At least six major hospitals have agreed to deny gender-affirming hormones and surgery to transgender young people, and have agreed to make payments to the federal government, according to deals with the Department of Justice.

The most recent accords were concluded only last week.

Most hospitals had already stopped providing the treatments, either because of state bans or due to earlier pressure from President Donald Trump's administration.

The DOJ agreements bring investigations into care previously provided to a close and eliminate the possibility that hospitals could be forced to turn over patient records.

The Justice Department says some providers have also agreed to help pay medical costs for children to “detransition.”

The hospitals have not acknowledged any wrongdoing.

“It’s a really dangerous precedent when the federal government is allowed to politicize any one group of people’s care and end it,” said Eliel Cruz, a cofounder of the Gender Liberation Movement.

What follows constitutes an examination of the situation:

The Justice Department announced last week that it had reached settlements with NYU Langone Hospitals and the University of Pittsburgh Medical Centers.

Under the agreements, the hospitals agreed not to provide puberty blockers, hormones or gender-affirming surgery — all of which the administration calls “sex-rejecting procedures” — to patients under 19.

“The Department of Justice is fighting to protect our nation’s children and working tirelessly to reach agreements with hospitals to end so-called ‘gender-affirming care’ for minors,” U.S. Attorney General Todd Blanche said in a statement last week.

In the deals, NYU agreed to pay the federal government $8.5 million, while UPMC agreed to pay $950,000; these deals followed similar settlements reached since May with Cleveland Clinic, Connecticut Children's Hospital, Mount Sinai Health System in New York, and Texas Children's Hospital.

The hospitals have asserted that the deals will not affect the manner in which their pediatric mental healthcare programs treat transgender children.

The Trump administration published a review last year advocating exclusively for therapy, rather than broader gender-affirming care, for youth.

Nevertheless, most major medical organizations, among them the American Medical Association and the American Academy of Pediatrics, endorse maintaining the availability of such treatment.

Mount Sinai is the only one of the six institutions that had not previously announced its decision and that has struck deals so far.

In Texas and Ohio, hospitals had already ceased providing care pursuant to state-wide bans.

The remainder had announced revisions to their policies following Trump's return to office in January 2025, when he initiated a series of measures aimed at targeting such care.

He signed an executive order in January 2025 advocating the reduction of federal support for gender transitions for individuals under 19, and the administration has prohibited federal Medicaid funds from covering the treatment.

The care remains accessible across a diverse array of hospitals and clinics, as well as through individual physicians.

One key action taken by the administration was to subpoena hospitals — first announced in July 2025 — seeking information on gender-affirming care for children, including patients' names.

NYU Langone said in a statement that agreeing to the settlement protects patients and their families, as it removes "the threat that NYU Langone would have to provide the confidential information previously demanded about patients under 18 who received gender-affirming care at our institution."

Several hospitals have petitioned courts to bar them from being compelled to surrender the records, and the majority succeeded in district courts.

Yet a ruling last month from an appeals court bolstered the government's case.

A 2-1 ruling from the San Francisco-based 9th U.S. Circuit Court of Appeals determined that the administration's aim of ending gender-affirming care for youth is not improper, and therefore cannot serve as grounds to halt the subpoenas.

No fewer than 27 states have enacted legislation that either restricts or outright prohibits gender-affirming care for minors.

In addition, over twenty hospitals, health systems and clinics in states without bans have stopped providing the care since last year — including some in states that have specific legal protections for it.

A group of Democratic state officials has sued the Trump administration over this, saying its efforts unlawfully intimidate medical providers.

Although gender-affirming surgery is uncommon among those under 18, many transgender adolescents receive hormone therapy, either to block puberty or to promote the development of sex-linked characteristics that align with their gender identity.

Cruz’s Gender Liberation Movement has protested hospitals that have terminated the care.

Cruz said some families have relocated to other states in pursuit of treatment, only to discover that providers cease it there as well.

Some, he said, have left the country.

He said the agreements with the Trump administration show "who has the courage to do what their calling and education calls them to do — which is do no harm — and those (who do) not."

The story has been updated to correct that the agreements require hospitals to pay the federal government, not to pay the government to reverse transitions.