Federal health officials published a report on Thursday declaring that the use of hormonal and surgical treatments in young people with gender dysphoria lacked scientific evidence and expressing concern about long-term harms, a stark reversal from previous agency recommendations and the advice of top U.S. medical groups.

The report instead prioritized the role of psychotherapy, a divisive intervention to treat gender dysphoria that many advocates and physicians have equated with so-called conversion therapy.

Other parts of the review seemed to call into question the very notion that some people have a gender identity that does not align with their sex at birth.

In January, President Trump signed an executive order titled “Protecting Children From Chemical and Surgical Mutilation” giving the Department of Health and Human Services 90 days to produce a report on the best practices for treating young people who say their gender does not align with their birth sex.

But the order made it clear that the administration had already reached its own conclusion about gender transition treatments for minors, characterizing the “blatant harm done to children” as a “stain on our nation’s history.”

The 400-page report took a more sober tone but reached a similar conclusion. In a remarkable departure from the standard for medical evidence reviews, the authors were not identified pending a post-publication review process that would begin in “the coming days.”