The largest children’s hospital in the country will establish the nation’s first “detransition clinic,” and will pay $10 million in damages and civil penalties as part of a massive settlement that ended a yearslong investigation by President Donald Trump’s administration and Texas.Republican Texas Attorney General Ken Paxton and the Department of Justice issued separate announcements on Friday that Texas Children’s Hospital in Houston would also fire five doctors who provided gender-affirming care for transgender youth.The settlement follows a lengthy investigation by the state of Texas and the DOJ, which alleged that the hospital manipulated billing codes to seek reimbursement from the state’s Medicaid program.The hospital said it complied with all laws and produced more than 5 million documents over the course of the investigation, which began in 2023.“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 in a statement to HuffPost. “To be clear — we are settling to protect our resources from endless and costly litigation.”The settlement is also a significant victory in the Trump administration’s efforts to block access to gender-affirming care for minors. In 2025, the Supreme Court cleared the way for states to ban gender-affirming care for minors, opening the door for 26 states to block access. The DOJ has investigated more than a dozen hospitals and clinics that offer transition care to youth, and this week launched the first known criminal probe of a New York hospital for providing gender-affirming care. More than 40 hospitals, including in states where gender-affirming care for minors remains legal, have shuttered their doors.A hospital spokesperson said that the detransition clinic will “formalize the supportive, multidisciplinary services we already deliver to all patients who need our care.”Under the agreement, the hospital will provide services at the clinic free of charge to patients for the first five years.Detransition generally refers to someone who once sought a gender transition, and then reversed, stopped or changed aspects of it. Data on people who detransition is scant, but some preliminary studies suggest that people detransition due to a variety of factors, citing mental health concerns, changes in identity, or external pressure and discrimination.While the experience of people who detransition is complex, Republicans across state and federal governments have seized on the stories of a small group of detransition activists — bankrolled by conservative nonprofits — to push forward policy to restrict gender-affirming care for all.Paxton has long tried to target Texas Children’s Hospital’s program for transgender youth.The hospital first came under scrutiny in May 2023 after Eithan Haim, a former doctor at Texas Children’s, alleged that the hospital was causing “malicious harm” to children and shared the information with Christopher Rufo, a conservative activist credited for leading the campaign against diversity initiatives. Rufo published a story claiming that the hospital was secretly providing transgender care to minors.At the time, gender-affirming care for minors was legal. But the Republican-led state legislature passed a ban on such care, which went into effect in September 2023.In 2024, President Joe Biden’s Justice Department indicted Haim, alleging that he violated the Health Insurance Portability and Accountability Act by sharing sensitive patient information with Rufo. But during the first week of Trump’s return to office, federal prosecutors reversed course and dropped his case. Haim, with Rufo, applauded Paxton and the DOJ’s actions on Friday in a post on X. Haim was invited by Sen. Josh Hawley (R-Mo.) to attend Trump’s joint address to Congress in March last year. Civil rights advocates have decried the settlement, saying that it disregards best medical practices for transgender people to score political points in the larger conservative anti-trans movement.“Paxton is blackmailing a hospital system into creating a resource that no one is asking for. It ignores the actual science and years of data about the overwhelming benefits of gender-affirming care, and it completely disregards the huge number of trans people who owe their lives to the very care Paxton is opposing,” Brad Pritchett, the CEO of Equality Texas, said in a statement. “This is what the political crusade against transgender Americans looks like in practice,” Kelley Robinson, president of the Human Rights Campaign, said in a statement.“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. 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.”