Texas Children’s Hospital in Houston will establish the nation’s first dedicated “detransition clinic” as part of a legal settlement with the Texas state attorney general’s office and the U.S. Department of Justice. The agreement, finalized in June 2026 after a three-year investigation, requires the hospital to provide comprehensive medical services for individuals who have previously undergone gender transition care before the age of 21.

Under the terms of the settlement, Texas Children’s Hospital will pay $10 million to the state to resolve allegations of improper Medicaid billing related to gender transition treatments. The agreement also bans five doctors from practicing at the hospital and mandates the permanent discontinuation of any “sex-rejecting procedures” for minors. The hospital is tasked with creating the detransition clinic within 90 days of the settlement. Services will be provided free of charge for five years and are to include endocrinology, surgery, fertility counseling, psychotherapy, speech pathology, primary care, obstetrics-gynecology for those over age 21, and social work support to help patients with insurance and legal name changes.

The clinic will operate under a formal structure with its own webpage and designated fundraising efforts, with donations specifically allocated for free treatment at the facility. Hospital staff and prospective appointees will be evaluated for compliance with the new restrictions, and violations could lead to automatic removal from their positions. The clinic’s director will report directly to the hospital’s chief compliance officer. Texas Children’s officials described the clinic as a formalization of supportive, multidisciplinary services they already provide, presenting it as a structured means of delivering care to this patient population.

The settlement has elicited mixed reactions from experts and advocates. Eithan Haim, a North Texas surgeon who publicly leaked patient records and described himself as a whistleblower, characterized the clinic as a comprehensive acknowledgment of harm caused by gender transition care. He particularly noted the inclusion of obstetric-gynecological services as important for patients who detransition due to the impact hormone treatments can have on pregnancy.

Conversely, Morissa Ladinsky, a clinical professor of pediatrics at Stanford University who has experience treating transgender youths, expressed skepticism about the clinic’s effectiveness given the loss of several specialists under the settlement. She questioned which medical professionals would provide the promised care, emphasizing that “regret is inordinately rare” among transgender youth and that only a small fraction seek to change their treatment path.

The settlement follows an investigation launched by Texas Attorney General Ken Paxton in May 2023 after a doctor leaked patient records, leading to allegations that gender transition care for minors constituted child abuse under Texas law and involved Medicaid fraud. Although such medical treatments were legal in Texas before a 2023 state ban, Paxton framed the settlement as a corrective measure, praising the hospital for “changing course” and committing to compliance.

Federal authorities have also increased scrutiny of gender transition care for minors, with the Department of Justice issuing subpoenas to more than 20 providers nationwide. Several hospitals, including a major facility in New York City, have been subpoenaed for records related to youth gender-related medical treatments as part of the ongoing broader federal investigation.

Texas Children’s Hospital has stated it remains committed to protecting patient privacy in accordance with federal law despite the requirement to maintain and audit a list of past transition care patients to ensure compliance with the settlement. The hospital framed the settlement as a decision to avoid protracted litigation while continuing to provide care consistent with state and federal requirements.