A protester waves a transgender pride flag during a protest against an anti-trans guest speaker on Tuesday, April 4, 2023, outside of the Corbett Center Student Union at New Mexico State University Matt Walsh Protest
Washington D.C. – The Department of Health and Human Services (HHS) on Thursday released a sweeping 400-page review that casts doubt on the scientific basis and ethics of gender-affirming medical treatment for transgender youth. The report, commissioned under a January executive order signed by President Donald Trump, is expected to influence federal policy on transgender healthcare and ignite further debate on an already divisive issue.
The report focuses exclusively on treatment of gender dysphoria in children and adolescents, recommending increased reliance on behavioral therapy while rejecting the widespread use of medical interventions such as puberty blockers, hormone therapy, and gender-affirming surgeries for those under 19. HHS stated that the review “finds that science and evidence do not support these drastic medical interventions for our nation’s youth.”
Despite the report’s length and its potential policy implications, HHS did not disclose the authors, reviewers, or institutions involved in its preparation. A news release said contributors included medical doctors, ethicists, and a methodologist “representing a wide range of political viewpoints,” but claimed their identities were withheld “to help maintain the integrity of this process.”
Medical professionals and advocacy groups were quick to push back. The report contradicts the positions of major U.S. medical organizations including the American Medical Association, the American Academy of Pediatrics, and the Endocrine Society, all of which support gender-affirming care as clinically appropriate and, in some cases, lifesaving for transgender youth.
“This document legitimizes the harmful idea that providers should approach young people with the notion that alignment between sex and gender is preferred,” said Dr. Scott Leibowitz, a child and adolescent psychiatrist who helped author youth guidelines for the World Professional Association for Transgender Health (WPATH).
The Trump administration has taken a hardline stance on transgender issues since the start of Trump’s second term. In addition to Thursday’s report, the administration has halted federal support for gender transition-related care for minors, cancelled $477 million in research and education grants tied to the transgender community, and threatened to strip funding from schools that allow transgender girls to participate in women’s sports.
NIH Director Dr. Jay Bhattacharya defended the administration’s position: “Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions. We must follow the gold standard of science, not activist agendas.”
The HHS review also references the 2023 Cass Review in the United Kingdom, which led to a halt in prescribing puberty blockers for minors outside of clinical trials. Like the Cass Review, the U.S. report claims the mental health benefits of such treatments are supported by “weak evidence” and raises concerns about adolescent consent and long-term effects like infertility.
However, critics argue the report was developed without input from mainstream pediatric and psychiatric associations. “The American Academy of Pediatrics was not consulted,” said its president, Dr. Susan Kressly.
As of March, 27 U.S. states have enacted restrictions on gender-affirming care for minors. The release of the HHS report may pave the way for further federal and state-level efforts to curtail access to such care.
The report is now undergoing a second phase of stakeholder review.
