The Texas attorney general has secured an unusual settlement over child transgender care that compels Texas Children’s Hospital to create the nation’s first ever “detransition clinic” in addition to paying the state $10 million.

According to Attorney General Ken Paxton, the multidisciplinary clinic would offer medical care to patients “who were subjected to ‘gender-transition’ procedures.” The care would be free of charge to patients for the first years of the clinic’s operation. The move follows an investigation that began in 2023 by the attorney general’s office into Texas Children’s Hospital in Houston. That same year, Gov. Greg Abbott signed legislation that bars transgender children from receiving puberty blockers and hormone therapies.

Gender-affirming care is an umbrella term for the treatment of gender dysphoria, or the discomfort that comes when someone’s gender identity does not align with the sex they were assigned at birth. Gender-affirming care ranges from “socially transitioning” — using different pronouns or dressing differently — to puberty blockers, hormone therapy and surgical interventions.

“Today is a monumental day in the fight to stop the radical transgender movement,” Paxton said in a statement issued Friday. “I applaud Texas Children’s Hospital for changing course and committing to being a part of the solution by agreeing to form a first-of-its kind Detransition Clinic that will help provide free care to those who have been victimized by twisted, morally bankrupt transgender ideology.”

For the first five years, all services provided through the Detransition Clinic will be funded by Texas Children’s.

The settlement also requires the hospital to pay $10 million for billing Texas Medicaid after the state accused the hospital of illegal ‘gender-transition’ interventions, including by using false diagnosis codes, and compels Texas Children’s to terminate and revoke the medical privileges of five physicians.

Texas Children’s said in a statement that it made the “difficult decision” to settle with the attorney general’s office to close a legal chapter that has been, “wrought with falsehoods and distractions.”

The hospital said it spent three three years producing more than 5 million documents to both the state and the U.S. Department of Justice.

“All reviews and investigations continue to support the facts – we have been compliant with all laws,” the hospital statement said. “To be clear – we are settling to protect our resources from endless and costly litigation … We stand proud knowing we will always put our purpose over politics and that we have and will continue to follow the law.”

Texas Children’s, one of the world’s leading pediatric hospitals, did not say in its statement how it will roll out its clinic or what services it will include.

Andrea Segovia with the Transgender Education Network of Texas said she’s worried that other states will follow Texas’ lead in forcing more of these clinics to open.

“It's terrifying what other states will take from this,” Segovia said, the organization’s senior field and policy director.

Transgender people make up about 1% of the population, Segovia said, and it is “infuriating” that the state is creating the detransition clinic as access to other healthcare services are struggling — such as rural hospitals and reproductive care.

She is also concerned that access to mental healthcare will not be woven into the clinic’s services.

“When trans people decide to detransition, it is because of social pressures from their job, from their friends, from their family, from their government,” Segovia said. “It is not normally because of healthcare complications.”

In March, Paxton released an opinion saying that mental health providers licensed by the state cannot provide gender-transitioning care to minors under state law. It’s not clear if Paxton believes state law bars detransitioning mental healthcare as well.

Brad Pritchett, CEO of Equality Texas, a nonprofit that advocates for the LGBTQ community, said in a statement that the attorney general is “blackmailing a hospital system into creating a resource that no one is asking for.”

Pritchett said a detransition clinic “ignores the actual science and years of data about the overwhelming benefits of gender-affirming care,” and that it is “embarrassing that a hospital once revered for its care has lost its integrity and put politics over patients.”

Several medical associations including the American Medical Association, American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and American Psychiatric Association, have supported evidence-based gender-transitioning care as appropriate and medically necessary for children.

Dallas State Rep. Jessica González who chairs the Texas House LGBTQ Caucus said in a statement that the settlement is “shameful, and is the furthering of an agenda to eradicate transgender people from the eyes of society.”

González, one of the few openly queer representatives, said “detransitioners already have access to care. There is no evidence that people who detransition lack access to medical care.”

She added that because Texas Children’s has to fully fund the clinic for five years, that will take away attention and limited resources from the hospital’s other departments, such as care for children with cancer and infants with heart conditions.

“Using a settlement to compel a hospital to build an ideologically framed clinic opens the door to more state interference in medical practice, more dangerous stigmatization that truly harms young Texans, and, sadly, more lives lost in our nation’s suicide epidemic,” González said.

This is a developing story. Check back for updates.

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This article first appeared on The Texas Tribune.