The Texas attorney general has reached a groundbreaking settlement concerning child transgender care, which mandates Texas Children’s Hospital to establish the nation’s inaugural “detransition clinic” while also paying the state $10 million.
Attorney General Ken Paxton announced that this multidisciplinary clinic will offer medical services to individuals who have undergone “gender-transition” procedures. For the first five years, patients will receive care at no cost. This decision follows an investigation launched in 2023 by the attorney general’s office into practices at Texas Children’s Hospital in Houston. That same year, Governor Greg Abbott enacted Senate Bill 14, prohibiting transgender minors from accessing puberty blockers and hormone therapies.
Gender-affirming care encompasses a range of treatments for gender dysphoria, which occurs when a person’s gender identity does not align with their assigned sex at birth. This type of care can include socially transitioning — such as adopting different pronouns or styles of dress — as well as medical interventions like puberty blockers, hormone therapy, and surgery.
“Today marks a significant milestone in the battle against the radical transgender movement,” Paxton stated in a press release. “I commend Texas Children’s Hospital for shifting its approach and agreeing to create a pioneering Detransition Clinic, which will offer free care to those who have been harmed by misguided and unethical transgender ideologies.”
Texas Children’s Hospital will be responsible for funding all services provided through the detransition clinic for the initial five years.
Additionally, the settlement obligates the hospital to pay $10 million for allegedly improper billing practices to Texas Medicaid, which included using inaccurate diagnosis codes related to gender-transition interventions. The agreement also mandates the hospital to terminate the medical privileges of five physicians involved, although neither Paxton’s office nor the hospital has disclosed their identities or provided a copy of the settlement.
In a statement, Texas Children’s Hospital described its decision to settle with the attorney general’s office as a “difficult choice” aimed at concluding a legal dispute filled with “misrepresentations and distractions.”
The hospital noted that it spent three years compiling over five million documents for both the state and the U.S. Department of Justice. “All reviews and investigations continue to affirm that we have complied with all laws,” the statement read. “We are settling to safeguard our resources from protracted and costly legal battles. We take pride in our commitment to prioritizing our mission over political agendas and our continuous adherence to the law.”
The Texas Medical Association and the Texas Hospital Association declined to comment on the matter.
Details on the Services of the Clinic Remain Uncertain
Texas Children’s has not clarified how it plans to operationalize the detransition clinic or the specific services it will offer, though the hospital has stated it will provide “supportive, multidisciplinary services that we already deliver to all patients in need of our care.”
Detransitioning involves reversing or halting transitioning care through social, medical, or legal avenues, and it is uncommon for individuals to regret transitioning after undergoing hormone therapy and surgical procedures.
Clinically, detransitioning may entail ceasing hormone treatments or seeking to reverse previous surgeries. Similar to the transitioning process, detransitioning necessitates comprehensive mental health evaluations to identify any underlying issues influencing the decision to halt transitioning, according to research. Common factors leading to detransitioning can include insufficient family support, financial constraints, and societal pressure.
Andrea Segovia, senior field and policy director for the Transgender Education Network of Texas, stated that when individuals choose to detransition, “it is not typically due to complications related to healthcare.”
Segovia expressed concerns that mental health care may not be integrated into the clinic’s offerings. In March, Paxton issued an opinion indicating that state-licensed mental health providers are prohibited from delivering gender-transitioning care to minors under Texas law. It remains unclear if this opinion extends to mental healthcare for those wishing to detransition.
For individuals seeking to detransition, existing resources are available, according to Kellan Baker, a senior advisor for the Movement Advancement Project, a national organization focusing on LGBTQ policies.
While proper detransitioning services can be provided alongside mental health support, Baker voiced skepticism regarding the clinic’s intentions, given its origins in a contentious dispute between the hospital and the attorney general. “This clinic is not the creation of Texas Children’s; it is a product of the Texas attorney general’s office. A clinic established through political pressure is unlikely to serve the best interests of any patient. Medical professionals, not politicians, should dictate healthcare decisions.”
A Resource That Is Not Needed
Brad Pritchett, CEO of Equality Texas, a nonprofit advocating for the LGBTQ community, criticized the attorney general for “coercing a hospital system into creating a resource that nobody has requested.”
Pritchett argued that the politically motivated detransition clinic disregards established scientific evidence and years of data demonstrating the significant benefits of gender-affirming care.
Numerous medical associations, including the American Medical Association and the American Academy of Pediatrics, have endorsed evidence-based gender-transitioning care as appropriate and medically necessary for children.
Pritchett lamented that it is “embarrassing” for a hospital once celebrated for its quality care to have compromised its integrity by prioritizing politics over patient welfare.
State Representative Jessica González, who chairs the Texas House LGBTQ Caucus, described the settlement as “shameful,” asserting that it further perpetuates an agenda aimed at erasing transgender individuals from societal visibility.
With transgender people comprising approximately 1% of the population, Segovia found it “infuriating” that the state is establishing a detransition clinic while access to vital healthcare services, such as rural hospitals and reproductive care, remains limited.
González noted that Texas Children’s will need to fully finance the clinic for five years, diverting attention and resources from other critical departments, such as pediatric oncology and neonatal care.
“Using a settlement to mandate a hospital to construct an ideologically driven clinic invites greater state interference in medical practice, intensifies harmful stigmatization that adversely impacts young Texans, and tragically contributes to the worsening suicide epidemic in our nation,” González remarked, highlighting her status as one of the few queer representatives in Texas.
Houston State Senator Molly Cook, also openly queer, criticized Paxton for creating a political spectacle, emphasizing that healthcare providers already possess the knowledge to assist individuals who wish to detransition without the need for a state-sponsored clinic. “This is a nonsensical expenditure that reflects Texas’s disconnected statewide leadership,” Cook stated. “Texas Children’s already provides care for patients who opt to alter their treatment path.”
The necessity for such a clinic in Texas is further diminished by the fact that the state’s ban on gender-transitioning care for minors has resulted in an extremely limited number of children who may need to detransition.
The five physicians that Paxton has ordered Texas Children’s to dismiss add to the four healthcare providers he has previously sued to halt their provision of gender-affirming care. He has also filed lawsuits against Children’s Health System of Texas, based in Dallas, alleging violations of SB 14. Some regions in Texas are already experiencing a shortage of pediatric endocrinologists following the enactment of SB 14.
Segovia expressed concern that other states might adopt Texas’s approach to enforcing similar clinics. “It is alarming to consider what other states might take away from this situation.”
