Texas Children’s also has to pay $10 million because the state says it illegally provided transgender care to kids.
AUSTIN, Texas — Texas Children’s Hospital will create the first-ever “detransition clinic” in the nation, and pay the state millions of dollars as part of a settlement over performing “gender transitioning” procedures on children, Texas Attorney General Ken Paxton announced on Friday.
According to Paxton, under the terms of the settlement, the multidisciplinary clinic will provide medical care to patients who were subjected to “gender-transition” procedures.
In 2023, the Texas Attorney General’s Office began investigating Texas Children’s Hospital in Houston over “gender transitioning” procedures. That same year, state lawmakers passed, and Gov. Greg Abbott signed Senate Bill 14 into law, which bans transgender youth from receiving puberty blockers and hormone therapies. The Texas Supreme Court upheld the law in 2024.
For the first five years, all services provided through the Detransition Clinic will be funded by Texas Children’s and be free of charge to patients.
“Today is a monumental day in the fight to stop the radical transgender movement. This historic settlement reflects an institutional and fundamental cultural shift away from radical ‘gender’ ideology,” Paxton said in a statement. “In addition to helping establish the first-ever Detransition Clinic and securing millions, this settlement will ensure that the deranged child mutilators who hurt our kids are fired and held accountable.”
The settlement requires the hospital to pay $10 million “for billing Texas Medicaid for unallowable and illegal ‘gender-transition’ interventions,” including the state alleged, by using false diagnosis codes.
It also compels Texas Children’s to” fire, permanently and irrevocably terminate all existing privileges, and never again hire or credential” five doctors and physicians who the state accused of performing “harmful medical interventions on Texans.”
As part of the settlement, Texas Children’s agreed not to provide “gender-transition” services anymore, implement new compliance and ethics measures and amend its bylaws to trigger automatic relinquishment of privileges for any physician who performs “gender-transition” care.
“I applaud Texas Children’s Hospital for changing course and committing to being a part of the solution by agreeing to form a first-of-its-kind Detransition Clinic that will help provide free care to those who have been victimized by twisted, morally bankrupt transgender ideology,” Paxton said in a statement. “Under my watch, I will investigate and bring the full force of the law against any Texas hospital that abuses children with harmful medical interventions to ‘transition’ kids.”
In a statement, Texas Children’s said it made “the difficult decision” to settle with the Texas Attorney General and the U.S. Department of Justice, to close “a chapter that has been wrought with falsehoods and distractions.”
“To be clear – we are settling to protect our resources from endless and costly litigation,” Texas Children’s said. “This settlement will allow us to redirect those precious resources to focus on the life-saving care and groundbreaking discoveries of our exceptional clinicians and scientists.”
The hospital said over the last three years, it has cooperated fully with the Texas Attorney General and Department of Justice, “navigating an unconscionable campaign of mistruths and mischaracterizations related to gender affirming care.” The hospital said it produced more than 5 million documents and conducted multiple internal and external investigations.
“These efforts have required significant staff time and financial resources to defend ourselves,” the hospital said. “All reviews and investigations continue to support the facts – we have been compliant with all laws.”
LGBTQ organizations said Friday that they were appalled by the announcement of the clinic.
“I think that overwhelmingly the reaction that I have had and a lot of other folks have had is one of disappointment,” Brad Pritchett, CEO of Equality Texas, said. “Essentially seeing the statement that was put out from Texas Children’s Hospital saying that they don’t think they’ve done anything wrong that they think they did the right thing, but still settling in such, bizarre way is disappointing, I think, for a lot of people who rely on Texas children, for health care, but who also look at that institution as something that has been revered in Texas for providing evidence based health care for people for a very long time.”
Advocates for the trans community say it’s a blow to Texans.
“As opposed to stepping up and saying they’re going to push back against this campaign of hate that Ken Paxton has been kind of crusading on for a decade, now they’re actively participating in it, and that’s going to harm the health of trans Texans,” Pritchett said. “For a hospital system to participate in this type of hateful rhetoric in this campaign and uplift this negative messaging that’s not based on science, that is going to have health outcomes on trans people, and it’s just not a good look for a hospital system to be contributing to that kind of negative impact on health.”
Pritchett said the attorney general is forcing the hospital system to create a resource “that no one is asking for.” He said Texas has one of the largest transgender populations in the country.
