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The Texas attorney general has secured an unusual settlement over child transgender care that compels Texas Children’s Hospital to create the nation’s first ever “detransition clinic” in addition to paying the state $10 million.
According to Attorney General Ken Paxton, the multidisciplinary clinic would offer medical care to patients “who were subjected to ‘gender-transition’ procedures.” The care would be free to patients for the first five years of the clinic’s operation. The move follows an investigation that began in 2023 by the attorney general’s office into Texas Children’s Hospital in Houston. That same year, Gov. Greg Abbott signed Senate Bill 14 that bars transgender children from receiving puberty blockers and hormone therapies.
Gender-affirming care is an umbrella term for the treatment of gender dysphoria, or the discomfort that comes when someone’s gender identity does not align with the sex they were assigned at birth. Gender-affirming care ranges from “socially transitioning” — using different pronouns or dressing differently — to puberty blockers, hormone therapy and surgical interventions.
“Today is a monumental day in the fight to stop the radical transgender movement,” Paxton said in a statement issued Friday. “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.”
Texas Children’s will fund all services provided through the “detransition clinic” for the first five years.
The settlement also requires the hospital to pay $10 million for billing Texas Medicaid after the state accused the hospital of illegal ‘gender-transition’ interventions, including by using false diagnosis codes. It also required Texas Children’s to terminate and revoke the medical privileges of five physicians. Paxton and the hospital have not released the name of the physicians or a copy of the settlement.
Texas Children’s, the nation’s largest pediatric hospital, said in a statement that it made the “difficult decision” to settle with the attorney general’s office to close a legal chapter that has been, “wrought with falsehoods and distractions.”
The hospital said it spent three three years producing more than 5 million documents to both 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 statement said. “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.”
The Texas Medical Association and Texas Hospital Association declined to answer questions for the story.
Unclear what services clinic will provide
Texas Children’s, one of the world’s leading pediatric hospitals based in the heart of Houston’s medical center, did not say how it will roll out its clinic or what services it will provide, though the hospital said in the statement that the clinic will include “supportive, multidisciplinary services we already deliver to all patients who need our care.”
Detransitioning is the stopping or reversal of transitioning care by social, medical or legal means, and it is rare for people to regret transitioning after taking hormone therapy and surgical interventions.
On the clinical side, detransitioning could mean stopping hormone treatment or procedures to reverse previous surgeries. Similar to transitioning, detransitioning requires intensive mental health assessments to root out other factors that might be creating the desire to stop transitioning, according to research. Common reasons for destransitioning include lack of family support, financial barriers and social pressure.
When someone chooses to detransition, “it is not normally because of healthcare complications,” said Andrea Segovia, senior field and policy director for the Transgender Education Network of Texas.
Segovia is concerned that access to mental healthcare will not be woven into the clinic’s services. In March, Paxton released an opinion saying that mental health providers licensed by the state cannot provide gender-transitioning care to minors under state law. It’s not clear if Paxton believes state law bars detransitioning mental healthcare as well.
For those who do want to detransition, the resources already exist, said Kellan Baker, senior advisor for the Movement Advancement Project, a national think tank that focuses on LGBTQ policies.
Detransitioning services, although they are rarely needed, can and have been offered properly when accompanied with mental health resources. But Baker said he’s not confident that this clinic, born out of a heated conflict between a hospital and the attorney general, has the best intentions for the transgender community.
“Texas Children’s is not creating this clinic — the Texas attorney general is creating it,” Baker said. “A clinic created by a politician via legal intimidation is not in the best interests of any patient. Doctors should be the ones making decisions about how to provide medical care, not politicians.”
‘Resource that no one is asking for’
Brad Pritchett, CEO of Equality Texas, a nonprofit that advocates for the LGBTQ community, said in a statement that the attorney general is “blackmailing a hospital system into creating a resource that no one is asking for.”
Pritchett said Texas’ politically-motivated detransition clinic “ignores the actual science and years of data about the overwhelming benefits of gender-affirming care.”
Several medical associations including the American Medical Association, American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and American Psychiatric Association, have supported evidence-based gender-transitioning care as appropriate and medically necessary for children.
Pritchett added that it is “embarrassing that a hospital once revered for its care has lost its integrity and put politics over patients.”
Dallas state Rep. Jessica González who chairs the Texas House LGBTQ Caucus said in a statement that the settlement is “shameful, and is the furthering of an agenda to eradicate transgender people from the eyes of society.”
Transgender people make up about 1% of the population, which is why, Segovia said, it is “infuriating” that the state is creating the detransition clinic as access to other healthcare services are struggling — such as rural hospitals and reproductive care.
Texas Children’s has to fully fund the clinic for five years, which will take away attention and limited resources from the hospital’s other departments such as care for children with cancer and infants with heart conditions, González said.
“Using a settlement to compel a hospital to build an ideologically framed clinic opens the door to more state interference in medical practice, more dangerous stigmatization that truly harms
young Texans, and, sadly, more lives lost in our nation’s suicide epidemic,” said González, one of the few only queer representatives in Texas.
Houston state Sen. Molly Cook, who is also openly queer, said Paxton is manufacturing a political spectacle because providers know how to help someone detransition and the state doesn’t need a clinic to train them on it.
“This is an asinine waste of money that is typical of Texas’s out-of-touch statewide leadership,” Cook said in a statement. “Texas Children’s already provides care for patients who choose to change a course of treatment.”
The need for such a clinic in Texas is made even smaller by the fact that the state’s ban on gender-transitioning care for minors has resulted in very few Texas children receiving such care statewide.
The five doctors that Paxton said Texas Children’s will need to fire adds to the four doctors he’s already sued to stop providing gender-affirming care. He’s also sued Children’s Health System of Texas, headquartered in Dallas, accusing them of violating SB 14. Some parts of Texas already suffer from a pediatric endocrinologist shortage in the wake of SB 14.
Segovia with the Transgender Education Network of Texas said she’s worried that other states will follow Texas’ lead in forcing more of these clinics to open.
“It’s terrifying what other states will take from this.”
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