealth sessions with Wood, which "focused almost exclusively" on relationship and co-dependency issues, not on her gender identity.

The Supreme Court summarised the key events:

Clinic staff advised that, to move forward, she'd need a letter from a practitioner recommending her for the surgery. They provided a template for the letter, plus a list of practitioners who would sign it upon request. — (Supreme Court of Texas 2026)

Aldaco asked Wood for the letter instead, and Wood signed it on 22 February 2021. Wood ended the therapy on 14 May 2021, after Aldaco missed a session and stopped making contact. On 11 June 2021 Aldaco had the mastectomy at the Crane clinic in Austin. KERA News, citing court records, reported that she then had complications, including blood pooling around the chest wounds and severe pain (KERA News 2026). The petition alleges she needed emergency treatment for bilateral hematomas (collections of blood on both sides of the chest) at UT Southwestern Medical Center in Dallas. It says she stopped testosterone in November 2021 after finding that meditation and mindfulness eased her distress.

Aldaco has spoken publicly about her case, mostly in conservative outlets. In a 2026 Fox News Digital interview she said:

I think in modern medicine, generally, it's really easy to slap a medication, you know, or a diagnosis onto a patient. — Soren Aldaco (Fox News, via WFMD 2026)

The claims

The original petition was filed on 21 July 2023 in the 67th District Court of Tarrant County (cause no. 067-343803-23). It sought more than $1 million and named nine defendants: a psychiatrist and the psychiatric hospital where she was admitted at 15, a nurse practitioner and the physician group that supervised him, Wood and Three Oaks/Thriveworks, two surgeons (Ashley DeLeon and Richard Santucci) and the Crane surgical practice (Aldaco original petition 2023). The claims as pleaded were as follows.

• Against the psychiatrist and hospital (2018): medical negligence. The petition says he pressed a 15-year-old about her gender identity during a three-day stay and then told her parents she was transgender, against her wishes.
• Against the nurse practitioner and physician group (2020–2021): negligence and gross negligence. The petition says he prescribed testosterone and an estrogen blocker at her first, roughly 30-minute appointment, when she was 17, without a mental-health assessment or a full discussion of risks.
• Against Wood and Thriveworks: negligence and gross negligence, vicarious liability, and direct negligence by Thriveworks for failing to have policies that would have stopped the letter. A fraud claim was added later.
• Against the surgeons and surgical practice: negligence and gross negligence. The petition says they approved surgery without their own assessment despite known mental-health conditions, performed a "drainless" mastectomy without disclosing that risk, and handled her post-operative complications poorly.

The heart of the case against Wood is the letter. The petition says it falsely stated that Wood had treated Aldaco for gender dysphoria since July 2020, that her transgender identity had been present for at least two years, and that she had completed "a minimum of 12 continuous months of living in a gender role" consistent with her identity. It also says the letter stated she did not drink or use drugs, although she had told Wood she did so socially. The Supreme Court restated her position this way: according to Aldaco, signing the letter was "a severe departure from any recognized standard of care" (Supreme Court of Texas 2026).

The petition also argued that if the two-year deadline barred any claim, applying it would violate the open courts guarantee of the Texas Constitution. This argument rested on her youth and mental-health conditions. She later dropped it against the Wood defendants. The court of appeals noted that she had nonsuited (voluntarily dropped) several other defendants against whom she had planned to rely on it (Texas Court of Appeals 2024).

Defendants' position

Wood and Thriveworks have not, in the filings reviewed here, argued the medical merits. They argued that the claims were simply too late. Their brief to the Supreme Court said the alleged breach happened "on a date certain, February 22, 2021," and that Chapter 74 (the Texas medical-liability statute; see below) has "a specific and rigid two-year statute of limitations" with no discovery rule (a rule that would delay the clock until a patient discovers the injury) (Respondents' brief 2025). They warned that her reading would "re-open the floodgates to sue doctors and healthcare providers." They argued that relabelling the claims as fraud was an attempt to plead around the limitation period. They also stressed that Aldaco herself asked Wood for the letter and supplied the clinic's template. They maintain that the therapy ended earlier than 14 May 2021, but the courts used Aldaco's date because the difference did not change the outcome. KERA and Fox News both reported asking Wood's side for comment after the ruling. Neither reported a reply.

The surgeons and surgical practice won dismissal on a separate procedural ground: Aldaco's expert report was late (see below). After the June ruling their lawyers' office told Fox News Digital that the "Crane Center Parties were parties to a separate appeal" and that her claims against them "were dismissed pursuant to a separate order entered on grounds unrelated to those at issue" (Fox News, via WFMD 2026).

