On Thursday, federal health officials released a report stating that hormonal and surgical treatments for young people experiencing gender dysphoria lack scientific support and cautioning against potential long-term risks. This move signifies a major departure from prior recommendations and guidelines from leading U.S. medical organizations.
The report emphasized the importance of psychotherapy, a controversial approach to address gender dysphoria that many supporters and healthcare professionals liken to conversion therapy.
Certain sections of the report appeared to challenge the fundamental idea that some individuals identify with a gender that differs from their sex assigned at birth.
In January, President Trump issued an executive order called “Protecting Children From Chemical and Surgical Mutilation,” mandating the Department of Health and Human Services to prepare a report within 90 days on the best treatment practices for young individuals expressing a gender identity inconsistent with their birth sex.
However, the order suggested that the administration had already formed a negative perspective on gender transition treatments for minors, describing the “clear harm inflicted on children” as a “blot on our nation’s history.”
The 400-page document adopted a more serious tone but came to a similar conclusion. Uniquely, the report’s authors were not disclosed, as a review process was set to begin shortly after publication.
Officials from H.H.S. refrained from commenting on the specifics of the review process. They mentioned that the contributors consisted of medical professionals, ethicists, and methodologists from diverse political backgrounds, all selected for their dedication to scientific integrity.
The document clarified that this new evaluation did not aim to establish a standard for medical care or provide policy suggestions.
It mainly drew upon analyses of scientific research regarding puberty blockers, hormone treatments, and surgeries made available to adolescents over the past few decades.
The evaluation concluded that while the advantages of medical treatments are uncertain, the potential harms, such as infertility risks, are more apparent.
The report criticized the current state of clinical practices in this area as “extraordinary and troubling” and took aim at American medical associations for creating oppressive workplace “conditions that make clinicians feel they must self-censor.”
The appropriateness of treatments like puberty blockers, hormone therapy, or surgeries for young individuals has sparked intense debate.
In recent years, several European nations have restricted these treatments after analyses discovered insufficient evidence supporting their benefits and raised concerns about long-term risks.
In the U.S., 24 states have enacted laws prohibiting physicians from administering such treatments to minors.
The American Academy of Pediatrics is conducting its own evidence review. The academy and several major medical organizations in the U.S. continue to support these treatments as effective measures for alleviating the psychological distress faced by many transgender adolescents.
Dr. Susan Kressly, president of the academy, remarked, “This report misrepresents the prevailing medical opinion and fails to acknowledge the realities of pediatric care.” She stated, “The report focuses more on opinions than objective assessments of evidence.”
Advocates for transgender rights criticized the new evaluation, arguing that it disguises an ideological stance as though it were based on scientific evidence.
During Donald Trump’s first 100 days in office, his administration has aimed to diminish recognition of transgender identities. They’ve threatened to revoke funding for hospitals providing gender-transition services to individuals under 19 and to prevent openly transgender individuals from serving in the military.
Additionally, the administration has moved to house transgender women in federal prisons with men and has ceased reflecting transgender individuals’ gender identities on passports.
“Is the administration’s aversion to this medical care based on genuine scientific findings, or is it influenced by this administration’s clear opposition to transgender identities and belief that such identities are invalid?” asked Shannon Minter, legal director at the National Center for Lesbian Rights.
The center represents transgender individuals in various lawsuits challenging the validity of the administration’s policies.
Casey Pick, director of law and policy at the Trevor Project, a nonprofit focused on preventing suicide among L.G.B.T.Q. youth, stated, “If this report questions the ability of young people to identify as transgender, that presents an ideological stance rather than a medical perspective.”
The report is seen as a success for those who view this area of medicine as part of a larger effort to undermine the realities of biological sex.
Roger Severino, vice president for domestic policy at the Heritage Foundation, a conservative think tank, praised the H.H.S. report, blaming “profit-driven physicians and ideological organizations” for convincing families that “a child’s sex is whatever they say it is.”
According to government statistics, about 3 percent of high school students identify as transgender, a figure that has significantly increased in the past decade. However, a smaller fraction of these adolescents actually pursue medical interventions.
Despite this, the topic of medical transitioning for minors has evolved into a political hot topic. Mr. Trump emphasized it during his campaign, and some Democrats speculate that it played a role in his electoral success.
The new H.H.S. report is more extensive than similar assessments in European countries that have implemented new limitations on gender treatments for adolescents.
An independent review of youth clinical services in England, led by Dr. Hilary Cass, a former president of the Royal College of Pediatricians, also reached analogous conclusions regarding the insufficient evidence supporting the use of puberty blockers and hormonal treatments for minors. (Surgeries remain unavailable to minors in the U.K.)
However, that review was conducted over a four-year span,
Interviews were conducted with young patients, transgender adults, parents, and healthcare providers to gather a comprehensive overview of the medical landscape.
Dr. Cass determined that the information regarding both the advantages and disadvantages of these treatments was “surprisingly weak,” but acknowledged that some young individuals might still gain from early intervention.
“There are indeed young individuals who can significantly benefit from a medical pathway, and it is crucial to ensure they have access — particularly through research protocols, as we need to enhance our understanding — without assuming this approach is suitable for everyone,” Dr. Cass expressed during an interview last year.
The review recommended that England’s National Health Service limit the use of puberty blockers to research trials only and advised practitioners to prescribe hormones to teenagers with “extreme caution.”
Other medical professionals who share concerns about the youth gender medicine sector were uncertain about how the new report might be interpreted.
“I’m pleased to see that U.S. authorities are finally recognizing the developments that have occurred in Europe in recent years,” stated Erica Anderson, a child psychologist and former president of the U.S. Professional Association of Transgender Health.
She has expressed her concerns that youth gender clinics may have neglected thorough mental health evaluations as the number of children seeking treatment has risen.
Despite her ongoing support for early intervention for specific young patients, Dr. Anderson pointed out that the provocative executive order leading to the report cannot be overlooked.
“It’s like hurling an offensive remark at someone and then wanting to engage in a dialogue with them,” she commented. “That approach doesn’t typically yield good results with real people who have feelings and histories.”
Mr. Minter from the National Center for Lesbian Rights argued that by prioritizing psychotherapy over medical treatment, the H.H.S. report indirectly advocated for conversion therapy aimed at altering a minor’s gender identity or sexual orientation.
Major medical organizations have condemned conversion therapy, citing evidence that it leads to depression, anxiety, and self-loathing.
However, the Supreme Court has agreed to review a First Amendment objection to a Colorado prohibition on conversion therapy in the next term, initiated by a licensed counselor whose Christian beliefs assert that “people thrive when they live according to God’s design, including their biological sex,” as noted in court documents.
Some therapists, including Dr. Anderson, maintain that “exploratory” therapy with supporting clinicians may assist adolescents in differentiating mental health issues from gender identity matters.
Kellan Baker, a researcher examining transgender health policies at Whitman Walker, a nonprofit health center in Washington, indicated that the report signifies a shift from traditional health policy formation in the U.S.
“It’s essential that medical practice is conducted by experts in the field, by qualified clinicians adhering to established care standards — not dictated by the federal government,” Dr. Baker commented.
He expressed concern that the report could be leveraged by the government to justify denying medical coverage for transgender youth.
The Centers for Medicare and Medicaid Services, a branch of H.H.S., recently sent a letter to state Medicaid agencies advising against using Medicaid funds for gender-transition treatment for minors.
Pam Bondi, the attorney general, has instructed the Justice Department to investigate physicians who provide such treatments.
“This document doesn’t set a standard of care, yet it is likely to be cited by the government as a reason to deny medical treatment for transgender youth,” Dr. Baker stated.
