The country’s largest children’s hospital has agreed to create a first-in-the-nation “detransition clinic” as part of a settlement closing a multi-year state investigation into its delivery of gender-affirming care to minors, Texas Attorney General Ken Paxton and the U.S. Department of Justice announced Friday.
Texas Children’s Hospital’s deal also includes a $10 million payment, an agreement to end “gender-transition” services and terminate its relationships with “five woke doctors who performed harmful medical interventions on Texans,” the attorney general’s office said in its announcement. The payment resolves allegations that the hospital submitted false billings to public and private payers related to the services, which DOJ alleged was in violation of the Federal Food, Drug, and Cosmetic Act, the False Claims Act, and federal fraud and conspiracy laws.
Texas Children’s acknowledged that it had entered a settlement with the state and the Department of Justice in an online statement that did not describe the terms highlighted by the government. When asked by Fierce Healthcare for confirmation of those terms, the organization referred to the same posted statement.
In it, the hospital said it had fully cooperated with the three-year investigation, which it characterized as “an unconscionable campaign of mistruths and mischaracterizations related to gender-affirming care." To do so, the hospital said it produced over 5 million documents and conducted multiple investigations that “required significant staff time and financial resources.”
“Today, we made the difficult decision to settle, … closing a chapter that has been wrought with falsehoods and distractions,” the hospital said in its statement.
“To be clear—we are settling to protect our resources from endless and costly litigation,” the statement continues. “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.”
Texas Children’s, based in Houston, operates roughly 1,000 beds and had 5 million total patient encounters in 2025.
The settlement represents a clear victory for Republican-controlled government offices, including the White House, that have sought to pressure or restrict providers of youth gender-affirming care, which comprises a range of social, behavioral and medical services that may include hormone therapy and, rarely, surgical procedures.
“The Justice Department will use every weapon at its disposal to end the destructive and discredited practice of so-called ‘gender-affirming care’ for children,” Acting Attorney General Todd Blanche said in the DOJ’s announcement of the settlement. “Today’s resolution protects vulnerable children, holds providers accountable and ensures those harmed receive the care they need.”
Paxton’s statement describes the detransition clinic as a multidisciplinary center that will provide medical care and “reverse the damage caused” to patients who received gender transition services and related medical interventions. He said all services delivered by the clinic will be fully funded by Texas Children’s and free to patients for its first five years.
“This historic settlement reflects an institutional and fundamental cultural shift away from radical ‘gender’ ideology,” Paxton said in the announcement. “… 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.”
Early in his second term, President Donald Trump signed an executive order instructing the executive branch to use everything at its disposal to limit gender-affirming care services for those under the age of 19. That kicked off a federal campaign that includes, among other efforts, administrative subpoenas sent by the DOJ to over 20 hospitals and a court-halted restriction on Medicare funding for hospitals offering the services. The pressure has led at least dozens of health systems to limit or fully shutter those services to avoid litigation or funding cutoffs.
This week has seen multiple developments on that front, beginning with NYU Langone Health disclosing it was “one of the several institutions” that received a grand jury subpoena on May 7, implying the first-known criminal probe related to gender-affirming care for minors.
Elsewhere, a DOJ petition for enforcement of its Brown University Health system administrative probe, swiftly granted by a Texas federal judge earlier this month, was blocked by another federal judge on Wednesday who rebuked the DOJ as “unworthy” of trust and acting in bad faith due to its tactics. To date, several district judges have similarly shot down or restricted the DOJ’s administrative subpoenas seeking information on hospitals’ gender-affirming care services.