The Texas Supreme Court opinion

The legal question

Texas treats most claims against doctors, therapists and clinics as health care liability claims under Chapter 74 of the Civil Practice and Remedies Code, also called the Texas Medical Liability Act (TMLA). Section 74.251(a) says such a claim must be filed:

within two years from the occurrence of the breach or tort or from the date the medical or health care treatment that is the subject of the claim or the hospitalization for which the claim is made is completed — Tex. Civ. Prac. & Rem. Code § 74.251(a), quoted in (Supreme Court of Texas 2026)

Section 74.251(b) adds a ten-year statute of repose, an outer limit that runs from "the date of the act or omission that gives rise to the claim." Formal pre-suit notice under § 74.051 extends the limitation period by 75 days. Aldaco gave notice on 9 May 2023, so her claims were on time only if the two-year clock started after 9 May 2021. There were three candidate dates:

The court of appeals had followed long-standing precedent, Shah v. Moss (2001) and earlier cases, holding that a plaintiff "may not choose the most favorable date": if the date of the tort can be pinned down, the clock starts then. It treated the letter as that date (Texas Court of Appeals 2024).

Holding: treatment ended in May 2021 (unanimous)

Justice James Sullivan wrote for all nine justices on Parts I, II.A and III. The court relied on the word "or" in § 74.251(a): "and combines items while or creates alternatives." It held that the relevant "health care treatment" was Wood's psychotherapy, which ended on 14 May 2021:

Because Aldaco gave pre-suit notice to Wood on May 9, 2023, which is within two years of the completion of treatment, her claims were timely. — (Supreme Court of Texas 2026)

The court did not overrule Shah. It distinguished it. In Shah and similar cases the patient suffered a bodily injury on a known date before treatment ended. Aldaco, by contrast, "couldn't ascertain any bodily injury until after completion of her treatment." She also argued that Wood had a continuing duty to withdraw the letter. The court accepted that this described "at least 82 days of continuing negligence," because the letter carried the same risk on the last day of therapy as on the day it was signed. Within that period there was no single date on which an injury occurred.

Plurality: the "tort" occurred at surgery (four justices)

Part II.B gave a second, independent reason, but only four justices joined it (Sullivan, Lehrmann, Devine and Busby), so it is a plurality, not a binding holding. It contrasted the two subsections of the statute. The repose period runs from the "act" that gives rise to the claim, which here is the signing of the letter. The limitation period runs from "the occurrence of the … tort," and negligence and fraud both require an injury. The plurality concluded:

For purposes of Section 74.251(a), therefore, the injurious surgery on June 11, 2021 marked "the occurrence of the … tort" and triggered the two-year statute of limitations. — (Supreme Court of Texas 2026)

The plurality said this is not a revival of the discovery rule, which the Legislature abolished for medical claims in the 1970s. The discovery rule delays the clock until a patient learns of a hidden injury. Here, the plurality reasoned, the clock simply could not start before any injury existed.

Justice Evan Young, joined by Justice Bland, concurred and explained his doubts about Part II.B. According to KERA's report, he wrote that the ruling should be "minimally disruptive" to medical-liability law, and that significant change "should come from the policymaking branches, not the courts" (KERA News 2026).

Some advocacy and media coverage summarised the ruling as "the clock starts at the surgery." That is the plurality's view. The unanimous holding rests on the date treatment ended.

Procedural history

Outcome and current status

As of October 2026:

• Wood and Thriveworks: the claims are pending on remand in the 67th District Court. The Supreme Court decided only that they were filed in time. It did not consider whether they could be reframed as fraud, whether the expert report against Wood was adequate, or whether Wood breached the standard of care. We found no public report of a trial date.
• Surgeons and surgical practice: dismissed with prejudice. The court of appeals held that a 60-day abatement Aldaco requested after amending her medical authorization form did not pause the strict 120-day deadline for serving an expert report (Texas Court of Appeals 2025). On remand the defendants gave up their claim for attorney's fees, and the trial court dismissed the claims. On 24 September 2026 the court of appeals held that this order merely carried out its earlier mandate and could not be appealed (Texas Court of Appeals 2026).
• Other defendants: several were nonsuited, according to the 2024 opinion. We could not find a public source confirming the current status of every remaining original defendant.

Significance

For limitation-period law in Texas. Before Aldaco, courts in Texas generally started the clock on the date of the clinician's act whenever that date was known. For a gatekeeping act (an assessment, a referral or a letter that enables a later procedure by someone else), that rule could use up months of the two-year window before any surgery took place. Aldaco holds that where the gatekeeper's treatment relationship continues after the act, the end of that treatment can start the period. Four justices would go further and start it at the injury itself. Lower courts have already begun citing the case on how § 74.251(a) works (Texas Court of Appeals 2026a).

For other detransitioner claims. Many detransition cases, including those of Camille Kiefel and Clementine Breen, involve letters, assessments or referrals, as the lawsuits overview describes. Aldaco means that in Texas a therapist who writes a letter is not shielded just because the letter came well before the surgery. That moves some of the legal risk onto mental-health professionals, not only surgeons. The ruling does not create a discovery rule, though, and it does not help someone whose treatment ended and whose surgery happened more than two years before they gave notice. Many detransitioners only reconsider years later, as the comments below show, and the two-year window still often closes before then. Other states' laws differ.

Procedural traps still matter. The same plaintiff lost her claims against the surgeons because an expert report was served roughly six to eight weeks after the 120-day deadline. Together, the two rulings show that detransitioner cases are often decided on procedural rules, not on the medical evidence.

Policy and reactions. The case drew strong political attention on both sides.

