US Hospitals Reach DOJ Agreements Over Gender-Affirming Care for Minors

At least six major U.S. hospitals and health systems have reached agreements with the Department of Justice (DOJ) under which they will stop providing gender-affirming medical treatments to patients under 19, according to the department and the hospitals involved.

The latest agreements, announced on September 18, involve New York University Langone Hospitals (NYU) and the University of Pittsburgh Medical Center (UPMC). Under the agreements, both institutions agreed not to provide puberty blockers, hormones or gender-affirming surgeries to minors. NYU agreed to pay $8.5 million to the federal government, while UPMC agreed to pay $950,000.

The DOJ said the agreements resolve investigations into potential violations of federal law related to the provision of gender-affirming care to minors. The department has said its nationwide investigation is examining possible violations of the Food, Drug and Cosmetic Act, the False Claims Act and other federal healthcare laws.

However, the DOJ stated that the claims resolved through the agreements are allegations only and that there has been no determination of liability. NYU and UPMC have denied the allegations. The agreements do not constitute an admission of wrongdoing by the hospitals.

Similar agreements have been reached since May with Cleveland Clinic, Connecticut Children's Hospital, Mount Sinai Health System in New York and Texas Children's Hospital. The DOJ's agreement with Mount Sinai, announced on September 4, also included a commitment to provide $2 million in medical care for people experiencing what the department described as harmful consequences of gender-affirming care received during childhood.

Several of the institutions had already stopped providing some or all of the treatments because of state laws or policy changes implemented after the Trump administration began taking steps to restrict gender-affirming care for minors in 2025.

The agreements also address federal investigations and requests for patient information. NYU said the settlement protects patients and their families from the possibility of having confidential information previously sought by the government disclosed.

The Trump administration has argued that restrictions are intended to protect minors. Major medical organizations, including the American Medical Association and the American Academy of Pediatrics, have continued to support access to gender-affirming healthcare for transgender youth, although recommendations and practices vary by treatment and clinical circumstances.

Access to such care remains subject to a patchwork of state laws and institutional policies across the United States. According to the report, at least 27 states have laws restricting or prohibiting some forms of gender-affirming care for minors.

The developments have also triggered legal challenges. Hospitals and other healthcare providers have contested government demands for patient records, while Democratic state officials have challenged federal efforts to restrict access to such care.

The latest agreements add to the ongoing legal and policy dispute over the availability of gender-affirming healthcare for transgender minors in the United States.