TOPEKA, Kan. (AP) — A Kansas judge on Friday protected access to gender-affirming care for transgender minors as the nation's largest children's hospital moved to restrict such care in Texas, buckling under pressure from the Trump administration.
Texas Children's Hospital, based in Houston, said in a statement that it had agreed to a legal settlement “to protect our resources from endless and costly litigation.” The hospital, which serves more than
1 million patients a year, stopped providing hormone treatments for transgender children and teens in 2022, a year before the state banned such care, but still faced a yearslong investigation by the U.S. Department of Justice and Texas Attorney General Ken Paxton's office.
Paxton and the Trump administration said the hospital would pay Texas $10 million and would be required to open what he called a "detransition clinic” to “reverse the damage” from gender-affirming care, which he's described as child abuse.
Most major medical groups say access to gender-affirming care as important for people with gender dysphoria. Transgender teens, parents and providers have described it as life-saving for kids who are depressed or suicidal because their gender identities do not match the sex assigned them at birth.
Gender-affirming care may include counseling, medications that block puberty, hormone therapy to produce physical changes or surgeries, although those are rare for minors.
Twenty-seven states have limited or banned gender-affirming care for minors, and the U.S. Supreme Court ruled in June 2025 that they could do so under the U.S. Constitution. But in Kansas, state District Court Judge Carl Folsom III ruled Friday that the state's ban, passed last year, is likely to violate the state Constitution. Folsom's order blocking the ban is set to remain in place until a lawsuit filed by two transgender teenagers and their parents is over. The trial has not yet been scheduled.
President Donald Trump has aggressively sought to roll back transgender rights. During his second term, the U.S. Department of Health and Human Services has moved to use its regulatory power to block gender-affirming care for minors, and the DOJ has demanded access to providers’ private records putting pressure on hospitals that often rely on federal funding to operate.
The state, represented by Republican Kansas Attorney General Kris Kobach, is expected to appeal, but Folsom said the law interferes with parents' right to make medical decisions for their children. In a lengthy opinion, he described gender-affirming care as “the treatment with the most evidence of being helpful to treat gender dysphoria.”
“The Kansas Constitution protects personal autonomy,” Folsom wrote, citing the state's Bill of Rights. “This personal autonomy includes the fundamental right of parents to the care, custody and control of their minor children.”
Kansas courts have previously declared that the state Constitution offers more protection for individual rights than the U.S. Constitution. In 2019, the state Supreme Court declared that Kansas protects a person's bodily autonomy, which guarantees access to abortion.
Kobach, like other opponents of gender-affirming care for minors, portrayed it as “experimental” and harmful, but Folsom disagreed.
His order said the teenagers who sued, identified as Lily Loe and Ryan Roe, had to go to Minnesota and Colorado for treatment, both costing them more for out-of-state care and causing anxiety.
“It is harmful to withhold medical treatment or withdraw medical treatment in progress that is safe, effective and medically indicated,” Folsom wrote.
In Texas, Paxton, a Republican, hailed the settlement with Texas Children's Hospital as “historic" and said it's a "fundamental shift away from radical ‘gender’ ideology.”
Paxton is running for the U.S. Senate, and he announced the settlement less than two weeks before a May 26 runoff in a tight race to unseat GOP incumbent Sen. John Cornyn. Trump has not publicly endorsed a candidate in the race.
Acting U.S. Attorney General Todd Blanche said in a statement Friday that the DOJ would “use every weapon at its disposal” to stop gender-affirming care for children.
The leader of the LGBTQ+ rights group Equality Texas said the settlement "ignores the actual science and years of data about the overwhelming benefits of gender-affirming care.”
"Paxton is blackmailing a hospital system into creating a resource that no one is asking for,” CEO Brad Pritchett said in a statement.
The hospital said it fully cooperated with Paxton's office and the DOJ, produced more than 5 million documents and did its own internal investigations. All of them showed that it never violated the law, the hospital said.
Its statement said the settlement will allow it to redirect “precious resources” to "life-saving care and groundbreaking discoveries of our exceptional clinicians and scientists.”
Paxton said the agreement also requires Texas Children's to fire — “and never again hire” — five doctors who provided gender-affirming care, and to automatically strip privileges from any doctor violating the state ban.
The $10 million payment will go to the state's Medicaid program. Paxton had accused the hospital of submitting false billings, an allegation it rejected.
