Texas Children's Hospital, the nation's largest children's hospital, has agreed to establish what officials are calling the country's first dedicated detransition clinic as part of a settlement with state and federal authorities. The agreement, announced Friday by Texas Attorney General Ken Paxton, also requires the Houston facility to terminate five physicians who previously provided gender transition care to minors and to pay $10 million to resolve Medicaid billing allegations.
The settlement concludes a three-year investigation during which the hospital produced more than 5 million documents and conducted internal reviews. The hospital said it cooperated fully throughout the inquiry while maintaining that all its practices complied with law.
Under the deal, the new clinic must operate free of charge for its first five years. However, hospital officials have not specified what services the clinic will actually provide. A spokesperson said it will "formalize the supportive, multidisciplinary services we already deliver to all patients who need our care," but declined to name who will lead or staff the operation.
The Justice Department called the settlement a victory in what it describes as a broader national effort to halt what it terms "sex-rejecting procedures" for minors. Acting Attorney General Todd Blanche said the resolution "protects vulnerable children, holds providers accountable, and ensures those harmed receive the care they need."
Paxton framed the agreement as evidence of a "fundamental cultural shift away from radical 'gender' ideology." His investigation was part of a wider state push to restrict transition care for minors. In 2022, Paxton declared such care to be child abuse after the state legislature failed to pass a ban. Texas subsequently became the largest state to enact a gender-affirming care prohibition for minors.
The detransition clinic requirement has drawn scrutiny from medical experts and advocacy groups. Dr. Morissa Ladinsky, a clinical professor of pediatrics at Stanford University, questioned why the hospital was forced to fire the doctors most equipped to treat detransitioning patients. "The settlement simply amplifies a fog of confusion," she said, describing it as a clinic "created by legal intimidation on terms set by politicians."
Detransitioning, which involves ceasing medical gender transition or no longer identifying as transgender, is uncommon. Research estimates between 1% and 10% of transgender people detransition, with less than 1% reporting regret about their transition. Studies cite pressure from parents, harassment, and difficulty continuing transition as the most common reasons people detransition. Potential medical interventions for detransition are similar to those used for transition: mental health therapy, hormone therapy, and surgeries.
The settlement represents the first resolution in the Justice Department's ongoing national investigation into gender-affirming care for minors. Last year, federal prosecutors subpoenaed more than 20 doctors and clinics treating transgender youth. This week, NYU Langone disclosed it received a grand jury subpoena for information about its transgender youth treatment over the past six years.
Major U.S. medical organizations including the American Medical Association, American Academy of Pediatrics, and American Psychological Association support access to gender-affirming care for minors, with recommendations varying by age. These organizations recommend no medical intervention for prepubescent children, puberty blockers for some adolescents, hormone therapy for older teens, and note that surgeries for minors are rare and not recommended.
Texas advocates for transgender rights warned the settlement could establish a troubling pattern. Andrea Segovia, senior field and policy director at the Transgender Education Network of Texas, said the state should focus on improving general healthcare access rather than targeting care for less than 1% of Texans who are transgender. "In Texas, the ability to get general regular healthcare is difficult," Segovia said. "To prioritize a clinic that is based on political gain as your state continues to struggle with basic general healthcare is a slap to people's face."
Texas Children's statement emphasized that it settled to avoid prolonged litigation and redirect resources toward other medical work. "Today, we made the difficult decision to settle with the Texas Attorney General and the Department of Justice, closing a chapter that has been wrought with falsehoods and distractions," the hospital said.
Author Sarah Mitchell: "This settlement creates a clinic nobody's really sure how to run, fires the doctors most qualified to run it, and sets a precedent that will likely ripple far beyond Texas."
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