Trans advocates in Ohio have condemned a federal settlement that the US Department of Justice announced on 6 June, saying Cleveland Clinic will put $2 million into no-cost “detransition” services and actively publicise them while continuing to refuse gender-affirming care for minors.

Dara Adkison, executive director of TransOhio, criticised the health system’s decision to comply with the settlement, saying: “Cleveland Clinic, once a highly respected medical institution, continues to show that maintaining medical integrity is no longer their priority by jumping to the front of the line to comply not with science and medicine, but with cruelty and anti-trans hate.”

Under the settlement, Cleveland Clinic must provide detransitioning medical care including hormonal treatment, surgical reconstruction, fertility restoration, psychological support, and insurance coordination. The agreement also requires the hospital to publicise the services via a dedicated website, phone number, and care coordinator, plus direct outreach to three entities that provide non-medical services to people seeking detransition.

What Cleveland Clinic must do

In its statement, the DOJ said Cleveland Clinic will “provide essential medical care for individuals living with the harmful consequences of such misguided medical interventions performed on them as children and adolescents,” adding: “These historic commitments pair the cessation of these dangerous practices masquerading as medical treatment with substantial investments in remediating the destruction they cause and restoring the health of the victims,”

The DOJ also said the settlement requires Cleveland Clinic to pay $308,000 to resolve allegations it falsely billed insurers for childhood gender-affirming care by passing it off as endocrine disorder treatment.

TransOhio backlash and a wider trend

Adkison argued that “Detransition services were always a part of gender affirming care,” adding that “there continues to be no increased need”, and describing the promotion of such services as “a bigoted, sad performative farce the Clinic is choosing to promote.” 

The Cleveland Clinic agreement is the second major health system deal of its kind in recent weeks, following a May settlement involving Texas Children’s Hospital. That settlement included a $10 million payment to Texas Medicaid and a promise to establish a detransition clinic, and the hospital said it was settling “to protect our resources from endless and costly litigation,” adding: “We stand proud knowing we will always put our purpose over politics and that we have and will continue to follow the law.”

Cleveland Clinic is a large, internationally recognised non-profit academic medical centre headquartered in Cleveland, Ohio, and its policy shifts can affect regional access to specialist care and shape wider institutional norms. The DOJ has also pursued other high-profile actions touching on trans youth, including a case in which a judge blocked the Trump DOJ from obtaining trans youth patient records in Rhode Island.