Texas Children’s will create ‘detransition clinic’ to settle DOJ and state investigation
Texas Children’s Hospital is to create the nation’s “first-ever detransition clinic,” Texas Attorney General Ken Paxton said Friday, announcing a settlement agreement that concludes a years-long investigation into the medical center’s treatment program for transgender youth.
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As part of the settlement, the Houston hospital also agreed to fire five doctors who previously provided transitional care to children and pay $10 million to resolve allegations that the hospital improperly billed the state’s Medicaid program for transitional care, according to a news release from Paxton’s office. For the first five years of the clinic’s operation, Texas Children’s must provide detransition care free of charge.
Officials have not detailed exactly what the detransition clinic will offer. Detransition, which involves no longer identifying as transgender or stopping medical transition, is rare. Potential medical interventions are similar to those involved in transition: mental health therapy, hormone therapy, and surgeries.
In a statement, Paxton said the agreement, which the hospital reached with his office and the U.S. Department of Justice, “reflects a fundamental institutional and cultural shift away from radical ‘gender’ ideology.”
Paxton’s office did not respond to a request for comment or provide a copy of the full settlement agreement.
Texas Children’s Hospital, the nation’s largest children’s hospital, said it agreed to the settlement after cooperating throughout the three-year investigation, during which the hospital produced more than 5 million documents and conducted its own investigations. The hospital claims to have complied with all laws.
“Today, we made the difficult decision to settle with the Texas Attorney General and the Department of Justice, closing a chapter that has been filled with lies and distractions,” the hospital said in a statement. “To be clear, we are resolving to protect our resources from endless and costly litigation. This settlement will allow us to redirect these valuable resources to focus on the lifesaving care and groundbreaking discoveries of our exceptional clinicians and scientists.”
In response to questions from NBC News about what type of care the clinic will provide, a hospital spokesperson said, “The detransition clinic will formalize the multidisciplinary support services we already provide to all patients who need our care.” »
It is unclear who will lead or run the clinic. The hospital declined to provide details about the fired employees, saying, “Our top priority throughout this settlement discussion was to protect our physicians.” »
Paxton’s investigation is part of a broader effort by his office to end all transitional care for minors in Texas. In early 2022, after the state failed to ban such care for minors, Paxton wrote a legal opinion declaring that transitional care for minors constitutes child abuse. Soon after, the state began investigating parents suspected of providing such care to their children. The following year, the state became the largest state to enact a ban on gender-affirming care for minors.
Months before the ban took effect, Paxton announced his investigation into Texas Children’s, which he said was “actively engaging in illegal conduct” by performing gender transition procedures on children.
“Under my leadership, I will investigate and bring the full force of the law against any Texas hospital that abuses children with harmful medical interventions on children in ‘transition,’” Paxton said.
The settlement marks the first resolution in the Justice Department’s ongoing national investigation into transitional care — which it calls “gender rejection procedures” — for minors. Last year, the department subpoenaed more than 20 doctors and clinics that treat trans minors over allegations of health care fraud and misrepresentations, among other allegations. This week, NYU Langone said it received a grand jury subpoena from federal prosecutors seeking information about the treatment of trans youth over the past six years.
“The Department of Justice 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 Friday. “Today’s resolution protects vulnerable children, holds providers accountable, and ensures those harmed receive the care they need.”
Studies have estimated that between 1% and 10% of trans people experience detransition. Less than 1% say they regret their transition, according to the study. The most commonly cited reasons for detransitioning were pressure from a parent, harassment or discrimination, and the fact that the transition was too difficult.
In recent years, some prominent detransitionists, including Chloe Cole and Prisha Mosley, have advocated for restrictions on transitional care for minors, arguing in lawsuits against the doctors who treated them that their care was too easy to access and that doctors were unresponsive. The medical providers accused by Cole and Mosley have denied wrongdoing.
Republican state representatives as well as federal officials have cited their stories as proof that transitional care is dangerous.
However, most major medical associations in the United States, such as the American Medical Association, the American Academy of Pediatrics, and the American Psychological Association, support access to gender-affirming care for minors.
The care recommended by medical associations depends on the age of the child. The associations do not recommend any medical intervention for children before puberty, but instead recommend allowing children to change their names or clothes. At puberty, some trans children may start taking puberty blockers, and then, as teenagers, begin hormone treatment. Surgical interventions on minors are rare and discouraged by medical associations.
In Texas, transgender rights advocates said the settlement with Texas Children’s sets a troubling precedent.
“We know that what starts in Texas spreads to the rest of the country,” said Andrea Segovia, senior field and policy director for the Transgender Education Network of Texas, a state trans rights group.
Segovia said Texas should work to make health care more accessible to those who struggle to afford it, rather than targeting care for fewer than 1% of trans Texans.
“In Texas, it’s difficult to get regular general health care,” Segovia said. “Prioritizing a clinic based on political gain while your state continues to struggle for basic general health care is a slap in the face to people. »
Dr. Morissa Ladinsky, a clinical professor of pediatrics at Stanford University School of Medicine, said that when she read news of the deal, she didn’t understand why the hospital had to lay off doctors who previously provided transitional care. They would have been the doctors best equipped to treat people seeking detransition because of their expertise, she said.
The regulation, she said, “only amplifies a fog of confusion” in which gender-affirming care providers operate, “because it is a clinic created by legal intimidation on terms set by politicians.”
Ladinsky practiced for 10 years as a pediatrician in Birmingham, Alabama, where she treated trans adolescents until the state’s ban on transitional care for minors took full effect in January 2024.
Out of hundreds of patients, she said, two or three decided to follow a different treatment path, but they didn’t regret the care they received.
“Regret is virtually non-existent,” Ladinsky said, “and that’s because we do what we do the way we do it – slowly, carefully, methodically and in the context of family and home.”
