Key takeaways:
- HHS launched a evaluation discovering important dangers and few advantages of gender-affirming take care of adolescents.
- Specialists advised Healio they took problem with the language, methodology and conclusions of the report.
HHS printed a evaluation of gender-affirming take care of minors that claimed there are important dangers related to medical interventions and what the division known as “very weak proof of advantages.”
On Jan. 28, President Donald Trump ordered HHS to conduct a evaluation of present literature for treating youngsters with gender dysphoria and publish it inside 90 days. The 409-page report was printed Could 1. HHS didn’t launch the names of the contributors, however a press launch acknowledged that the authors included medical docs, medical ethicists and a methodologist.
Researchers who research gender-affirming drugs questioned the methodology of the HHS evaluation and the language that the authors used to explain gender dysphoria and gender-affirming medical care.
Stéphanie J. Madill, PhD, an assistant professor on the College of Saskatchewan, advised Healio that the authors “discovered what they wished to search out, very clearly.”
‘Not a scientific follow guideline’
The Williams Institute on the College of California Los Angeles College of Regulation estimates that greater than 1.6 million folks aged 13 years or older in the USA establish as transgender, together with 0.5% of adults and 1.4% of adolescents aged 13 to 17 years.
Well being take care of transgender folks has been underneath a microscope within the U.S., the place greater than half of states have handed payments limiting gender-affirming take care of minors up to now 5 years, in keeping with KFF, which reported that 40% of transgender adolescents dwell in these 27 states.
In keeping with the Human Rights Marketing campaign, some states have handed legal guidelines prohibiting the usage of public funds to pay for gender-affirming take care of folks of any age, which impacts folks on Medicaid, those that work within the public sector and people who find themselves incarcerated.
Previous analysis has proven that transgender youth might expertise higher psychological well being after being handled with puberty blockers and gender-affirming hormones, and that transition care can saves lives. Nonetheless, the authors of the HHS report carried out an umbrella evaluation of systematic critiques and reported discovering an absence of high quality proof on the advantages of gender-affirming care.
“This means that the helpful results reported within the literature are more likely to differ considerably from the true results of the interventions,” the authors wrote.
In addition they cited dangers of pediatric transition care — together with osteoporosis, cognitive results and psychiatric problems — and argued that puberty blockers and hormone remedy may cause everlasting injury to sexual organs, thereby inflicting everlasting infertility.
The authors quoted a scientific evaluation that argued towards following pointers from the World Skilled Affiliation for Transgender Well being (WPATH) and the Endocrine Society as a result of they “lack developmental rigour and transparency.”
The authors claimed that insurance policies printed by U.S. medical associations have been influenced by WPATH and, “It isn’t clear that the official views of those associations are shared by the broader medical group, and even by most of their members.”
Psychotherapy was a outstanding focus of the report. The authors argued that extra analysis ought to delve into utilizing psychotherapy alone to deal with gender dysphoria as a result of it’s much less invasive than hormones and surgical therapy. They categorized psychotherapeutic approaches to managing gender dysphoria as being unfairly maligned as “conversion remedy.”
The authors additionally claimed there isn’t any unbiased affiliation between gender dysphoria and suicidal ideation and “no proof that pediatric medical transition reduces the incidence of suicide,” though research have discovered the other to be true.
The authors acknowledged that the report “just isn’t a scientific follow guideline, and it doesn’t problem legislative or coverage suggestions. Fairly, it seeks to offer probably the most correct and present info obtainable relating to the proof base for the therapy of gender dysphoria on this inhabitants, the state of the related medical discipline in the USA, and the moral issues related to the therapies supplied.”
‘Quick shrift’ to opposing views
Researchers advised Healio that they took problem with the language and methodology used within the report, and several other organizations that have been named within the report launched statements refuting the claims the authors made about transgender well being care.
“They provide a really quick shrift to any opposing factors of view. They have lots of canine whistles,” Madill mentioned. “They put lots of issues that ought to be simply impartial phrases — like gender dysphoria and gender-affirming care — in citation marks to make them appear to be they’re new or they’re significantly political or bizarre after they’re not.”
“In addition they use some actually robust language with out giving examples or supporting it: issues like ‘suppressed dissent’ and ‘stifled debate,’ ‘drastic interventions,’” she mentioned.
Madill additionally questioned why the authors opted for an umbrella evaluation as a substitute of a “true systematic evaluation.”
“An umbrella evaluation is a scientific evaluation of systematic critiques,” she defined. “Most of the systematic critiques comprise the identical authentic research, and so research that have been in there greater than as soon as are being amplified, and research which might be solely in there as soon as are due to this fact being given much less weight.”
Jae D. Corman, PhD, senior director of scientific analytics at FOLX Well being, a well being and wellness platform providing well being care to LGBTQ+ sufferers, mentioned the conclusions of the report weren’t primarily based on science.
