The largest US children's hospital has reached a legal settlement with Texas and the Trump administration over gender-affirming care for transgender minors, involving a $10 million payment to the state, officials announced on Friday.
Settlement Details
Texas Children's Hospital in Houston agreed to the settlement to avoid prolonged litigation, according to a statement from the hospital, which serves over one million patients annually. The hospital noted that it had been under investigation by Texas Attorney General Ken Paxton and the US Department of Justice for three years, enduring what it described as a campaign of misinformation.
In 2022, the hospital stopped providing gender-affirming hormone treatments to minors after Paxton issued a legal opinion labeling such care as child abuse, and Governor Greg Abbott directed child welfare authorities to investigate related reports. Texas subsequently became the most populous state to ban gender-affirming care for minors in 2023, joining at least 26 other states with similar restrictions. The US Supreme Court upheld states' rights to impose such bans in June 2025.
Detransition Clinic Requirement
Paxton stated that the settlement mandates Texas Children's to establish a detransition clinic offering free care to transgender patients for five years to reverse the effects of prior treatments. He claimed this would be the first clinic of its kind in the nation, though this could not be independently verified.
"This historic settlement reflects an institutional and fundamental shift away from radical gender ideology," Paxton said. The agreement's full terms were not released, and the hospital's statement did not specify details.
Reactions
Brad Pritchett, CEO of Equality Texas, criticized the settlement, calling it "embarrassing" and accusing Paxton of blackmailing the hospital into creating an unnecessary resource that ignores scientific evidence supporting gender-affirming care.
Under the Trump administration, the Department of Health and Human Services has used regulatory powers to block gender-affirming care for minors, and the DOJ has sought access to provider records. Acting Attorney General Todd Blanche vowed to use all available tools to halt such care.
Paxton, who is running for the US Senate in a tight runoff against incumbent Senator John Cornyn, announced the settlement less than two weeks before the May 26 election. President Trump has not endorsed a candidate in the race.
Medical Context
Major medical organizations consider gender-affirming care essential for individuals with gender dysphoria, and many transgender youth, parents, and providers describe it as life-saving for those experiencing depression or suicidal ideation due to gender incongruence. Such care may include counseling, puberty blockers, hormone therapy, and surgeries, though surgeries are rare for minors.
Texas Children's Hospital stated it fully cooperated with investigators, producing over five million documents and conducting internal reviews, all of which showed no legal violations. The hospital emphasized that the settlement allows it to redirect resources to patient care and research.
Paxton also noted that the agreement requires the hospital to terminate five doctors who provided gender-affirming care and never rehire them, to cease such care permanently, and to amend bylaws so that any physician violating state law loses hospital privileges. The $10 million payment will be directed to Texas's Medicaid program, following allegations of false billings that the hospital denied.