• Aldaco called the ruling "a watershed moment" and said providers "can't twist the statute of limitations to escape accountability" (KERA News 2026).
• Sixty Texas House Republicans signed a statement in February 2026 supporting her. Rep. Shelby Slawson said she would refile bills extending the limitation period for injuries from gender-transition treatment, and Rep. Jeff Leach called the opinion "just the next step."
• Johnathan Gooch of the LGBTQ+ advocacy group Equality Texas said the case "only further compounds the fear and chaos surrounding essential medical care for trans folks across the state" (all via KERA).
• KERA itself noted that major US medical associations support such care and that regret estimates are uncertain.
• Advocacy groups opposed to youth transition, such as the Independent Women's Forum, called the ruling a path to accountability in pediatric gender medicine. Aldaco, however, was an adult (19) at the time of the surgery.

What detransitioners say about the case

We found no r/detrans comments in the site's archive that discuss Aldaco by name. The issues at its centre, surgery letters and limitation periods, come up often.

Several detransitioners describe letters like the one alleged in this case:

She lied in the letter that I was seeing her for 1 year, but I only saw her one time. —adisillusionedtruth, detrans female

It was FULL of typos, featured a quote from Winnie the Pooh, and just kind of strange rambling about how my eyes were not bloodshot and were "crystal clear" … I don't know how any self-respecting surgeon accepted that letter as valid but here we are. —phantomofthedennys, detrans female

Others place more of the responsibility on themselves, or on the wider culture. This tension also runs through the defendants' point that Aldaco asked for the letter herself:

She was asking me all kinds of things and in the end asked me to bring in a sample letter so she could see what was needed. Surgeon didn't care where the letter was from. I really, really wanted top surgery and was easily able to manipulate the system in place to get what I wanted. —Expensive-Web-2989, detrans female

I don't blame the individual doctors but I do blame the culture that convinced me I should transition. —10231570600, detrans male

Some reject the "you chose it" framing, saying they never understood what they were consenting to:

I felt like transition was something I have to do to be happy. Everyone around me affirmed this narrative. … The "funny" part is that i actually DIDN'T know the consequences. A naive autistic school girl (me) was told by a medical professional that detransitions are VEEEERY rare and that its definitely not my case. —thistle_ev, detrans female

The limitation period itself is a recurring source of grief:

I felt too rushed to go forward with a lawsuit before the statute of limitations passed, as I was still grieving a lot and generally not in a good headspace. —blueshrubs, detrans female

Some trans commenters also find surgery letters perfunctory, but they draw the opposite conclusion and see them as needless gatekeeping. One describes getting a letter from a therapist "I talked to for 10 minutes" and adds:

This whole system is dumb. —DecoraKat, trans woman (MTF)

Another trans commenter puts letter requirements down to fear of lawsuits: "The issue in America has less to do with the patient and more to do with covering the doctor & hospital and the possibility for a lawsuit" (LadyTelia, trans woman (MTF)). Cases like Aldaco are likely to push this further, with letter-writers either assessing patients more carefully or refusing to write letters at all.

Related pages

• Detransitioner lawsuits: cases, claims and outcomes
• Healthcare during detransition
• Critique of the informed consent model
• Mastectomy and top surgery regret
• Testosterone in females
• Autism and mental health as correlates
• Gender exploratory therapy
• Detransition support resources

References

• Supreme Court of Texas (2026). Aldaco v. Wood, No. 24-1069, decided 26 June 2026 (Sullivan, J.; Young, J., concurring). opinion (FindLaw), court PDF, Justia.
• Texas Court of Appeals, Second District (2024). Aldaco v. Wood, No. 02-24-00217-CV, memorandum opinion, 21 November 2024 (reported at 727 S.W.3d 213). opinion.
• Texas Court of Appeals, Second District (2025). Crane Surgical Services, P.A. v. Aldaco, No. 02-24-00468-CV, memorandum opinion, 20 March 2025. opinion.
• Texas Court of Appeals, Second District (2026). Aldaco v. DeLeon, No. 02-26-00295-CV, per curiam memorandum opinion, 24 September 2026. opinion.
• Texas Court of Appeals, Second District (2026a). Larson v. Medical City Hospital Fort Worth, No. 02-25-00674-CV, 13 August 2026. opinion.
• Aldaco, S. (2023). Plaintiff's Original Petition, Cause No. 067-343803-23, 67th District Court, Tarrant County, filed 21 July 2023 (allegations only). PDF.
• Wood, B. R. & Three Oaks Counseling Group (2025). Respondents' Brief on the Merits, No. 24-1069, filed 11 August 2025. PDF.
• Supreme Court of Texas (2025). Orders pronounced December 19, 2025. order list.
• Osibamowo, T. (2026). Texas Supreme Court rules woman's suit over gender transition can move forward. KERA News, 26 June 2026. source.
• Fox News Digital (2026). A landmark Texas ruling breathes new life into one detransitioner's quest for justice, 3 July 2026 (syndicated). source.
• Independent Women's Forum (2026; advocacy group). Texas Supreme Court Unanimously Revives Detransitioner Lawsuit, 26 June 2026. source.