Texas Children’s Hospital has reached a settlement with the Texas Attorney General’s office and the U.S. Department of Justice to resolve a three-year investigation into its treatment program for transgender youth.
As part of the agreement, the hospital will create a clinic for individuals seeking detransition care, cease providing certain medical treatments to minors, and pay a financial penalty.
Key Terms of the Settlement
- Texas Children’s Hospital will pay $10 million to the state of Texas to resolve allegations of improper Medicaid billing for transition care.
- The hospital agreed to terminate five physicians who provided transition care to minors.
- The hospital will no longer provide puberty blockers, hormonal therapy, or surgical procedures to minors seeking to align their physical characteristics with their gender identity.
- The hospital will establish a clinic dedicated to detransition care, described by the Texas Attorney General’s office as the first such clinic in the United States.
- The detransition clinic will be funded by the hospital for the first five years of operation, and services provided there will be free of charge to patients.
- Details regarding the clinic’s services and leadership have not been publicly disclosed.
Official Statements
Texas Attorney General Ken Paxton stated that the settlement reflects “an institutional and fundamental cultural shift away from radical ‘gender’ ideology.” He added that his office would investigate any Texas hospital providing what he described as harmful medical interventions.
The U.S. Department of Justice said this is the first resolution in its national investigations into gender-affirming care for youth. Acting Attorney General Todd Blanche stated the department will continue to pursue medical providers and pharmaceutical companies that provide such care for minors.
Texas Children’s Hospital stated that it settled to avoid costly litigation and to redirect resources to other areas of care, maintaining that it has followed all laws. The hospital noted that the process involved navigating what it called a “campaign of mistruths and mischaracterizations.”
Background and Regulatory Context
- In 2022, Texas Attorney General Ken Paxton issued a legal opinion classifying certain gender-affirming care for minors as child abuse.
- In 2023, the state of Texas enacted a law banning hormonal therapy and gender-affirming surgery for minors.
- On January 28, 2025, President Donald Trump issued an executive order directing federally funded institutions to end what the order described as “chemical and surgical mutilation of children.”
- The settlement followed a subpoena issued by a Texas federal prosecutor to multiple medical institutions, requesting information about minor patients who received gender-affirming care over the past six years.
Perspectives on the Settlement
Advocates for transgender rights criticized the settlement, calling it a troubling precedent. Dr. Morissa Ladinsky, a professor at Stanford University, questioned the decision to require the termination of physicians experienced in transition care, noting that such doctors would be most qualified to provide detransition care.
Major U.S. medical associations, including the American Medical Association and the American Academy of Pediatrics, support gender-affirming care for minors, with specific protocols dependent on age. Studies cited in reporting estimate that 1% to 10% of transgender individuals detransition, with less than 1% reporting regret.
Ongoing Investigation
The DOJ stated that the investigation into gender-affirming care for minors is ongoing, and that it will continue to pursue other medical providers and pharmaceutical companies involved in such care.