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Texas Children's Hospital Must Open a Detransition Clinic and Pay $10 Million Under AG Settlement

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The Settlement Terms Are Now Public

The Texas Attorney General’s Office released a 10-page list of conditions from its settlement with Texas Children’s Hospital. The hospital must create a detransition clinic later in 2026, the first of its kind in the country.

The clinic must offer endocrinology, surgery, primary care, fertility counseling, psychiatry, and psychotherapy. The hospital must create a public website for the clinic and a dedicated donation page. The settlement also requires Texas Children’s to compile a “Potential GAC Patient List” and conduct an internal compliance review of past gender-affirming care cases.

Texas Children’s paid $10 million as part of the settlement. Multiple physicians had their privileges terminated or revoked.

How the State Got Here

Texas banned gender-affirming care for minors under SB 14 in 2023. The Texas Supreme Court upheld the ban in 2024. Attorney General Ken Paxton then pursued a healthcare fraud case against Texas Children’s Hospital, the largest pediatric hospital in the country, alleging it continued providing care after the ban took effect.

The Justice Department joined the settlement, calling it a “landmark resolution.” Paxton’s office described it as “the largest healthcare fraud settlement” in the AG’s history.

The Hospital and the State Tell Different Stories

Texas Children’s said the detransition clinic will “formalize” services it already offers, framing it as an administrative designation rather than a new treatment model. The Attorney General’s office framed it as a groundbreaking enforcement outcome.

The final signed agreement has not been fully released. It is not yet clear whether all adult transgender patients seeking related services must go through the new clinic, or how the patient-list review will work in practice.

What This Means Beyond Texas

The settlement creates a template. Other states with healthcare bans can point to it as a precedent for enforcement actions against hospitals. KFF reported that Texas has emerged as the focus of new federal and state actions to limit gender-affirming care. The detransition clinic model could spread if other attorneys general follow Paxton’s approach.

What You Can Do Now

  1. Contact your state representative. If your state is considering similar enforcement actions against hospitals, tell them the Texas settlement model turns medical institutions into enforcement arms of the state. Call the Capitol switchboard at (202) 224-3121 for federal representatives, or find your state legislature contact.

  2. Support shield laws. States with shield laws protect families who travel for care and physicians who provide it. Read our coverage of shield laws.

  3. Know the pattern. This is the third front in a coordinated effort: SB 14 banned the care, Paxton sued the hospital, and the DOJ joined the settlement. Each step builds on the last.

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