“There are so many trans people in Texas who need that health care to be prioritized, and unfortunately, their health care is not being prioritized,” Pritchett said. “But this detransition health care is, and the number of people that benefit is so drastically small. So we are prioritizing a type of health care that benefits a very narrow group of people, and then rejecting health care that benefits a huge population of folks who live in Texas.”
Conservative advocacy group Texas Values cheered the settlement.
“It’s good accountability for Texas Children’s Hospital, and I think it recognizes that both the medical and the financial consequences tied to these procedures, they’ll help people receive coverage for the downstream effects of these harmful transition procedures,” Texas Values Director of Policy Jonathan Covey said. “I think it’s a very practical solution that should be very effective.”
While transition-related surgeries very rarely happen for trans youth, Covey said the settlement speaks to the fact that the concerns are real.
“Patients deserve coverage of their health care needs. That includes reconstructive surgeries returning to the reality of their sex, function restoration and ongoing tests. All of those things,” Covey said. “There is a large potential patient population. They have high rates of serious medical complications, and there are high out-of-pocket costs for a lot of those things. So, this is going to help address a lot of those needs, and I think that’s a good thing.”
Covey said it is about offering real help, not false solutions, which he said are “built on harmful ideology.” He said the documented medical complications of these harmful gender transition interventions are “well known and documented.”
“Four to five times higher heart attack risks in female patients compared to male patients. 6% of them developed blood clots in male-to-female patients, 25% develop osteoporosis, 94% on testosterone experience pelvic dysfunctions,” Covey said. “There’s a lot of very real documented medical complications, and we want to offer them real help for those things.”
A 2025 study from UCLA estimated that trans people make up less than 1% of the state’s population.
Andrea Segovia with the Transgender Education Network of Texas said most who detransition do so because of social pressures, not medical complications.
“When you think about detransition, that’s even less,” Segovia said. “The number of people who have regret about transitioning is less than the number of people who have regret about knee surgeries or, you know, getting a tattoo.”
Last year, during the 89th legislative session, state lawmakers passed, and Gov. Abbott signed SB 1257, authored by State Sen. Bryan Hughes (R-Mineola), which requires health insurance companies that cover the cost of transition-related care also to cover the cost of reversal procedures. The treatments must cover adverse effects and related health conditions, and they apply to new or renewed health plans as of January 2026.
Generally speaking, gender-affirming care is a broad term. It is what is used to treat gender dysphoria, which people experience when their gender identity does not align with the sex they were assigned at birth. The type of care provided runs a wide range from changing the pronouns that one goes by or dressing differently to using puberty blockers, hormone therapy, or surgical interventions.
Texas Children’s has not said how it will roll out the new clinic or which specific services will be included. The hospital said the “detransition clinic will formalize the supportive, multidisciplinary services we already deliver to all patients who need our care.”
“Our state has our priorities all wrong,” Segovia said. “Our priority should be that we’re trying to get people health care that’s affordable and close to them, so that they don’t have to travel, and instead, we’re making clinics that are baseless.”
Major medical groups and studies say gender affirming care lessens higher rates of depression and suicide for trans youth.
“As an organization that works really closely with trans Texans and the families of trans Texans. I can guarantee you I’ve had conversations with so many folks about how they were struggling until they got supportive health care, and then when they got that health care, everything changed for them,” Pritchett said. “Their lives got worlds better overnight, just knowing that their providers were affirming them. That saves lives across the board, whether you’re a young person or you’re an adult.”
Major medical associations such as the American Medical Association, American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and American Psychiatric Association support gender-transitioning care in cases where it is appropriate and medically necessary for children.
“The science and health care of how we support trans people has been going on for years. There is a body of research to back it up, and it is scientific, accurate, valid, and not experimental,” Pritchett said. “It is health care that saves lives. That is the full story with it. It saves lives. It should be accessible to everyone.”
Segovia said she is worried that other states will follow Texas’ lead and force more clinics like this one to open.
“However far a state government or the federal government can bully people into doing what they want them to do, they’re going to attempt that,” Segovia said. “I think this is detrimental because it puts hospitals and, and health care systems in a really tough place of do they do the right thing and potentially lose funding, which then means that they have to close clinics and hospitals and let staff go depending on how far the state or the federal government wants to go or do they be discriminatory towards what they see is a small group of people and move about their day.”