SB 1188
Threatening the health, privacy, and dignity of transgender, nonbinary, and intersex Texans by mandating a binary definition of “biological sex” on medical records
What's in the bill?
Texas Senate Bill 1188, filed by Senator Lois Kolkhorst, mandates that electronic health records (EHRs) must include a distinct, unalterable field for an individual’s “biological sex at birth,” defined as the reproductive trait determining production of male or female gametes. The bill allows changes to this field only for clerical errors or in cases of diagnosed sexual development disorders (intersex conditions). While binary sex records are required, the bill does allow for additional information related to gender identity to be recorded in a separate section. It also gives parents and guardians unrestricted access to minors’ health records and imposes fines of up to $250,000 for noncompliance.
What does it mean?
Misgendering
Transgender and nonbinary individuals will be required to have their sex assigned at birth prominently displayed in EHRs, potentially leading to misgendering and exposure of sensitive personal information to healthcare providers and support staff.
Privacy of Trans Kids
Minors’ records are accessible to parents/guardians without restriction, which could out transgender youth to unsupportive families, increasing risk of abuse, neglect, or family conflict.
Barriers to Care
Fear of being outed or discriminated against may cause individuals to avoid seeking necessary healthcare, especially sensitive or gender-affirming services. Providers may struggle with EHR fields that do not align with a patient’s lived gender, leading to errors in care or inappropriate screening recommendations.
Going Farther than Required
Providers risk financial penalties for noncompliance, which may lead to over-compliance and reluctance to provide affirming care or update records appropriately.
Erosion of Trust
Patients may lose trust in healthcare systems, fearing that their records could be used against them or shared without consent. Trans Texans require specialized health care, this could impact the health of the whole community.
What can we do now?
Reaching Out to Vendors
Equality Texas has identified 15 Electronic health records (EHR) vendors that operate in Texas within hospital districts, private practices, ambulatory services and dental services. Equality Texas has sent letters to each provider making recommendations to the vendors to ensure that updates to their systems included specific steps to mitigate the potential harm of this legislation and laid out ways to ensure that transgender, non-binary and intersex individuals still have the ability to reflect who they are and how they move through the world prominently on their medical records.
Community Education and Advocacy
Equality Texas is working with healthcare partners to ensure that transgender, nonbinary, and intersex individuals know their rights, how to navigate EHR systems, and how to advocate for themselves in healthcare settings. Along with our partners, we are updating trainings for healthcare providers on the importance of using correct names and pronouns and on the legal and ethical obligations to protect patient privacy. We are also launching a statewide Know Your Rights campaign, underscoring the specifics of this law and its potential impacts.
Frequently Asked Questions
How will my medical records change?
New requirements to the Texas Health and Safety Code will mandate that electronic health records include a distinct, unalterable field for “biological sex at birth.” This field must be defined as the biological trait determining whether an individual produces male or female gametes, and it can only be changed for clerical errors or in cases of diagnosed intersex traits.
How will this affect transgender, nonbinary, and intersex patients?
Transgender and nonbinary individuals will have their sex assigned at birth permanently recorded in their health records, regardless of their gender identity or any legal updates to their documentation. This could result in misgendering, privacy violations, and barriers to appropriate, affirming healthcare. Intersex individuals may be assigned a binary sex at birth.
What are the penalties for noncompliance?
The bill authorizes civil penalties for physicians who alter the “biological sex at birth” field except for specific reasons (clerical errors or intersex diagnoses). Penalties like this may have a broader impact than intended, effectively scaring doctors into over complying with the bill.
Can medical records still include a patient’s gender identity?
Yes. SB 1188 does not prohibit recording a patient’s gender identity in addition to “biological sex at birth.” Providers may still include gender identity as a separate field, but the “biological sex at birth” field is mandatory and cannot be changed except for specific reasons.
Do other states have laws like this?
Similar laws in states like Florida and Tennessee have focused on restricting gender marker changes on birth certificates and other official documents. These laws have faced legal challenges but as of mid-2025, none specifically targeting electronic health records have been struck down. In states with similar laws, EHR vendors have had to modify systems to accommodate new fields, often at significant cost. These changes have not always improved care and have sometimes resulted in patient harm or administrative errors.
What are the practical implications for healthcare providers?
Providers will need to update their EHR systems to include the new “biological sex at birth” field and ensure that it is not altered except in specific cases. This could create confusion, increase administrative workload, and potentially lead to errors in patient care if gender identity is not clearly communicated alongside biological sex.
How will SB 1188 impact patient privacy and trust?
The requirement to permanently record a patient’s sex assigned at birth—regardless of their gender identity—could erode trust between patients and providers, discourage patients from seeking healthcare of any kind, and increase the risk of privacy violations.
Are there any exceptions for intersex individuals?
Yes, SB 1188 allows corrections to the “biological sex at birth” field for individuals with diagnosed intersex traits. However, the law still imposes a strict binary framework that may not reflect the full diversity of human biology.