One of the country’s premier pediatric hospitals is agreeing not only to abandon transgender youth care, but to help construct a new medical framework around the idea that transition itself is harmful.

The Trump administration and Texas Attorney General Ken Paxton announced what they called a “landmark” settlement Friday with one of the nation’s largest children’s hospitals, forcing the end of pediatric gender-affirming care at the institution, imposing a $10 million payment, and requiring the creation of what federal officials described as the country’s first clinic dedicated to so-called “detransition” care.

The agreement with Texas Children’s Hospital marks one of the most stunning setbacks for trans people in the Republican administration’s accelerating campaign against their healthcare.

Under the settlement, Texas Children’s will stop providing puberty blockers, hormone therapy, and surgeries to transgender minors, according to the U.S. Department of Justice and Paxton’s office. The agreement also requires the Houston-based hospital system to establish, as the DOJ called it, a “restorative care” clinic for detransitioners and to terminate five physicians tied to the program.

“The Justice Department will use every weapon at its disposal to end the destructive and discredited practice of so-called ‘gender-affirming care’ for children,” Acting Attorney General Todd Blanche said in a statement Friday.

Related: Texas Republican proposes ban on gender-affirming care for all trans people

The settlement goes beyond ending care. Reuters reports that Texas Children’s agreed to fire five physicians involved in treating transgender youth and permanently revoke their privileges, while changing its bylaws to automatically strip privileges from any doctor found violating Texas’s ban on gender-affirming care for minors.

Federal officials alleged Texas Children’s improperly billed insurers and government healthcare programs for transgender-related care, citing possible violations of fraud statutes and the False Claims Act. The DOJ noted, however, that the allegations were not proven in court and that the settlement did not constitute an admission of liability.

Texas Children’s portrayed the settlement as an act of institutional survival.

In a statement posted Friday, which has since been deleted from its website, the hospital accused Texas and federal officials of conducting “an unconscionable campaign of mistruths and mischaracterizations related to gender affirming care.”

Related: Trump-appointed judge says DOJ ‘proven unworthy’ of trust in blistering trans care case ruling

“Today, we made the difficult decision to settle with the Texas Attorney General and the Department of Justice, closing a chapter that has been wrought with falsehoods and distractions,” the hospital said. “To be clear — we are settling to protect our resources from endless and costly litigation.”

The hospital said it had produced “over 5 million documents” and undergone “multiple internal and external investigations,” which it said continued to show it had complied with the law.

“This settlement will allow us to redirect those precious resources to focus on the life-saving care and groundbreaking discoveries of our exceptional clinicians and scientists,” the statement continued.

Critics of the administration’s policies see the settlement as a test case for how aggressively the federal government can use investigations, subpoenas, political pressure, and the threat of criminal enforcement to reshape healthcare access for transgender Americans.

Adrian Shanker, who most recently served as deputy assistant secretary for health policy and senior adviser on LGBTQI+ health equity at the U.S. Department of Health and Human Services during the Biden administration, said the agreement reflects the weaponization of federal power against providers offering medically recognized care.

Related: Children’s National Hospital caves under Trump’s pressure & ends gender-affirming care for trans patients

“The science and evidence haven't changed. The politics have changed, and we've seen a weaponized Department of Justice target providers of best practice transgender medicine for providing care that is well within the standard of care,” Shanker told [em]The Advocate [/em]in an interview. “Instead of saying, ‘Look, we have a political disagreement with this type of care,’ they've used every tool in the tool belt to attack providers of this care, from regulatory to bullying and now to a weaponized Department of Justice.”

He called the requirement that Texas Children’s open a detransition clinic “an absurd remedy.”

Gender-affirming care for minors can include mental health counseling, social transition support, puberty blockers, and hormone therapy. Major medical organizations, including the American Academy of Pediatrics, the American Medical Association, the Endocrine Society, and the American Psychological Association, support access to such care for carefully evaluated patients and describe it as evidence-based and medically necessary in many circumstances.

Studies on regret after transition-related care have consistently found low rates of regret. A 2021 systematic review published in Plastic and Reconstructive Surgery Global Open found the pooled prevalence of regret after gender-affirming surgery was approximately 1 percent — lower than regret rates associated with many other surgical procedures.

Related: Texas AG Ken Paxton won't leave trans people alone, again requests data from out of state

Research has also found that detransition is relatively uncommon and is often linked to external pressures rather than regret over transition. A 2021 study published in LGBT Health found that many transgender people who detransitioned cited factors such as family rejection, harassment, discrimination, financial hardship, or difficulty accessing care. Many later resumed transition.

Shanker said the settlement’s emphasis on detransition ignores the broader scientific landscape.

“We know that there's a less than 1 percent regret rate on gender-affirming care, significantly lower than the regret rate for pretty much any other type of care,” he said. “So if there's such a low regret rate, then we're talking about an incredibly small number of people that may even want a so-called detransition clinic.”

Karen Loewy, senior counsel and director of constitutional law practice at Lambda Legal, accused Texas Children’s of capitulating to political coercion.

“It is deeply appalling to see a hospital that previously demonstrated its commitment to ensuring that transgender adolescents had access to medically necessary healthcare capitulate to the relentless pressure campaigns of both AG Paxton and the Trump Administration to end this care and penalize physicians who faithfully and lawfully provided it,” Loewy said in a statement to [em]The Advocate[/em].

She argued that the mandated detransition clinic “elevates ideology over evidence and diverts resources away from urgently needed healthcare services.”

“Creating a politically mandated program built around a statistically rare outcome does not address a demonstrated gap in healthcare access and ignores the medical consensus on the safety, efficacy, and necessity of gender affirming medical care,” Loewy added. “The real effect of this settlement is to stigmatize transgender people and intimidate healthcare providers nationwide.”

Kelley Robinson, president of Human Rights Campaign, identified the settlement as part of a broader campaign of intimidation.

“Firing and blacklisting doctors. Terrorizing families seeking access to healthcare. This is what the political crusade against transgender Americans looks like in practice,” Robinson said.

Related: Cisgender kids in Texas can’t get care due to anti-trans laws

“AG Ken Paxton didn’t uncover fraud — he weaponized the law to remove medical professionals and strip trans youth of the care that they and their families have every right to access,” she added. “And the Trump Administration is taking it further — pursuing criminal charges in New York by violating patient and provider privacy to build a bogus case.”

In recent weeks, federal prosecutors in Texas issued grand jury subpoenas to hospitals, including NYU Langone Health, seeking records related to transgender youth care, triggering alarm among privacy advocates and LGBTQ+ organizations.

Earlier this week, U.S. District Judge Mary McElroy blocked the Justice Department from enforcing a subpoena targeting Rhode Island Hospital records involving transgender youth, sharply criticizing the government’s conduct and accusing federal officials of misleading the court.

Democratic-led states have increasingly moved to shield providers from out-of-state investigations and federal scrutiny, warning that the administration’s tactics threaten both healthcare access and patient privacy rights.

For hospitals still providing gender-affirming care, Shanker said, the pressure is becoming relentless.

“I could only imagine that every hospital that's been providing care for transgender people feels like they are between a rock and a hard place in terms of their responsibility to their patients and the continuous attacks from the Trump administration from all angles almost weekly,” he said.

Shanker added, “I'm sure that it is a very challenging circumstance for them, and also we should hold hospitals accountable for complying in advance with this unscientific, unethical, and harmful decision-making that has limited access to care in many places, and now is going to see the opening of a so-called detransition clinic.”