Texas settlement papers describe nation’s first gender ‘detransition clinic’

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In Brief

• Texas Children’s hospital to create detransition clinic within 90 days.
• Settlement includes $10 million payment and ban on sex-rejecting procedures.
• Clinic services include surgery, fertility counseling, and psychotherapy.
• Five doctors banned from practicing at Texas Children’s hospital.

HOUSTON – The nation’s first “detransition clinic” will provide an array of medical treatment, including surgery, fertility counseling, psychotherapy and speech pathology to patients who have received gender transition care before the age of 21, according to a previously unreleased settlement agreement with the Texas state attorney general’s office.

The agreement between State Attorney General Ken Paxton (R) and Texas Children’s Hospital in Houston, coordinated with the Justice Department, ended a three-year investigation into the hospital’s treatment of transgender youths. Under the terms of the settlement, announced last month, the hospital will pay $10 million to the state to resolve allegations of improper billing to the state’s Medicaid program, ban five doctors from practicing at the facility and “permanently and irrevocably cease providing … any sex-rejecting procedures.”

The 10-page settlement, obtained Monday by The Washington Post through a public records request to the attorney general’s office, details how the detransition clinic must be run.

Under the agreement, Texas Children’s, the nation’s largest pediatric hospital, will create its detransition clinic within 90 days of the settlement.

The clinic’s services provided at no cost for five years – will include a patient navigator to coordinate care across departments, endocrinology, surgery, primary care, fertility counseling, psychiatry, speech pathology and social work to assist with insurance and legal name changes. Care will be provided to patients who have received gender transition care before age 21, and obstetric-gynecology care for those over age 21.

“The detransition clinic will formalize the supportive, multidisciplinary services we already deliver to all patients who need our care,” Texas Children’s said in a Monday statement. “This simply provides structure and a name for the services we currently provide.”

The agreement requires that the hospital’s medical staff amend their bylaws within 90 days to require that staff and prospective appointees be evaluated on compliance with the new ban on “sex-rejecting procedures” and that anyone who violates it automatically relinquishes their position, according to the agreement.

The clinic’s director will report directly to the hospital’s chief compliance officer.

The detransition clinic will have its own page on the hospital website and a gift designation on the hospital’s fundraising webpage, the agreement stipulated, and any donations must be used to fund free treatment at the clinic beyond five years.

Texas Children’s also agreed to maintain a list of patients who had received gender transition care and have their compliance department audit the list annually “to confirm compliance with state and federal laws and with this agreement.” The agreement did not stipulate that the list remain confidential.

“We abide by HIPAA and protecting patient privacy is one of our top priorities,” the hospital statement said, referring to the Health Insurance Portability and Accountability Act, a federal law created to protect patient records from being disclosed without their consent.

When the settlement was announced in May, Texas Children’s said in a statement that officials made the “difficult decision” to settle with the attorney general’s office “to protect our resources from endless and costly litigation” following an investigation into the hospital’s billing practices.

Paxton announced he was investigating the hospital in May 2023, alleging gender transition care constituted child abuse under state law after a doctor leaked transgender children’s medical records. The state also accused the hospital of Medicaid fraud and submitting false billing claims to conceal gender transition care. Such care was still legal in Texas at the time, although state lawmakers outlawed it in September 2023.

Federal prosecutors initially charged the doctor who leaked the children’s records with four felony counts of wrongful disclosure of individually identifiable health information, but the charges were later dismissed.

“I applaud Texas Children’s Hospital for changing course and committing to being a part of the solution,” Paxton, who is running for U.S. Senate, said last month in announcing the settlement.

The Justice Department has issued administrative subpoenas seeking records from more than 20 providers of gender transition care to minors. And last month, a New York City hospital said it was one of several to have received a grand jury subpoena from a federal prosecutor in Texas seeking information about youths who received gender-related medical care.

A report commissioned by the Trump administration concluded that the risks of gender transition care outweigh the benefits. The Department of Health and Human Services has proposed rules that would bar federal funding to hospitals that provide such treatments to young people.

There’s an intense debate about when young people should be able to get medical interventions as more have sought gender transition. Some systematic reviews have suggested the evidence for the benefits and risks of pediatric transition is insufficient. Supporters of transition care for youths have pointed to the widespread endorsement by U.S. medical organizations.

“Regret is inordinately rare” among transgender youth, said Morissa Ladinsky, a clinical professor of pediatrics at Stanford University’s medical school.

Ladinsky practiced for a decade in Birmingham, where she treated several hundred youths until Alabama’s ban on transition care for minors fully took effect in 2024. Only two or three decided they wanted to pursue a different treatment path, she said, and even they didn’t regret the care they had received.

Ladinsky said she was “flummoxed” by the agreement’s description of the clinic.

“It’s not clear to me what care will be delivered and who will be delivering that care,” she said, given, “the specialists and the teams best suited to provide the care they articulate were terminated as part of this same settlement.”

Eithan Haim, the North Texas surgeon who leaked the Texas Children’s patient records and described himself at a congressional hearing as a whistleblower, called the detransition clinic outlined in the settlement “very comprehensive” and “an acknowledgment of the damage this twisted field of medicine caused in the first place.”

Haim was particularly impressed that the clinic would provide OB/GYN care to patients over age 21 because he said hormone treatments can complicate pregnancy and childbirth for those who detransition.

“The fact that they even put this on paper is a massive step forward in the right direction,” he said.