
Texas Attorney General Ken Paxton has secured a settlement requiring Texas Children’s Hospital to establish what he called the nation’s first-ever “detransition clinic” for patients who previously received gender-affirming care.
Under the settlement, negotiated with Paxton’s office and the U.S. Department of Justice, Texas Children’s must provide free medical care to patients who underwent gender transition procedures, according to a press release.
The clinic is intended to help patients stop hormone treatments or seek medical care related to detransitioning. Under the settlement, Texas Children’s will fund all services provided through the clinic for its first five years.
It remains unclear whether the clinic will offer mental health services or counseling as part of its detransition care.
Paxton previously issued a legal opinion asserting that mental health providers cannot offer therapy affirming a minor’s gender identity if it differs from their sex assigned at birth. Critics say that the position has created fear among providers about treating transgender youth without risking accusations that they are violating the state’s ban on gender-affirming care.
Texas Children’s Hospital also agreed to stop providing gender-affirming care to minors and to amend its bylaws to revoke the privileges of any doctor who violates that policy.
Additionally, the hospital agreed to fire and permanently revoke the privileges of five unnamed doctors accused of prescribing gender-affirming treatments to minors in violation of state law. Texas Children’s will also pay $10 million to settle allegations that it improperly billed Texas Medicaid for transition-related treatments using false diagnosis codes.
The settlement concludes a years-long investigation by Paxton as part of a broader statewide crackdown on providers accused of offering gender-affirming care to minors. The Texas Tribune previously reported that Paxton also sued four doctors in an effort to revoke their medical licenses, along with the Children’s Health System of Texas in Dallas.
Paxton hailed the settlement as “a monumental day in the fight to stop the radical transgender movement” and praised Texas Children’s Hospital for agreeing to establish what he called a first-of-its-kind detransition clinic.
Studies have found that only a small percentage of transgender youth who receive gender-affirming care later detransition. Researchers say those who do often cite factors such as cost, lack of insurance coverage, or fear of family or societal rejection, rather than regret over transitioning itself.
Opponents of gender-affirming care, however, have argued that many children experiencing gender dysphoria will eventually identify with their sex assigned at birth.
Several studies have challenged those claims. A 2024 study published in JAMA Pediatrics found that just 1% of transgender youth later detransitioned, while a 2022 study from the American Academy of Pediatrics found that only 2.5% of transgender youth identified as cisgender after five years.
Texas Children’s Hospital said it made a “difficult decision” to settle with Paxton’s office in order to close a legal chapter that has been “wrought with falsehoods and distractions.” The hospital said it spent three years producing more than 5 million documents to the state and the U.S. Department of Justice.
“All reviews and investigations continue to support the facts — we have been compliant with all laws,” the hospital said in a statement disputing some of Paxton’s assertions. “To be clear — we are settling to protect our resources from endless and costly litigation.… We stand proud knowing we will always put our purpose over politics and that we have and will continue to follow the law.”
Brad Pritchett, CEO of the statewide LGBTQ nonprofit Equality Texas, accused Paxton of “blackmailing a hospital system into creating a resource that no one is asking for,” and said the focus on detransitioning ignores “the actual science and years of data about the overwhelming benefits of gender-affirming care.”
Pritchett said it is “embarrassing that a hospital once revered for its care has lost its integrity and put politics over patients.”
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