Texas Children's Hospital to create nation's first detransition clinic

Texas Children’s Hospital has agreed to create what Texas officials called the nation’s first detransition clinic, a settlement that puts a major pediatric medical system at the center of the fight over youth gender care, Medicaid billing and state power. The deal requires the Houston hospital to pay more than $10 million, permanently cut ties with five doctors who performed the treatments at issue and provide the new clinic’s services free for its first five years.

The U.S. Department of Justice said the settlement was the first resolution in an ongoing national investigation into pediatric sex-transition procedures and that Texas Children’s agreed not to perform puberty blockers or cross-sex hormones on children. The department said the hospital also committed to dedicate millions of dollars to care for detransitioners, patients who want support reversing or addressing prior gender-affirming treatment. Texas Attorney General Ken Paxton’s office said the agreement was coordinated with federal officials and would require the hospital to amend its bylaws so doctors who violate Texas law can automatically lose privileges.

The state’s case grew out of a years-long review of Texas Children’s billing and clinical practices, including allegations that the hospital used false billing codes and billed Texas Medicaid for care banned under state law. Under the settlement, the five doctors involved may never be rehired or recredentialed. Paxton’s office said the hospital must also adopt compliance and ethics measures aimed at preventing future violations, a move that could ripple beyond Houston’s Texas Medical Center and into other children’s hospitals confronting similar legal pressure.

Texas had already drawn a hard line with SB 14, which took effect on Sept. 1, 2023, and prohibited certain gender-transition procedures and treatments for minors while limiting public coverage for them. Texas Children’s said in an Aug. 22, 2024 statement that it had stopped prescribing medications for gender dysphoria to pediatric patients as of that date. The hospital also said it briefly paused care in February 2022 after Paxton issued an opinion, then resumed days later after concluding its practices complied with existing law.

Texas Children’s said it has more than 70 years of history and more than 120 locations across Texas, and said it accepted the settlement to avoid costly litigation and focus on patient care. The hospital denied unauthorized procedures and rejected Medicaid fraud allegations, but the settlement still marks a major political and legal victory for opponents of pediatric gender medicine and a possible template for future enforcement fights in other states.