On 5 June, the Cleveland Clinic, one of the world’s largest healthcare systems, vowed not to perform pediatric sex-trait modification — which includes puberty blockers, cross-sex hormones, and surgeries — for 20 years as part of a settlement with the Department of Justice. In addition, it pledged $2 million in care for detransitioners and agreed to pay $308,000 to resolve allegations regarding falsely billing insurance to secure coverage for these procedures in the past. This comes on the heels of a similar settlement last month between the DOJ and Texas Children’s Hospital, which agreed to pay $10 million and establish the nation’s first detransition clinic.

According to Jamie Reed, co-executive director of the LGB Courage Coalition, which campaigns against the medicalization of gender non-conformity, more settlements are likely to follow. Alternatively, hospital executives may decide to halt pediatric transition programs before they face similar legal challenges.

“If I were running a hospital and I went to my gender clinic and said, ‘Hey, the Department of Justice is coming after clinics for billing fraud — are we at risk?’ I think most hospital administrators are going to come to find out that, yes, they are,” said Reed. “And they’re not dumb. They’ll know that the prudent thing will be to stop these services, so if the DOJ comes, they can say, ‘We already looked into it. Yes, there were some issues, and we took care of it.’”

Many major hospitals around the country have already chosen to stop transitioning minors due to the Trump administration’s threats to cut off funding, including in deep blue states like New York and California. This week, New York City Mayor Zohran Mamdani reneged on his campaign promise to put $65 million towards transition services for adults and minors. That number is now $15 million, and the services will only be for adults 19 years and older.

Hospitals are also watching a growing number of malpractice cases and lawsuits involving transition-related care. In January, a jury found two New York doctors liable for medical malpractice and awarded 22-year-old Fox Varian — who received a double mastectomy when she was 16 — $2 million. And in April, 36-year-old detransitioner Camille Kiefel reached a settlement with two mental health providers whom she sued for $3.5 million after they approved her for a mastectomy after only one visit. Providers are suffering real consequences, and executives are taking note.

Yet according to Cori Cohn, who began hormones at 18 and underwent vaginoplasty at 19, these institutional retreats and settlements should not be mistaken for acknowledgments that the underlying treatment model was flawed. “[Hospital] leadership is just using it as an excuse to stop services that they didn’t have a lot of faith in to begin with,” said Cohn, now 50, who grew disillusioned with the process of transition after realizing he could never actually change his sex.

Reed agrees. To her, the real question is about the caliber of care these clinics will be providing to detransitioners. “I mean, this is a huge shift, if you’re going from having a gender center to a detransition center,” she said. “Just the cultural understanding of it alone. I hope that there are people who are ready to step in and say, ‘We can assist you with this.’”

The reality is, we can’t. If there was a weak evidence base supporting transition, there would doubtlessly be an even flimsier one when it comes to achieving the best outcomes for individuals who were misled. Even the best endocrinologists are left befuddled by a male patient who had his testes removed a decade earlier but who now wants to discontinue estrogen and start testosterone. Add to that mind-bending equation a male whose body was never allowed to go through puberty.

Rest assured, the Democratic Party shows no signs of moderating its position, even though over half of its constituents support bans on pediatric medical transition. Even if many Democratic lawmakers whisper their agreement with opponents behind closed doors, they know they need to remain in the good graces of the radicalized special interest groups if they hope to win reelection.

Though the Democrats may gain a majority of seats in Congress this November, it’s unlikely that it would do anything to stall the momentum of the Trump administration. The real test will come in 2028, if a Democrat is elected president and, upon entering office, immediately puts everything in reverse. There may be some serious whiplash. No matter the outcome, you can be certain that neither side will be fully satisfied, and politicians will campaign on this issue for decades to come.

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Ben Appel is the author of Cis White Gay: The Making of a Gender Heretic.

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China is trying to catch up with America on artificial intelligence. The Wall Street Journal has reported that Zhipu AI — one of China’s six “AI tiger” LLMs — has released a new model that can rival leading US systems, including Anthropic’s Mythos, in cybersecurity tasks such as pinpointing security bugs. While this marks a milestone in China’s drive to catch up with Western AI capabilities, strong performance on a single benchmark does not mean it has taken the lead. Chinese models still lag behind their Western counterparts in broader capabilities, such as autonomous operation. Skepticism is therefore warranted before resorting to hysterical conclusions, but complacency about the geopolitical implications of China’s AI advances would be an even greater mistake.

On the infrastructure side, Chinese AI is still constrained by access to advanced chips, with American labs way ahead in computing capacity as well as investment. Analysis from earlier this year suggests that Chinese models are likely to be at least a few months behind those in the US. But they are still continuing to make progress, or that the geopolitical importance of AI will be decided only by whose LLM has ventured deeper into the technological frontier. The practical applications of AI, countries’ to capture foreign markets, and the application of AI into the real economy will matter just as much.

Here, China may hold an advantage. As with its dominance across many critical supply chains, Beijing may not need to produce the most advanced AI systems — only those that are affordable and widely deployable. In doing so, it could consolidate global influence by supplying functional, low-cost AI at scale.

Beijing seems to be pursuing exactly that path, developing an AI “open-source” strategy that offers affordable, widely available AI models for companies and individuals to use and modify as they wish. The production of the DeepSeek AI model, which matched the performance of Silicon Valley tools such as ChatGPT at a fraction of the cost for users, created goodwill among Chinese models with developers.

The four most popular models on OpenRouter, an AI hardware platform for developers, are now all Chinese. The goal for China is not only to win the frontier-model race, but to make its systems the default layer of AI adoption across industries and global markets. For most economies, the choice is increasingly between an affordable tool they can deploy now and a more robust one that may be out of reach.

And while the countries adopting Chinese models may be exposed to political pressure and cyber threats from Beijing, safer and more capable alternatives matter little if they are unaffordable. American AI companies are already under pressure to monetize products whose operating costs are rising. If Chinese open-source models become the cheap default for startups, universities, governments and businesses across the developing world, then America’s AI lead will be eroded from below.

Perhaps more concerning for America in the long run is how AI can give Chinese manufacturing even more strength, through the ongoing integration of AI as a general-purpose technology. China’s new Five-Year Plan mentioned AI more than 50 times and includes an “AI+” action plan aimed at spreading AI across the economy.

Beijing has been pioneering automation of its critical infrastructure for years, with promising recent results in increasing warplane production capacity. In that regard, China’s open-model strategy and manufacturing dominance will reinforce each other. Cheap, adaptable models accelerate deployment across the real economy while those deployments generate real-world data and use cases that can feed back into further model improvement.

The United States should not dismiss the importance of its lead in the AI race. That lead worries Beijing, not least because a more automated Chinese economy would also become more vulnerable to AI-generated cyber threats. But nor should Washington assume that China cannot catch up with American capabilities over time.

This AI competition represents part of a broader struggle over tech supply chains and geopolitical influence. Decisions over whether to adopt US or Chinese models could produce a more fragmented global reality, with different regions relying on different cloud providers, chips and security structures. The result will likely be a global economy which is divided into competing spheres, rather than one which produces a single winner.

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Miquel Vila is a political and geopolitical risk consultant focusing on industrial strategy, critical infrastructure and global supply chains.

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