The Cleveland Clinic Foundation will stop providing puberty blockers, cross-sex hormones and other transgender medical treatments to minors for the next 20 years under a settlement with the U.S. Department of Justice and the Ohio Attorney General's office, the department announced June 5.

The agreement requires Cleveland Clinic to pay $308,000 to resolve allegations that it submitted false billing claims to public and private insurers to secure coverage for the treatments. The hospital system will also set aside $2 million for "detransition" services, care for people who discontinue or reverse a prior gender transition, available regardless of a patient's insurance or ability to pay.

It is the second such resolution in a month. In May, Texas Children's Hospital agreed to pay a $10 million penalty and permanently end the treatments for minors in a settlement the Justice Department reached with Texas Attorney General Ken Paxton.

Cleveland Clinic described the matter narrowly.

In a statement, the organization said it was "pleased to have worked collaboratively toward a resolution related to an unintentional coding issue involving a small number of patients" and said it has complied and will continue to comply with state and federal law.

The Justice Department said the claims are allegations only and that no liability has been determined.

Cleveland Clinic has denied the allegations.

The department refers to the treatments as "sex-rejecting procedures,” while medical organizations, including the American Academy of Pediatrics and the Endocrine Society, call the same treatments gender-affirming care.

"The Department of Justice is steadfastly committed to protecting America's children," Associate Attorney General Stanley Woodward said in a statement.

Assistant Attorney General Brett Shumate credited Cleveland Clinic for cooperating with the investigation and pointed to its detransition funding as evidence of that cooperation.

An estimated 724,000 youth, ages 13 to 17, identify as transgender in the United States, about 3.3% of that age group, according to an August 2025 report from the Williams Institute at UCLA School of Law. The figure has roughly doubled since the institute's 2017 estimate. Far fewer, however, receive medical treatment.

A study published in JAMA Pediatrics in January 2025 reviewed private insurance claims for more than 5.1 million patients, ages 8 to 17, between 2018 and 2022.

It found 926 adolescents with a gender-related diagnosis received puberty blockers in that period, and 1,927 received hormones, fewer than 1 in 1,000 privately insured adolescents. No patient under 12 was prescribed hormones.

The study did not count minors on Medicaid.

By the end of 2025, 29 states had adopted at least one law restricting transgender care, sports participation, bathroom access, or pronoun use for transgender youth, according to the Williams Institute.

Ohio is among them.

Its SAFE Act, which bars physicians from providing the treatments to minors, was sponsored by state Rep. Gary Click.

Click called the Cleveland Clinic agreement too lenient and said the ban should be permanent. "I think that they need to just remember our children are not their science experiments," he told News 5 Cleveland.

Eli Frohnapfel, a former Cleveland Clinic patient who had a double mastectomy at 17, told the station the settlement is "a significant setback" and called the treatments "lifesaving care."

Hilary Frohnapfel, Eli's mother, said she worries about families who will now be turned away.

Assistant Attorney General Shumate said the department's investigation is ongoing and that additional settlements with providers and pharmaceutical companies are expected.

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