The Department of Health and Human Services released a review on Thursday that found that the quality of evidence regarding the effects of transition-related care for minors “is very low,” and that, as a result, many U.S. doctors have managed to unintentionally “fail their patients” by providing them with such care.
“A central theme of this Review is that many U.S. medical professionals and associations have fallen short of their duty to prioritize the health interests of young patients,” the conclusion of the 409-page report states.
The HHS review found that there is limited evidence regarding the effects of medical interventions for youth with gender dysphoria on “psychological outcomes, quality of life, regret, or long-term health.” At the same time, it found that “evidence for harms associated with pediatric medical transition in systematic reviews” is “sparse,” but said “this finding should be interpreted with caution” because there are no studies that track and report harms.
It also sharply criticized the World Professional Association for Transgender Health, an international nonprofit made up of medical professionals that develops guidance regarding trans health care, arguing that its guidelines are biased and politically motivated. The HHS report alleges that WPATH has influenced U.S. medical associations to create a false perception that there is consensus regarding transition care for minors despite concerns from whistleblowers and detransitioners, or the relatively small number of people who no longer identify as trans or regret transition care they received.
The review also casts doubt on the increasing number of studies in recent years that have found a significant independent association between gender dysphoria and suicide, and on studies that have linked access to transition care to improved mental health outcomes for youth.
The HHS review ultimately calls for psychotherapy as “a noninvasive alternative to endocrine and surgical interventions for the treatment of pediatric gender dysphoria” and for more research regarding the effects of exploratory psychotherapy on minors with gender dysphoria.
The report marks the most recent escalation of the Trump administration’s efforts to roll back access to transition-related care and other rights for trans people. President Donald Trump issued several executive orders targeting trans people during his first weeks in office, including one declaring there are only two unchangeable sexes assigned at birth, another banning trans people from serving or enlisting in the military and one prohibiting federal funding for hospitals that provide transition care to minors.
The order regarding trans care for minors, signed on Jan. 28, required HHS to publish a review of the existing literature on “best practices for promoting the health of children who assert gender dysphoria,” the medical term for the distress caused by the misalignment between someone’s birth sex and gender identity. The HHS review notes that it is “not a clinical practice guideline,” which is meant to help clinicians and patients make decisions about care, “and it does not issue legislative or policy recommendations.” However, the review could still affect access to transition care for minors nationwide by adding fuel to the political firestorm surrounding it.
The review’s findings mark a significant break between the federal government and the stance of major U.S. medical associations — including the American Medical Association, the American Academy of Pediatrics and the American Psychological Association — which support access to transition-related care for minors and oppose restrictions on it.
As a result, the review was met with immediate backlash from medical associations and trans activists, who criticized its methods and lack of transparency. Most notably, HHS did not list any of the review’s authors in what appears to be a break with protocol, as the names of authors are generally required to be included on any scientific publication.
“While this is a systematic review of the literature on this subject executed by experts in the field, the credibility of this report plummets in the mind of many folks in the scientific and medical communities because those experts are not named anywhere,” said Dr. Morissa Ladinsky, a clinical professor of pediatrics at Stanford University’s medical school.
She added that a scientific report of this kind generally also lists the names of the experts who peer-reviewed it, and this review does not.
It’s unclear if the entire report was peer-reviewed or only a portion of it. A news release issued by HHS on Thursday states: “Chapters of this review were subject to peer review prior to this publication, and a post-publication peer review will begin in the coming days involving stakeholders with different perspectives.”
Ladinsky said that is highly out of the ordinary, and that post-publication peer review generally only happens when there has been “serious doubt cast” on the findings of a study or report.
Andrew Nixon, a spokesperson for HHS, said the department “stands firm in its decision to withhold the names of the contributors to this report in order to protect them from intimidation tactics and undue pressure campaigns.”
He added, “These tactics aim to stifle thoughtful, evidence-based analysis, preventing contributors from making independent judgments and engaging in honest peer reviews.”
He said the contributors’ names will be shared after the post-publication peer review is conducted.
Susan J. Kressly, the president, American Academy of Pediatrics, said the organization is “deeply alarmed” by the report.
“For such an analysis to carry credibility, it must consider the totality of available data and the full spectrum of clinical outcomes rather than relying on select perspectives and a narrow set of data,” Kressly said in a statement. “This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care.”
The review also promotes “exploratory psychotherapy,” which refers to talk therapy as an alternative treatment to puberty blockers or hormone therapy. In this kind of therapy, therapists try to help youth “come to terms with their bodies,” according to the review, or accept their birth sex.
Some of the nation’s largest LGBTQ advocacy organizations — including GLAAD, an LGBTQ media advocacy organization, and The Trevor Project, an LGBTQ youth suicide prevention and crisis intervention organization — as well as medical experts who specialize in research regarding care for LGBTQ youth said “exploratory psychotherapy” is often another way of referring to “conversion therapy,” or a discredited practice that attempts to change someone’s sexual orientation or gender identity.
“This is the argument they have been using for decades, and really it’s conversion therapy light,” said Doug Haldeman, a psychologist and professor of clinical psychology at John F. Kennedy University. “We are in an era where the administration has made it clear from the very first day that their wish is to erase trans identity altogether.”
Haldeman, who is also the author of “The Case Against Conversion ‘Therapy’: Evidence, Ethics, and Alternatives,” said there is years of research showing that trying to get trans people to “accept” their birth sex has negative mental health outcomes.
The HHS review pushes back on equating “exploratory” therapy with so-called conversion therapy, arguing that all psychotherapy is “exploratory by definition.”
The review also mentions multiple “whistleblowers,” or people who previously helped provide care to trans youth who have since denounced such care. It mentions Jamie Reed, a former case worker at the Transgender Center at the St. Louis Children’s Hospital, who alleged in a 23-page affidavit that children were being routinely prescribed puberty blockers or hormone therapy without “appropriate or accurate” mental health assessments. Her allegations were used by state lawmakers in support of legislation that eventually barred gender-affirming care for minors in the state of Missouri.
The review says that the concerns of whistleblowers have been “discounted, dismissed, or ignored by prominent advocates and practitioners of pediatric medical transition.”
Reed said that, “as a named whistleblower in the report, and as a lesbian myself with insider knowledge of this field, I wholeheartedly agree with the conclusions” of the review.
“Gender medicine has been gay conversion therapy since the beginning,” Reed said in a statement to NBC News. “The HHS review shares that history and concludes the practice raises ‘serious justice-related concerns’ because of the overrepresentation of LGB youth among patients. As a lifelong Democrat, I believe it is high time for bipartisan support to acknowledge the findings of this report.”
Ladinsky previously practiced as a pediatrician in Birmingham, Alabama, for 10 years, where she treated hundreds of trans adolescents until the state passed a ban on transition care for minors in 2022. The state is one of 25 that have enacted such restrictions.
“All of us on the front lines will tell you that in these 25 states where elements of the care is banned, we have yet to learn of one young person who is no longer transgender,” Ladinsky said.