Texas Children’s Hospital will create the nation’s first clinic focused on medical care for young people who stop or reverse their gender transitions under an agreement to settle a state investigation, Ken Paxton, the Texas attorney general, said on Friday.

The settlement, coordinated with the U.S. Justice Department, is the latest indication of pressure on hospitals across the country to end gender-related treatments for adolescents who say they feel a mismatch between their gender identity and sex at birth. Last week, a New York City hospital said it was one of several to have received a grand jury subpoena from a federal prosecutor in Texas seeking information about adolescents who received gender-related medical care.

“I applaud Texas Children’s Hospital for changing course and committing to being a part of the solution,” Mr. Paxton, who is seeking the Republican nomination for a U.S. Senate seat, said in a statement.

According to Mr. Paxton’s office, the “detransition clinic” will offer medical services to patients who underwent gender-transition procedures. For the first five years, he said, those services would be paid for by the hospital. It was unclear from the attorney general’s statement precisely what treatments would be available at the clinic, and who would provide them. As part of the agreement, the hospital will also pay $10 million and fire or terminate the privileges of five doctors who had previously provided gender-transition treatments, the statement said.

Texas Children’s, a Houston provider that is one of the largest children’s hospitals in the country, said in a statement that it had made the “difficult decision” to settle with the attorney general’s office to close a legal chapter that has been “wrought with falsehoods and distractions.” An investigation into the hospital’s billing practices related to gender-transition treatment was expected to end as part of the settlement, the hospital said.

The hospital said it had spent three years producing more than five million documents to officials in Texas and the Justice Department. The investigation began in 2023, the same year that Texas enacted legislation barring transgender children from receiving puberty blockers and hormone therapies. The state had accused the hospital of using false billing codes when seeking Medicaid reimbursements for gender treatments prohibited by the law.

Transgender advocates criticized the settlement. “Paxton is blackmailing a hospital system into creating a resource that no one is asking for,” Brad Pritchett, chief executive of Equality Texas, an L.G.B.T.Q. advocacy group, said in a statement. “It is embarrassing that a hospital once revered for its care has lost its integrity and put politics over patients.”

Little research exists on how often people stop or reverse their gender transitions, often referred to as “detransitions,” or why. Available estimates of people who detransition vary widely, from 2 percent of people who sought transitions to 17 percent. Detransitioners currently seek care from gender clinicians, primary care providers or endocrinologists, experts said.

In recent years, a growing number of young people have shared personal stories of detransition online, in testimonies in statehouses and in appearances in right-wing media. Several have filed malpractice lawsuits, saying that they were misled by clinicians into agreeing to medical interventions that they had come to regret.

An estimated 2.8 million people aged 13 and older in the United States identify as transgender, according to the Williams Institute, a demographics research center at the University of California, Los Angeles. That amounts to about 1 percent of the U.S. population in that age group. A small fraction of them seek medical transition.

Gender-transition treatments remain a topic of fraught debate among medical authorities. The major American medical societies endorse them, but a report commissioned by the Trump administration concluded that the risks outweigh the benefits.

In December, the Department of Health and Human Services proposed rules that would prevent any federal funding from going to hospitals that provide gender treatments to adolescents — though such rules are not yet in effect.

In addition to the grand jury subpoenas, the Justice Department has issued administrative subpoenas demanding patient and hospital records to more than 20 providers of gender-related services to minors. Several major hospitals in states where the treatments are legal have closed their pediatric gender clinics in recent months.

Some experts in the field of gender-transition health care have said that it is important to improve the quality of care for people who stop treatment. Patients may benefit from support as they taper off hormone therapy, for instance. But some said the agreement to form a clinic focused on that care reflected the polarization around gender transition care in American politics more than a medical imperative.

Lindsey Dawson, director of L.G.B.T.Q. health policy at KFF, a nonpartisan health research organization, said the call for a clinic specifically focused on detransitioners was creating “an issue where there may not be one” given that other providers can offer such care.

Lauren McGaughy contributed reporting.