The HHS report found that the quality of research on so-called gender-affirming care for minors is ‘very low.’
Major medical associations and LGBTQ+ organizations have condemned the recent Department of Health and Human Services report that found that the quality of research on so-called gender-affirming care for minors is “very low.”
In the January 28 executive order titled “Protecting Children from Chemical and Surgical Mutilation,” President Trump announced that the secretary of health and human services would publish a review of “the existing literature on best practices for promoting the health of children who assert gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion” within 90 days.
The HHS report, released on May 1, evaluated 17 systematic reviews and concluded that the existing literature suffers from methodological flaws such as small sample sizes and a lack of appropriate comparison groups. Additionally, the HHS report found that the studies on medicalized transition for children often neglected to appropriately consider harms and long-term effects.
“The ‘gender-affirming’ model of care includes irreversible endocrine and surgical interventions on minors with no physical pathology,” reads the report’s foreword. “These interventions carry risk of significant harms including infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret. Meanwhile, systematic reviews of the evidence have revealed deep uncertainty about the purported benefits of these interventions.”
The American Academy of Pediatrics issued a statement saying it was “deeply alarmed” by the “inaccurate” and “misleading” HHS report — just a few hours after the 400+ page document was released.
“Patients, their families, and their physicians — not politicians or government officials — should be the ones to make decisions together about what care is best for them based on evidence-based, age-appropriate care,” reads the statement.
In 2018, the American Academy of Pediatrics formally issued an endorsement of “gender-affirmative care.” In its acknowledgements, that policy statement thanked two reviewers for contributions: Isaac Albanese, a self-described “trans person” who has stated that it is “important to be a visible transgender activist” and “there is no ‘right’ way to transition,” and Jayeson Watts, who claims to “advance rights for the Transgender and Queer communities” so that “future generations of transgender individuals in Rhode Island and beyond have fewer barriers to living authentically as themselves.”
National Review previously reported that the American Academy of Pediatrics adopted new procedural rules that effectively prevented a resolution critical of the 2018 policy from being reviewed. The resolution requested that the organization “undertake a rigorous systematic review of available evidence regarding the safety, efficacy, and risks of childhood social transition, puberty blockers, cross sex hormones and surgery” and then “update the 2018 guidelines for the care of gender dysphoric youth, based on the results of this evidence review.”
The American Academy of Pediatrics also stated that the HHS report “misrepresents the current medical consensus and fails to reflect the realities of pediatric care.” However, the HHS report arrived at a similar conclusion as the Cass Review, an independent review commissioned by the U.K. National Health Service that found “this is an area of remarkably weak evidence.”
“It has been evident that there has been a failure to reliably collect even the most basic data and information in a consistent and comprehensive manner; data have often not been shared or have been unavailable,” reads the Cass Report that was published in 2024.
In a joint statement released on May 2, the World Professional Association for Transgender Health and the U.S. Professional Association for Transgender Health said that they are “deeply concerned” about the HHS report.
“Efforts to halt research funding and ban gender-affirming interventions threaten the health and dignity of transgender individuals and hinder medical progress,” the two associations said.
A previous president of WPATH stated in a Duke University talk that “every single child who was, or adolescent, who was truly blocked at Tanner stage 2 has never experienced orgasm.” (Tanner stage 2 is one of four developmental stages in puberty, typically occurring between ages nine and eleven.)
The Trevor Project, which describes itself as “the leading suicide prevention and crisis intervention nonprofit organization for LGBTQ+ young people,” called the HHS report “deeply troubling,” accusing it of including “dangerous misinformation” and encouraging “conversion therapy.” National Review previously reported that the Trevor Project — which has received millions in funding from corporations like Google, Macy’s, AT&T, Lululemon, and Abercrombie & Fitch — maintained an anonymous online chat forum “Trevor Space” where adults communicated with minors and discussed sexual preferences such as bondage and polyamory.
“Transgender status is an immutable trait like eye color or height, and using language that suggests otherwise perpetuates falsehoods and stereotypes,” reads a statement about the HHS report by Casey Pick, the Director of Law and Policy at the Trevor Project. “What this report is pushing is just the same dangerous, discredited conversion therapy by a different name — a long discredited and disproven set of practices forced on young people and their families that attempt to ‘change’ a person’s sexual orientation or gender identity.”
The HHS report notes that it is difficult to generalize the available evidence on psychotherapy, since it can occur in many different forms (online, in person, one-on-one, group, family-based, at a brief retreat, in a clinic, during a residential program, etc.). Some of the available studies, according to the HHS review, did not properly isolate the effects of psychotherapy from those possibly resulting from concurrent interventions like social transition. However, the report did not find any reported harms from psychotherapy treatment.
The HHS report states that the available literature sometimes conflates “psychotherapy” with “conversion therapy,” which it describes as “a problematic and potentially harmful rhetorical device.” The report suggests that “psychotherapy for adolescents with [gender dysphoria] is a well-suited intervention, as it is intended to help patients develop self-understanding, engage with emotional vulnerability, and build practical strategies for managing distress.” It further cites that Sweden, Finland, and England have recently imposed restrictions on medicalized interventions for gender dysphoria, and those countries now encourage more traditional mental health approaches such as psychotherapy.
The Autistic Self Advocacy Network explicitly “condemns” the “transphobic” HHS report, suggesting that it “promotes conversion therapy,” includes “dog whistles,” and sets forth “hateful, unscientific attacks.”
“The report repeatedly implies that autism is a root cause of gender dysphoria, quoting known conversion therapy practitioners to do so. This suggestion falsely twists what we know — that transgender and nonbinary people are up to six times more likely to be autistic,” stated the Autistic Self Advocacy Network on May 1. “We have seen prior efforts at the state level to block autistic people specifically from accessing gender-affirming care. By implying that autistic people cannot ‘truly’ be transgender, this report empowers that kind of harmful policymaking.”
The HHS report cites that “The current patient population [for pediatric gender medicine] has a high rate (relative to the general population) of comorbid mental health problems, including depression, anxiety, suicidality, self-harm, and eating disorders; as well as neurodevelopmental conditions like autism spectrum disorder.”
The IYG, an organization that says its mission is “creating safer spaces and empowering queer young people since 1987,” issued a statement that “strongly condemns” the HHS report. “This report is not based on science; it is simply another agenda-driven political attack on transgender young people and their families,” said the IYG in an announcement that is not dated.
The Academy of Family Physicians, the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association, and American Psychiatric Association jointly released a statement opposing “infringements on medical care” and the “patient-physician relationship” on the same day the HHS report was released. Although the joint statement did not explicitly mention the HHS or its report, it did make reference to the “actions of policymakers.”
“Our organizations have consistently opposed any legislation, regulation, or executive action that interferes in the confidential relationship between a patient and their physician or undermines the provision of evidence-based standards of patient care and physician training and education,” reads the statement issued by the six associations. “Politics should not get in the way of evidence-based care and a strong patient-physician relationship. We support our members and will continue to advocate for access to the full spectrum of evidence-based health care and medical education.”