Federal health officials issued a report Thursday declaring that there is no scientific evidence for the use of hormones and surgical treatments in young people with gender discomfort, and that they will express concerns about long-term harm, a severe reversal from previous agency recommendations, and advice from US health groups.
Instead, the report prioritized the role of psychotherapy, a divisive intervention to treat gender discomfort, which many supporters and physicians equate with so-called conversion therapy.
Other parts of the review seemed to question the very concept of having a gender identity that did not match the gender at birth.
In January, President Trump signed an executive order entitled “Protecting children from chemical and surgical amputations.” For 90 days, we have prepared a report to the Department of Health and Human Services on best practices for treating young people who say gender doesn't match birth sex.
However, the order revealed that the administration had already reached its own conclusions about gender transition treatment for minors, characterising “blatant harm done to children” as “a stain on our country's history.”
The 400-page report gained a more calm tone, but came to a similar conclusion. Among the significant deviations from the criteria for medical evidence review, the author has not been identified as pending post-publication review process beginning with “the coming days.”
HHS officials refused to answer questions about what comes with the review process. The department noted that contributors included all physicians, medical ethicists and methodologists from a “broad political perspective” chosen “for commitment to scientific principles.”
The report specified that the new assessment is not intended to set standards for health care or to make policy recommendations.
This relied primarily on the analysis of reviews of scientific research on adolescent blockers, hormone therapy, and surgical agents published in the past decades when these treatments first became available to adolescents.
The assessment concluded that the benefits of medical interventions are uncertain, but that the potential harms that may include loss of birth rates are less significant.
“Clinical practice in this field of medicine is exceptional and concern,” the report states, criticising American medical groups to promote intolerant work, “an environment in which clinicians feel forced to self-censor.”
The question of whether treatments such as adolescent blockers, hormonal therapy, or surgery are suitable for young people, and when are they subject to intense debate.
Several European countries have limited treatment in recent years after scientific reviews have found poor quality of evidence to support long-term risk benefits and uncertainties.
In the United States, 24 states have passed laws except that doctors provide such treatment to adolescents.
The American Academy of Pediatrics conducts its own review of evidence. The Academy and most major US healthcare groups continue to support these treatments as effective in alleviating the psychological distress experienced by many transgender youth.
“This report misrepresents the current healthcare consensus and does not reflect the reality of pediatric care,” said Dr. Susan Cresley, president of the academy. “This report prioritizes opinions over a calm review of evidence.”
Transgender rights advocates criticized the new assessment for portraying ideological views with a scientific luster.
During Trump's first 100 days in office, his administration sought to limit the perception of transgender identity in public life. The administration has ended funding for hospitals that provide gender transition treatment to people under the age of 19 and threatened to ban transgender people from serving the military.
The administration has moved men and transgender women from federal prisons to their homes, and no longer reflecting the gender of transgender people with their passports.
“Is the administration's hostility towards this healthcare based on real scientific research ideologically driven by the administration's disapproval of transgender people and the belief that transgender identity is false?” said Shannon Minter, director of legal affairs at the National Center for Lesbian Rights.
The Centre represents transgender individuals in several lawsuits that challenge the constitutionality of the administration's policies.
“It's an ideological statement – it's not a medical statement,” said Casey Pick, director of law and policy for the Trevor Project, a nonprofit organization focusing on suicide prevention among LGBTQ youth.
This report is a victory for those who described this field of medicine as part of a broader project that denies the reality of biological sex.
Appreciation of conservative Think, Roger Severino, vice president of domestic policy at the Heritage Foundation, praised the HHS report and denounced “profit-seeking physicians and ideological groups” for persuading families that “children's sex is everything they say.”
According to government data, about 3% of high school students have identified as transgender. This has risen significantly over the past decade. A much smaller proportion of these adolescents are seeking medical intervention.
Nevertheless, the issue of medical transition for minors has become a political flashpoint. Trump has built the focus of his campaign, with some Democrats believing that strategy will help him win.
The new HHS report goes further than similar reports in European countries that have introduced new restrictions on gender treatment for adolescents.
An independent review of clinical services for young adults in the UK, led by Dr. Hilary Cass, former dean of the Faculty of Pediatric Medicine, reached similar conclusions on the quality of evidence in support of adolescent blocking and use of hormonal therapy in minors. (Surgery is not available to minors in the UK.)
However, the review, which took place over four years, attracted a wider picture of the medical field by interviewing young patients, transgender adults, parents and clinicians.
Dr. Kass concluded that evidence on both the benefits and risks of treatment is “significantly weak,” but said some young people are still likely to benefit from early intervention.
“There are young people who will absolutely benefit from the medical pathway. As research needs to be improved, we need to make sure that those young people are accessible under research protocols, but don't assume that it is the right pathway for everyone,” Dr. Cass said in an interview last year.
The review concluded by recommending that the National Health Service in England limit adolescent blocking drug use to study trials only, and clinicians were advised to prescribe hormones to teenagers with “extreme caution.”
Other clinicians who expressed concern about the field of gender medicine in adolescents were ambiguous about how the new report would be used.
“We are pleased that in recent years, US authorities are finally taking into account what is happening in Europe,” said Erica Anderson, a child psychologist and former president of the American Transgender Health Association.
She has spoken out about concerns that youth gender clinics are moving away from careful mental health assessments as the population of children seeking gender treatment has increased.
But Dr Anderson, who still supports early intervention in some youth, noted that it is impossible to ignore the inflammatory enforcement orders that led to the report.
“It's like calling someone to insult the rank and then deciding to have a conversation with them,” she said. “Well, that doesn't work very well with real people with emotions and history.”
Minter of the National Center for Lesbian Rights said, by highlighting psychotherapy for medical interventions, the HHS report supports effectively approved conversion therapy aimed at changing the gender identity or sexual orientation of minors.
Major healthcare groups support a prohibition on this practice, citing evidence that it causes depression, anxiety and self-loathing.
However, the Supreme Court agreed to hear the First Amendment challenge for the next term of Colorado's conversion therapy. It was brought by a licensed professional counselor who, according to court documents, includes the belief that “when people thrive when they live consistently in God's design, including their biological sex.”
Other therapists, including Dr. Anderson, argue that so-called “exploratory” therapy with supportive clinicians can help to help solve mental health problems from adolescent gender identity.
Kellan Baker, a researcher of transgender health policies at Whitman Walker, a Washington nonprofit health center, said the report is a departure from the way health policies were commonly formed in the United States.
“It's important that the medicine be practiced by people with that expertise, not by federal government, but by trained clinicians who work according to the standards of care set by their respective healthcare sectors,” Dr. Baker said.
He said he was worried that the report would be cited by the government as justification for refusing to cover medical care for transgender youth.
The Centers for Medicare and Medicaid Services, a division of HHS, wrote a letter to state Medicaid agencies last month, urging them not to use Medicaid funds for gender transition care for minors.
Attorney General Pam Bondi has directed the Department of Justice to investigate doctors who provide such care.
“This document is not standard care, but it will be cited by the government as justification for refusing to cover medical care for transgender youth,” Dr. Baker said.
