Texas is arguably the most frightening place in the country for families of transgender children. The state’s GOP leadership, often in partnership with the Trump administration, has threatened to take children away from their families, chased physicians out of the state and attacked children’s hospitals. Fearing for their safety, many families have fled. In 2022, one mother of a transgender daughter warned, “This is a crisis … we have political refugees in the U.S., leaving with whatever they can fit in their car.”
As part of this ongoing focus on transgender youth, the state, in partnership with the Justice Department, held a yearslong investigation of Texas Children’s Hospital, focusing on the medical center’s treatment of transgender youth. On Friday, the DOJ and Texas Children’s Hospital announced they had reached a settlement.
Detransition can mean many things, ranging from regretting treatment to being forced by the state to stop treatment against your will.
While denying any wrongdoing, the hospital agreed to pay $10 million and fire five physicians who provided gender-affirming care to adolescents. The settlement also includes an unexpected provision: The hospital will fully fund a “detransition clinic.”
What that means remains to be seen. Detransition can mean many things, ranging from regretting treatment to being forced by the state to stop treatment against your will. Texas Attorney General Ken Paxton said the detransition clinic will provide care free of charge for its first five years of operation, adding that the hospital’s $10 million settlement money will go toward covering costs from the hospital billing Texas Medicaid for gender-affirming services performed for patients.
As a physician-scientist, I am always in favor of expanding support for patients and collecting more research. I genuinely hope this new clinic will support young people and advance the science of pediatric gender care. But we need to be honest about what the science shows: When offered under current guidelines, regret following gender-affirming medical care for adolescent gender dysphoria is rare. In many states, “detransition” is not a personal medical decision; it is forced upon people by the law.
A recent longitudinal study from Princeton examined regret among 220 adolescents who underwent gender-affirming medical interventions such as pubertal suppression or gender-affirming hormones (estrogen or testosterone). The research team followed these adolescents a mean 4.8 years after pubertal suppression and a mean 3.4 years after gender-affirming hormones. Only 4% expressed any kind of regret. Among those, half continued treatment, suggesting the benefits outweighed the things they regretted. This regret rate is far lower than other areas of pediatric medicine. For example, 38% of caregivers report some level of regret following their children’s surgery for congenital adrenal hyperplasia.
You will sometimes hear about studies of detransition that cite much higher percentages. That is because those studies are measuring when patients stop medical treatment, which is different from when people regret medical treatment. Transgender people stop hormone treatment for all sorts of reasons, including harassment, discrimination, pressure from their families and fear that they won’t find a job. A 2021 study from our group found that, among a sample of over 17,000 transgender adults, 13.1% had “detransitioned” at some point in their lives. In these cases, detransition was not synonymous with regret or coming to identify with one’s birth sex.
Though the number of transgender people coming to identify with their birth sex appears small, these individuals have been extensively covered by the media. Their experiences certainly warrant attention, so that we can further minimize already low regret rates. Some people have told researchers that their initial transgender identity was due to their gender dysphoria being from trauma, internalized misogyny or internalized homophobia. Some have reported their transgender identity was from something called “social contagion”— a term for when peer pressure or other social forces cause a condition.
Under the settlement, the hospital appears to have fired the very physicians with expertise in this area.
In a 2021 study of these individuals, the average age of starting medical treatment was 22, well outside the pediatric care model, which requires a comprehensive mental health evaluation before treatment to rule out these possibilities. While there is little convincing evidence supporting theories of “social contagion,” for instance, current guidelines recommend screening for it regardless. It is also worth remembering that similar claims about queer identities being caused by trauma or social influence were widely promoted during the ex-gay movement, before many former participants later said they were pressured into those narratives by religious counselors and anti-gay groups.
Details are scant on what this Texas Children’s Hospital clinic will entail. The hospital has said it “will formalize the supportive, multidisciplinary services [they] already deliver to all patients who need [their] care.” However, under the settlement, the hospital appears to have fired the very physicians with expertise in this area. The state outlawed the only evidence-based treatment for gender dysphoria. The most common “detransition” patients they will likely see are those who have been harmed by the state taking away their medical care.
The hospital now has a prime opportunity to document and publish research on their experiences. The question is not whether people who have detransitioned deserve care. They of course do. The real question is whether clinical care and research in the U.S. will remain guided by evidence and compassion — or by political ideology.
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