Justice Department Settlements Halt “Sex-Rejecting” Procedures for Minors at Six Major Hospitals
Updated
The Department of Justice has secured settlements with major hospital systems that include payments to the federal government and agreements to not provide puberty blockers, cross-sex hormones, or gender-affirming surgeries to anyone aged 18 or younger. In some cases, the institutions have agreed to fund the costs of reversing the “gender-affirming” treatment, also known as detransitioning.
Settlements have been made with six large institutions across the country: Texas Children’s Hospital, Cleveland Clinic, Connecticut Children’s Medical Center, Mount Sinai Health System, NYU Langone Health, and UPMC Children’s Hospital of Pittsburgh.
The settlements are part of an investigation by the Justice Department into fraudulent billing practices in which hospitals have allegedly coded procedures in a different way to get reimbursement from federal programs like Medicaid.
Texas Children’s agreed to pay more than $10 million in a May 2026 settlement and agreed to create the nation’s first dedicated “detransition clinic.” NYU Langone agreed to pay $8.5 million, UPMC agreed to $950,000, Cleveland Clinic paid $308,000 and committed $2 million for “restorative care.” Mount Sinai dedicated $2 million to free medical care for former pediatric patients. Connecticut Children’s agreed to keep its clinic closed for a decade, pay $60,000, and set aside $500,000 for patients under 19 seeking to reverse effects of prior treatment.
The Trump administration has been working for the last 20 months to reduce access to “sex-rejecting” procedures for children since President Trump signed Executive Order 14187, “Protecting Children from Chemical and Surgical Mutilation.” HHS finalized a rule prohibiting funds from Medicaid and CHIP from going toward puberty blockers, hormones, and surgeries, which takes effect on October 13, 2026. The agency also proposed rules to disqualify providers from Medicare and Medicaid participation if they provide these services to children.
An HHS-commissioned report titled Wolves in White Coats identified tens of millions of dollars in insurance claims with mismatched or unspecified endocrine diagnoses for sex-rejecting procedures on minors. That report led to referrals of many hospitals and clinics to the Justice Department.
A STAT News analysis from February 2026 estimated at least nine hospitals or health systems stopped providing gender-affirming treatments to children experiencing gender dysphoria since the beginning of the year. More than 40 have halted some form of gender-affirming or sex-rejecting treatment since President Trump signed the executive order in January 2025. These figures don’t include the clinics who have halted gender-affirming procedures since February 2026.
A total of 27 states have also implemented bans or restrictions on these procedures for children across the country, which represents about half of the trans-identified youth population. In United States v. Skrmetti, the U.S. Supreme Court upheld Tennessee’s ban on puberty blockers, cross-sex hormones, and related procedures for minors. The court ruled that the law does not classify by sex or transgender status and only needs to satisfy the rational-basis review.
HHS also completed a peer-reviewed report about treatments for minors with gender dysphoria and found there is a low quality of evidence supporting the safety and efficacy of such treatments. The authors recommend psychotherapy as a noninvasive alternative treatment option, which continues to be available in all states where bans have been implemented and by all health systems that have agreed to halt sex-rejecting procedures for minors.
HHS cited a March 2023 estimate that at least 271 clinics offered pediatric medical transition in the United States, and about 70 of those were inactive due to legislative restrictions. With the state-level bans and federal pressure, that number has likely declined steeply to dozens of clinics concentrated in urban hubs of states that have no restrictions against providing the procedures for minors.
The first detransition medical malpractice lawsuit against a psychologist and surgeon resulted in a $2 million payout for the plaintiff in January. Journalist Benjamin Ryan tracked at least 28 detransition lawsuits in a post following the January verdict.
Colorado has no laws against pediatric gender transition, but one of the largest hospitals that provided gender-affirming or sex-rejecting treatments to minors stopped offering the procedures in January 2026 amidst funding threats from the Trump administration. Families sued Children’s Hospital Colorado, and the Colorado Supreme Court ordered the hospital to offer the treatments in a May 2026 ruling. Puberty blockers and cross-sex hormones were restored to the hospital’s scope of services in response to the court ruling, but the independent doctors refused to offer the services.
The hospital maintained that it was not violating the court order because it cannot compel independent doctors, who are not hospital employees, to provide a particular service for a certain diagnosis. This week, the court sided with Children’s Hospital Colorado and said it is not in contempt for failure to provide gender-affirming services to minors.
The Cass Review and the HHS report from November 2025 both suggest there is insufficient evidence that puberty blockers improve gender dysphoria or mental health. Both reports also found risks associated with bone density and height, along with unknown potential effects on cognition and fertility. Sweden, Finland, and other European health authorities have reached similar conclusions and implemented restrictions to gender-affirming care for the treatment of gender dysphoric children.
A White House summary said more than 7,000 children were given puberty blockers or cross-sex hormones and more than 4,000 underwent sex-trait surgeries during the first three years of the Biden administration.