“It might definitely not cross peer evaluation for any scientific journal as a result of it depends closely on anecdotes and misrepresents the state of science,” Corman advised Healio.
Madill additionally famous the quick window of time between when the evaluation was ordered and when the outcomes have been printed in contrast with “how lengthy these types of issues often take,” which is as much as a few years for “a real systematic evaluation utilizing Cochrane strategies.” She additionally mentioned that the methodology didn’t come till chapter 5 — a lot later than is typical — and that contributors’ ages have been ambiguous and doubtlessly deceptive.
“A part of it is because they have been caught with who was included within the systematic critiques to begin with. They included youth as much as age 26, and I do not find out about you, however I do not think about a 26-year-old adolescent,” she mentioned. “Once we’re speaking about youngsters and adolescents, what number of of those adolescents have been 26 and what number of of them have been youthful? That info just isn’t obtainable, and it makes an enormous distinction.”
Madill mentioned that the report was appropriate in acknowledging that the power of proof is poor.
“There aren’t any good randomized managed trials. That’s true for lots of issues in drugs, and significantly for drugs associated to youngsters and youth,” she mentioned. “There is not lots of analysis, and there is not lots of long-term follow-up.”
“There’s a great quantity of scientific expertise amongst physicians who deal with youngsters with gender dysphoria,” she mentioned.
‘Not primarily based in science’
Madill additionally questioned among the dangers related to gender-affirming care that have been listed within the report. For instance, infertility was listed, “however simply happening cross-sex hormones doesn’t essentially result in infertility,” she mentioned. A extra everlasting surgical transition would result in infertility, however that can be the affected person’s alternative, and so they have the choice to freeze sperm or eggs in case they modify their thoughts about parenting down the street, she mentioned.
“Anyone who’s assigned feminine at delivery however who’s transmasculine and who’s on testosterone and is sexually energetic with any individual who produces sperm additionally needs to be on contraception as a result of simply being on testosterone does not assure — even when they are not menstruating — that they can not get pregnant,” Madill mentioned. “I feel it’s unfair to categorize infertility as a capital-R danger.”
Notably, among the therapies talked about within the report have been used for cisgender sufferers with out controversy. For instance, puberty blockers are part of commonplace medical care recurrently used for younger cisgender ladies who start puberty at age 8 or 9 years after they “aren’t socially and intellectually mature sufficient to deal with being sexual beings,” Madill mentioned.
“That’s what these medicines have been developed for initially. There’s numerous expertise with what they do and the way they work with these youngsters; we’re simply utilizing them otherwise in different youngsters, and they’re 100% reversible,” Madill mentioned.
This previous 12 months, the UK banned the usage of puberty blockers to deal with gender dysphoria amongst minors after the publication of the Cass Report, a evaluation authored by British pediatrician Hilary Cass, MBBS, which discovered weak proof of their advantages for treating gender dysphoria. Corman mentioned the Cass Report has been “discredited and disproven.”
In 2017 pointers for treating transgender sufferers, the Endocrine Society didn’t suggest prescribing remedy like puberty blockers or hormones earlier than sufferers attain puberty. The rules state that suppliers ought to create a multidisciplinary workforce — together with psychological well being professionals — to deal with adolescents with gender dysphoria, and counsel sufferers about fertility preservation earlier than they start puberty blockers or hormone remedy.
In an announcement offered to Healio, the Endocrine Society identified that the usage of puberty blockers and hormone remedy stays uncommon for adolescents, which “displays a cautious method as beneficial in our guideline.”
As Healio beforehand reported, a research of personal insurance coverage claims from 2018 via 2022 discovered that fewer than 8,000 youth have been prescribed puberty blockers and roughly 16,000 obtained hormone remedy over the 5-year interval. No youngsters aged youthful than 12 years obtained hormone remedy.
An identical research on gender-affirming surgical procedures within the U.S. discovered that 85 adolescents obtained gender-affirming surgical procedure in 1 12 months — virtually all of which have been breast reductions carried out on cisgender boys.
In a joint assertion, WPATH and the U.S. Skilled Affiliation for Transgender Well being mentioned the HHS report misrepresents present analysis and WPATH’s strategies for creating scientific follow pointers.
WPATH printed its first scientific follow pointers in 1979. The newest model, Requirements of Care — Model 8, was printed in 2022.
“Transgender younger folks deserve well being care that’s knowledgeable by science, compassion and respect,” the assertion mentioned. “Gender-affirming care is backed by rigorous analysis, skilled consensus and patient-centered values. Research constantly present its optimistic affect, together with improved psychological well being and general high quality of life.”
AAP President Susan Kressly, MD, FAAP, mentioned in an announcement that the report fails to replicate the realities of pediatric care.
The AAP printed a coverage assertion in 2018 and reaffirmed in 2023 that transgender youth ought to have entry to protected, developmentally applicable, gender-affirming well being care and that pediatricians ought to advocate for insurance policies that shield transgender youth.
