EL PASO, Texas (AP) — On the Texas border, Dr. Hector Granados treats children with diabetes at his El Paso clinics and makes hospital rounds under the shadow of accusations that have thrown his career into jeopardy: providing care to transgender youth.

In what’s believed to be a U.S. first, Texas is suing Granados and two other physicians over claims that they violated the state’s ban on gender-affirming care for minors, calling the doctors “scofflaws” in lawsuits filed last fall that threaten to impose steep fines and revoke their medical licenses. He denies the accusations, and all three doctors have asked courts to dismiss the cases.

The cases are a pivotal test of intensifying Republican efforts to prevent such treatments, including President Donald Trump’s executive order that would bar federal support for gender-affirming care for youth under 19.

Some hospitals have already begun unwinding services for pediatric patients. But, so far, only Texas is demonstrating what punishing doctors looks like when bans are allegedly broken.

Granados, in an interview with The Associated Press, said he was meticulous in halting transgender care before Texas’ ban took effect in 2023. He denied that he continued prescribing puberty blockers and cross-sex hormones to transitioning patients and said he was initially unclear which patients, who are not named in the lawsuit, he is accused of wrongfully treating.

The other accused doctors — both in Dallas — are under temporary court orders not to see patients and only practice medicine in research and academic settings.

“Looking at the patients was hard because they were kind of disappointed of what was going on,” Granados said of ending their care. “But it was something that needed to be followed because it’s the law.”

The lawsuits are believed to be the first time a state has brought enforcement under laws that ban or restrict gender-affirming care for minors, which Republicans have enacted in 27 states, including this month in Kansas over the Democratic governor’s veto. Although those accused of violating bans face criminal charges in some states, they do not in Texas.

Nationwide, doctors and hospital executives are reevaluating transgender health programs that carry a widening risk of litigation and losing federal funding. For transgender Americans, the climate has narrowed options for care and deepened fears.

Trump has launched a broad charge against transgender rights quickly in his second term, signing executive orders that include barring schools from using federal education dollars to support students who are socially transitioning. Supporters say restrictions protect vulnerable children from what they see as a “radical” ideology about gender and making irreversible medical decisions.

The Texas lawsuits were brought by Republican Attorney General Ken Paxton, who has previously gone beyond the state’s borders to launch investigations into gender-affirming treatment.

His office did not respond to requests for an interview. At a court hearing Wednesday involving the Dallas doctors, an attorney in Paxton’s office declined to comment and referred questions to the agency’s press office.

“I will enforce the law to the fullest extent to prevent any doctor from providing these dangerous drugs to kids,” Paxton said in a statement this month.

Granados is one of two pediatric endocrinologists in El Paso, a desert city of about 700,000 where mountains rise in the distance.

Granados, 48, is from Ciudad Juarez, the neighboring Mexican city that sprawls out south of El Paso. He said that after attending medical school in Mexico he completed additional training in New York and Connecticut but he wanted to return to what he said is an underserved region.

He opened a gender clinic at Texas Tech University Health Sciences Center in El Paso before starting his own practice in 2019. Before the ban, Granados said, treating transgender youth was just an extension of his practice that also treats youth with diabetes, growth problems and early puberty.

He said he accepted transgender patients only if they had first received a diagnosis of gender dysphoria from a mental health provider.

“It was not different from doing everything else that a pediatric endocrinologist does,” he said. “It was just taking care of children who required that specific therapy.”

Emiliana Edwards was among them. Now 18, she called Granados an “amazing” caregiver who carefully explained her gender-affirming treatment. But at her first appointment after Republican Texas Gov. Greg Abbott signed the ban in 2023, Edwards said the room felt different, “like there were wires everywhere.”

“It felt like we couldn’t talk about anything really, even the most simple stuff,” she said.

Her mother, Lorena Edwards, said Granados put a “cold stop” to her daughter’s care.

“It was just: ‘I don’t provide that care anymore.’ And it was done,” she said.

At the heart of Texas’ lawsuits against Granados, Dr. May Lau and Dr. M. Brett Cooper are allegations of prescribing treatment to transition their patients’ sex after the ban took effect.

In one instance, the state accuses Granados of prescribing testosterone to a 16-year-old, alleging that although the doctor’s records identify the patient as male, the teenager’s sex assigned at birth is female. Granados and Lau are also accused of having instructed patients to wait until after the ban was in place to fill prescriptions.

Granados does not dispute that he has continued prescribing puberty blockers and hormone replacement therapy. He said those treatments are not for gender transition but for children with endocrine disorders, which occur when hormone levels are too high or too low.

He said he prescribes testosterone for many reasons, including for patients whose testicles don’t work or had to be removed because of cancer. Others have brain tumors, or surgery or radiation to the brain, that impact puberty. Patients with early onset puberty also need puberty blockers, he said.

Attorneys for Lau said she has always complied with the law and the claims have no merit. Attorneys for Cooper did not respond to requests for comment.

“This is really part of a bigger pattern of extremism within the state that even other states have shied away from replicating,” said Sarah Warbelow, vice president of legal for the Human Rights Campaign.

Transgender adults and youth make up less than 1% of the U.S. population, according to estimates by the Williams Institute, an LGBTQ+ research center at the UCLA School of Law.

Granados’ trial has been set for late October; trial dates have not yet been set yet for Lau and Cooper. While the cases are pending, Lau and Cooper agreed to practice medicine only in research and academic settings and not see patients.

Neither Lau or Cooper attended the Wednesday hearing in their cases by a judge who is set to decide where their trials will be held.

Under Texas’ ban, the state medical board is instructed to revoke the licenses of doctors who are found to have violated the law.

Lorena Edwards said she watched her daughter thrive during her transition then descend into melancholy as laws targeting transgender rights gained steam.

Emiliana Edwards has switched to receiving treatment in neighboring New Mexico — where gender-affirming care is legal — but she said attacks on the transgender community have taken a toll on her mental health.

“We’re normal people, too, and we’re just trying to live,” she said.

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