HHS Releases 400-Page Report on Gender Affirming Care

This post was originally published on this site

The Department of Health and Human Services released a 400-page report today titled “Treatment for Pediatric Gender Dysphoria.” The report only addresses treatment for those 18 and under and appears to follow the UK’s Cass Review in recommending more therapy for children and less use of medical intervention, such as puberty blockers and hormones.

The 409-page Health and Human Services report questions standards for the treatment of transgender youth issued by the World Professional Association for Transgender Health and is likely to be used to bolster the government’s abrupt shift in how to care for a subset of the population that has become a political lightning rod.

This new “best practices” report is in response to an executive order Trump issued days into his second term that says the federal government must not support gender transitions for anyone under age 19.

“Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions,” National Institutes of Health Director Dr. Jay Bhattacharya said in a statement. “We must follow the gold standard of science, not activist agendas.”

The report sharply contradicts guidance from the American Medical Association, which has urged states not to ban gender-affirming care for minors, saying that “empirical evidence has demonstrated that trans and non-binary gender identities are normal variations of human identity and expression.”

The report itself is lengthy but I’ll highlight a few parts. Chapter 4 is titled “International Retreat from the “Gender Affirming” Model” and cites several recent changes made in European countries.

Starting in 2020, PMT [Pediatric Medical Transition] began to face growing scrutiny from public health authorities worldwide, resulting in substantial reversals of clinical protocols in an increasing number of countries. The most influential effort to date has been the Cass Review—a four-year independent evaluation of PGM that was published in April 2024. The findings of the Cass Review led to the closure of the UK’s PGM clinic, the Gender Identity Development Service (GIDS), which had been given a rating of “inadequate” by the Care Quality Commission in 2021. The Cass Review recommended a restructuring of the care delivery model—away from the centralized “gender clinic” model of care toward a more holistic framework centering psychosocial support, to be delivered through regional hubs. The Cass Review’s findings also led the UK to ban the use of PBs [Puberty Blockers] outside clinical trials, and to significantly restrict CSH [cross sex hormones]. While CSH are still officially an available treatment, the National Health Service (NHS) recently revealed that since the Cass Review was published, no minor has been found eligible to receive CSH according to the updated policy. In the UK, minors have never received GD-related surgery through the NHS.

Finland was the first country to curtail PMT, issuing revised national guidelines in 2020. In 2022, Sweden’s National Board of Health and Welfare concluded that, for most young people, the potential harms of hormonal interventions outweigh the benefits, and subsequently restricted both to research settings or exceptional cases. Denmark followed Sweden’s lead in 2023, restricting the use of endocrine intervention in minors, and Norway’s public health agency (the Norwegian Healthcare Investigation Board) advised that PBs and CSH should be considered experimental treatments. Most recently, hormonal interventions have been restricted in Brazil, Chile, the province of Alberta in Canada, and the state of Queensland in Australia.

The report also challenges the claim that gender affirming care is “lifesaving,” a claim constantly made by proponents.

Some physicians recommending PMT have urged anxious parents to consent to irreversible interventions for their distressed children, warning that not doing so may increase the risk of suicide. Such claims are not supported by the evidence and have been criticized as unethical. 

Adolescents and adults with GD do exhibit higher rates of suicidality—including suicidal thoughts, self-harm, and suicide attempts—compared to the general public. However, completed suicide among adolescents with GD remains rare. Moreover, there is no evidence that elevated suicidality can be attributed solely to GD, as it frequently cooccurs with other mental health conditions. A 2020 report by the Swedish National Board of Health and Welfare (Socialstyrelsen) concluded that “people with gender dysphoria who commit suicide have a very high rate of co-occurring serious psychiatric diagnoses, which in themselves sharply increase risks of suicide … it is not possible to ascertain to what extent GD alone contributes to suicide.”

Further, the evidence for whether PMT reduces suicidality-related outcomes in adolescents—such as self-reported frequency of suicidal thoughts, or healthcare utilization for self-harm or suicide attempts—is inconsistent. When the focus turns to preventing suicide mortality, there is no evidence that hormonal interventions are effective. A large, register-based study from Finland found that overall suicide mortality in patients with GD was rare and that when mental health comorbidities were controlled for, the rate did not differ from that of the general population. The study authors concluded that hormonal interventions did not appear to have impacted suicide risk.

Chapter 5 is the review of evidence and that gets even further into the weeds. Chapter 8 offers a summary of the implications of the evidence review.

Medical and surgical interventions for children and adolescents with gender dysphoria (GD) are widely promoted as essential and even lifesaving, yet the evidence base does not support strong conclusions about their effectiveness in improving mental health or reducing GD. Analysis of the biological plausibility of harms is necessary, and suggests that some short- and long-term harms are likely (in some cases expected) sequelae of treatment…

Some of the plausible harms of PMT are serious. The likelihood of infertility when puberty blockers (PBs) are provided at the early stage of puberty and followed by cross-sex hormones (CSH) does not have to be demonstrated in a clinical trial. This is because the mechanism is well-understood and conducting a trial would amount to an unethical “parachute test.”

There’s a lot more in the report including a review of high-quality guidelines in other countries, the influence of WPATH in the US, the collapse of assessment times in US children’s hospitals, a review of various whistleblowers, the role of US medical associations and the use of psychotherapy. It’s quite a lengthy report.

On thing that is not included in the report are the names of the authors.

“Contributors to the review include medical doctors, medical ethicists, and a methodologist. Contributors represent a wide range of political viewpoints and were chosen for their commitment to scientific principles,” HHS said in a news release about the review, adding that contributors’ names are not initially being made public “in order to help maintain the integrity of this process.”

The agency said chapters of the report underwent peer review but did not specify who reviewed it. The agency also said it will undergo additional review “involving stakeholders with different perspectives” in the days ahead.

I suspect this will leak before long as the pressure to destroy everyone involved will be substantial. We saw this after the release of the Cass Review in the UK. She was warned not to take public transportation in the wake of publication of her report.

Cass said: “There are some pretty vile emails coming in at the moment. Most of which my team is protecting me from, so I’m not getting to see them.” Some of them contained “words I wouldn’t put in a newspaper”, she said.

She added: “What dismays me is just how childish the debate can become. If I don’t agree with somebody then I’m called transphobic or a Terf [trans-exclusionary radical feminist].”…

Asked if the abuse had taken a toll on her, she said: “No … it’s personal, but these people don’t know me…

She added: “I’m not going on public transport at the moment, following security advice, which is inconvenient.”

The same thing could happen here if the names are released.