“As now we have seen with immunizations, bypassing medical experience and scientific proof has actual penalties for the well being of America’s youngsters,” Kressly mentioned within the assertion. “AAP was not consulted within the growth of this report, but our coverage and intentions behind our suggestions have been cited all through in inaccurate and deceptive methods. The report prioritizes opinions over dispassionate critiques of proof.”
Corman mentioned the report mustn’t affect affected person care, which the authors famous themselves.
“Nonetheless, it may set off overcompliance or be utilized in lawsuits, regardless that it’s not primarily based in science,” Corman mentioned.
Advantages of transition care
Madill confused the advantages of gender-affirming take care of youth, similar to having “a physique that matches your sense of who you’re.”
“What we see is that children who typically do very well as little youngsters with simply social transition — as a result of if you’re a bit of child, a reputation, a haircut and garments are sometimes adequate for gender — unexpectedly go right into a spiral of despair and nervousness after they hit adolescence as a result of their physique begins creating in ways in which do not match who they know themselves to be,” she mentioned. “It may be actually psychologically traumatic. … These issues simply really feel actually unsuitable. And we frequently see lots of suicidality.”
Suicide prevention is among the high causes advocates champion gender-affirming care in youth and adolescents. Analysis has proven that transgender folks face a better danger for suicide than people who find themselves not transgender and that suicide makes an attempt rose when state-level anti-transgender legal guidelines have been handed. Madill mentioned the authors largely ignored suicidality within the report.
“There definitely is proof that offering transition care to adults decreases suicidality dramatically,” she mentioned. “The inference on this paper was it did not make a distinction in youngsters’s suicides to offer transition care, however I discover that troublesome to consider, significantly for youngsters, and that was the place they have been arguing in favor of simply psychological care.”
However psychological care ought to be coupled with transition care, Madill defined.
“These are massive choices, and they need to be made with the identical care that different types of main well being care choices can be made. It ought to be made with the perfect pursuits of the kid in thoughts,” she mentioned. “Medical and psychological care ought to be offered to the kid, not one or the opposite.”
References:
- AAP. Assertion on HHS report therapy for pediatric gender dysphoria. https://www.aap.org/en/news-room/news-releases/aap/2025/aap-statement-on-hhs-report-treatment-for-pediatric-gender-dysphoria/. Printed Could 1, 2025. Accessed Could 8, 2025.
- Coleman E, et al. Int J Transgender Well being. 2022;doi:10.1080/26895269.2022.2100644.
- Dai D, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.18814.
- Endocrine Society. An announcement on medical take care of transgender and gender-diverse youth. Offered Could 8, 2025.
- Hembree WC, et al. J Clin Endocrin Metabol. 2017;doi:10.1210/jc.2017-01658.
- Hughes LD, et al. JAMA Pediatr. 2025;doi:10.1001/jamapediatrics.2024.6081.
- Human Rights Marketing campaign. Map: Assaults on gender affirming care by state. https://www.hrc.org/sources/attacks-on-gender-affirming-care-by-state-map. Up to date Dec. 4, 2024. Accessed Could 7, 2025.
- KFF. Coverage tracker: Youth entry to gender affirming care and state coverage restrictions. https://www.kff.org/different/dashboard/gender-affirming-care-policy-tracker/. Up to date March 19, 2025. Accessed Could 8, 2025.
- Rafferty J, et al. Pediatrics. 2018;doi:10.1542/peds.2018-2162.
- U.S. Division of Well being and Human Providers. HHS launch complete evaluation of medical interventions for youngsters and adolescents with gender dysphoria. https://www.hhs.gov/press-room/gender-dysphoria-report-release.html. Printed Could 1, 2025. Accessed Could 8, 2025.
- U.S. Division of Well being and Human Providers. Therapy for pediatric gender dysphoria. https://opa.hhs.gov/websites/default/information/2025-05/gender-dysphoria-report.pdf. Printed Could 1, 2025. Accessed Could 8, 2025.
- Williams Institute. What number of adults and youth establish as transgender in the USA? https://williamsinstitute.regulation.ucla.edu/publications/trans-adults-united-states/. Printed June 2022. Accessed Could 8, 2025.
- World Skilled Affiliation for Transgender Well being. SOC-8 historical past and goal. https://wpath.org/publications/soc8/soc8-history/. Accessed Could 8, 2025.
- World Skilled Affiliation for Transgender Well being. WPATH and USPATH response to the HHS report on gender dysphoria. https://wpath.org/wp-content/uploads/2025/05/WPATH-USPATH-Response-to-HHS-Report-02May2025-3.pdf. Printed Could 2, 2025. Accessed Could 8, 2025.
For extra info:
Jae D. Corman, PhD, and Stéphanie J. Madill, PhD, might be reached at pediatrics@healio.com.
