Federal prosecutors based in North Texas helped secure an agreement requiring Mount Sinai Health System to stop providing “gender-transition” drugs and surgical procedures to minors.
The Department of Justice announced the agreement on September 4, 2026, following an investigation into potential violations of federal law.
Under the agreement, Mount Sinai will cease administering “puberty blockers” and “cross-sex hormone”s and performing “gender-transition” surgeries on minors. The New York health system will also pay an undisclosed monetary penalty and dedicate $2 million to free medical care for people suffering harmful consequences from gender-related treatments they received as children.
The announcement does not limit the $2 million commitment to former Mount Sinai patients.
Mount Sinai Denies Federal Allegations
The agreement resolves the federal investigation without a determination that Mount Sinai violated the law. Mount Sinai denied all allegations, according to the Justice Department.
Federal officials credited the health system for cooperating with the investigation and described Mount Sinai as proactive and solution-driven during the process.
“This agreement puts an end to these practices at Mount Sinai and provides meaningful relief for individuals who have already suffered harm,” Attorney General Todd Blanche said.
The Justice Department did not disclose the amount of Mount Sinai’s monetary penalty, how many minors previously received the procedures, or the agreement’s effective date.
The department refers to the interventions as “sex-rejecting procedures,” while hospitals and medical organizations supporting the treatments generally use the term “gender-affirming care.”
Northern District Of Texas Participated
The U.S. Attorney’s Office for the Northern District of Texas participated in the investigation and resolution.
The Dallas-based office worked with the Justice Department’s Civil Division, the Department of Health and Human Services Office of Inspector General, and the FDA’s Office of Criminal Investigations.
U.S. Attorney Ryan Raybould said the Northern District of Texas would continue using civil and criminal enforcement tools when federal officials believe hospitals, medical providers, or pharmaceutical companies violated federal law while providing the treatments.
The nationwide investigation is examining potential violations of the Food, Drug and Cosmetic Act, the False Claims Act, and other federal healthcare laws.
Federal investigators are also examining whether medical providers used false diagnosis or billing codes to obtain reimbursement from government healthcare programs and private insurers.
The Mount Sinai announcement did not identify a specific false claim, billing submission, or diagnosis code attributed to the health system.
Fourth Major Health System To Settle
Mount Sinai is the fourth major healthcare system to reach an agreement under the Justice Department investigation.
Texas Children’s Hospital reached the first resolution in May 2026. The Houston hospital agreed to stop providing the procedures to minors, pay a $10 million penalty, and establish a clinic for people seeking medical care after discontinuing or attempting to reverse “gender-transition” treatment.
The Cleveland Clinic subsequently agreed to stop offering the procedures to minors for decades, pay a $308,000 penalty, and dedicate $2 million to related medical care.
Connecticut Children’s Medical Center later agreed to stop providing “puberty blockers,” “cross-sex hormones,” and “gender-transition” surgeries to minors. The hospital also committed $500,000 to medical care for people reporting harmful effects from treatment received as children.
The Dallas Express previously reported that Kaiser Permanente planned to suspend “gender-transition” surgeries for patients younger than 19 beginning in August 2025. Its policy continued to allow other treatments, including hormones and “puberty blockers.”
Medical Organizations Continue To Disagree
The federal action comes during an ongoing dispute within medicine and government over the risks and benefits of pediatric gender-related treatments.
The American Academy of Pediatrics reaffirmed its policy supporting access to “gender-affirming” care in 2023 while also authorizing a systematic review of the evidence to guide updated recommendations.
The Trump administration maintains that the interventions can cause irreversible physical harm and that the evidence supporting their use in minors is insufficient.
President Donald Trump issued a January 28, 2025, executive order directing federal agencies to end government support for the procedures and investigate possible consumer deception, fraud, and violations of federal drug laws. The order defines a child as an individual younger than 19.
The Justice Department said its nationwide investigation of hospitals, medical providers, and pharmaceutical companies remains active.
