Texas Children’s Hospital will create what officials describe as the nation’s first detransition clinic as part of a settlement agreement with the Texas Attorney General’s Office and the U.S. Department of Justice.

The agreement ends a multiple-year investigation into the Houston hospital’s program providing transition-related care to minors, according to state officials.

The hospital also agreed to terminate five physicians who had previously offered transition care to children and to pay $10 million to settle allegations that it improperly billed the state’s Medicaid program for those services.

For the first five years, the new clinic must provide detransition care at no cost.

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The settlement was announced by Texas Attorney General Ken Paxton, who said the deal signals what he called “a cultural shift away from radical ‘gender’ ideology.”

Officials have not disclosed the specific medical or psychological services that will be offered by the detransition clinic.

Detransitioning, which involves halting or reversing aspects of a medical or social gender transition, is rare and may include mental health counseling, hormone therapy adjustments, or surgical procedures.

Texas Children’s Hospital said it had cooperated fully with the investigation, producing more than 5 million documents and conducting its own internal inquiries.

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In a public statement, the hospital said it chose to settle “to protect our resources from endless and costly litigation” and to focus on its broader mission of “life-saving care and groundbreaking discoveries.”

Responding to questions about what the clinic will provide, a hospital spokesperson said it will “formalize the supportive, multidisciplinary services we already deliver to all patients who need our care.”

The hospital declined to identify the doctors who will leave or to say who will lead the new clinic, saying its priority during settlement negotiations was to protect staff.

Paxton’s office began investigating Texas Children’s after the state failed to pass legislation banning transition care for minors in early 2022.

He issued a legal opinion that same year declaring such care to be child abuse, spurring investigations of families who pursued transition-related treatment for their children.

The following year, Texas enacted a statewide ban on gender-affirming care for minors, becoming the largest U.S. state to do so.

The Justice Department called the Texas settlement its first major resolution in a broader national review of transition care for minors, which it refers to as “sex-rejecting procedures.”

Acting Attorney General Todd Blanche said the agreement “protects vulnerable children, holds providers accountable, and ensures those harmed receive the care they need.”

Studies suggest that between 1 percent and 10 percent of transgender people detransition, while less than 1 percent report regretting their transition.

Advocates of restrictions on youth transition care, including detransitioners Chloe Cole and Prisha Mosley, have sued doctors, alleging their care was too easy to access; the physicians have denied any wrongdoing.

Major medical groups, including the American Medical Association and the American Academy of Pediatrics, continue to endorse access to gender-affirming care for minors.

Transgender rights organizers in Texas criticized the settlement, calling it politically motivated and warning that it could shape national policy trends.

Andrea Segovia of the Transgender Education Network of Texas said state leaders should focus on improving access to basic healthcare instead.

Dr. Morissa Ladinsky of Stanford University’s medical school said the requirement to dismiss physicians who had treated trans youth was “confusing,” arguing they were best qualified to provide detransition care.

She said the agreement adds “a fog of confusion” for clinicians now practicing under legally restrictive conditions.

Ladinsky said in her own ten years of pediatric practice she saw very few patients reconsider transition, and that “regret is virtually nonexistent” among those she treated.