One of New York City's largest hospitals has agreed to stop performing sex-reassignment procedures on minors after a Department of Justice investigation, and will pay millions to help those already harmed.
Mount Sinai entered an agreement with the Trump administration that ends the hospital's youth transgender treatment program, includes an unspecified monetary penalty, and requires $2 million in free medical care for patients who suffered harmful consequences from transgender procedures received as children, Fox News Digital reported.
The DOJ did not release the full details of the agreement. But Attorney General Todd Blanche framed the settlement in unmistakable terms.
"The Department of Justice is committed to holding accountable medical providers that violate federal law and endanger children through so-called gender-affirming care. This agreement puts an end to these practices at Mount Sinai and provides meaningful relief for individuals who have already suffered harm."
The agreement makes Mount Sinai the fourth major hospital to halt youth transgender procedures under DOJ pressure in recent months. Texas Children's Hospital, the Cleveland Clinic Foundation, and Connecticut Children's Hospital all reached similar settlements in the weeks before Mount Sinai's deal was announced.
The federal investigation into Mount Sinai goes well beyond the question of whether minors should receive sex-reassignment treatments. The DOJ is examining potential violations of the Food, Drug, and Cosmetic Act, the False Claims Act, and other federal health care statutes, a legal framework that reaches into how the hospital billed taxpayers for these services.
Among the allegations: Mount Sinai used false diagnosis codes to obtain payment from federal health care programs and private insurers. That is not a philosophical disagreement about medicine. It is an accusation of fraud.
The hospital's own 2025 annual report from its Institute for Advanced Medicine showed that providers saw 4,931 transgender and gender-diverse patients that year. Mount Sinai has not publicly disclosed how many of those patients were minors. The gap between the hospital's patient volume and its silence on the pediatric numbers is worth noting, especially now that the DOJ has stepped in.
Mount Sinai's Center for Transgender Medicine and Surgery was led by Dr. Joshua Safer, who co-authored the medical guidelines published by the World Professional Association for Transgender Health, known as WPATH. Those WPATH guidelines served as the foundation for Mount Sinai's own treatment protocols.
That connection matters. WPATH itself is now the target of a federal lawsuit. The Federal Trade Commission, along with several states, has sued the organization, alleging it made false and unsubstantiated claims about the safety, effectiveness, and medical necessity of pediatric medical-transition services. The case remains pending.
The broader push to protect alternative approaches for minors with gender dysphoria has gained ground in courtrooms across the country, with federal judges blocking state-level restrictions on talk therapy and other non-surgical options.
Assistant Attorney General Brett Shumate, who heads the DOJ's Civil Division, signaled that more settlements, or enforcement actions, are coming.
"A growing number of hospitals, like Mount Sinai, have recognized the medical scandal of sex-rejecting procedures. While we are grateful when we secure resolutions to end this discredited practice and protect children, we must not and will not rest in our pursuit of justice for the victims it has left behind."
Shumate's language, "medical scandal," "discredited practice," "victims", reflects the administration's position that these procedures cause lasting harm to children who cannot meaningfully consent to irreversible treatments. That position now carries the weight of federal law enforcement behind it.
The legal architecture for this campaign traces back to an executive order President Trump signed roughly a week after taking office, titled "Protecting Children from Chemical and Surgical Mutilation." The order directed the DOJ to enforce federal female genital mutilation laws, investigate drug-safety violations and potential parental rights violations, and instructed federal agencies to rescind or amend any policies that relied on WPATH guidance.
The Department of Health and Human Services followed with sweeping regulatory proposals to end government funding of transgender procedures for minors. Together, the executive order and HHS action created the policy framework the DOJ is now using to pressure hospitals into compliance.
That framework has produced results beyond the hospital system. The Trump administration's broader effort to enforce biological-sex distinctions in public institutions has forced policy changes at organizations ranging from school athletic programs to community centers.
Mount Sinai, for its part, offered a carefully worded statement to the New York Times that avoided any admission of wrongdoing, or any defense of its former practices.
"The settlement is complex, but at its core reflects Mount Sinai's commitment to safeguarding our patients' confidential information and protecting our clinicians."
The statement is notable for what it does not say. It does not defend the treatments. It does not dispute the DOJ's characterization. It does not promise to resume the procedures if circumstances change. It reads like a hospital that wants to move on quietly.
The DOJ described Mount Sinai as "cooperative, proactive, and solution-driven" during the process, language that suggests the hospital did not mount a legal challenge to the investigation. Whether that cooperation was driven by genuine reconsideration or simple institutional self-preservation, the practical result is the same: one of the country's most prominent medical centers has walked away from youth sex-reassignment procedures.
Other institutions have faced similar crossroads. The YMCA recently confronted mounting pressure to revise its transgender access policies after a series of legal and political developments made the status quo untenable.
Perhaps the most revealing element of the agreement is the $2 million Mount Sinai must dedicate to free medical care for people suffering harmful consequences from transgender treatments they received as minors. The fund's existence is itself an acknowledgment, by the terms of a federal settlement, that some patients were harmed.
The specific monetary penalty Mount Sinai must pay on top of that $2 million has not been disclosed. The DOJ's decision to withhold the full terms of the agreement leaves open questions about the scope of the hospital's exposure and the extent of the practices the investigation uncovered.
What is clear is the trajectory. Four major hospitals have now agreed to stop these procedures under federal pressure. The FTC is suing the professional organization whose guidelines underpinned the treatments. And the DOJ has made plain it intends to keep going.
The administration's position has found support in broader public debates over biological sex and institutional policy. First Lady Melania Trump publicly backed a Supreme Court ruling protecting women's sports on the basis of biological sex, a signal that the issue carries weight at the highest levels of the administration.
For years, hospitals, advocacy groups, and medical associations treated pediatric gender-transition services as settled science and compassionate care. The DOJ is now treating them as potential violations of federal law. When the institutions that built these programs start signing agreements to shut them down and fund care for the patients they harmed, the debate is no longer theoretical. It is an accounting.
