The Trump administration questioned the evidence supporting gender-affirming health care for youth in a lengthy review published Thursday by the Department of Health and Human Services (HHS) that could further upend the nation’s transgender care landscape.
The roughly 400-page, unsigned review states there is a “lack of robust evidence” supporting interventions such as puberty blockers, hormone therapy and the rare surgeries to treat gender dysphoria in minors. It advocates for a greater reliance on psychotherapy to treat the condition, which is characterized by severe psychological distress that stems from a mismatch between a person’s gender identity and sex at birth.
The document contradicts guidance from major medical organizations including the World Professional Association for Transgender Health and the American Medical Association, which opposes statewide bans on gender-affirming care for youth. Neither group immediately returned a request for comment on the report.
“Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions,” National Institutes of Health Director Jay Bhattacharya said in a news release accompanying Thursday’s report.
The review’s release comes at the direction of an executive order President Trump issued days into his second term to end federal support for gender-affirming care for minors, which his administration has said includes children and adolescents up to 19 years old. Two federal courts blocked parts of the order that sought to withhold funding from hospitals providing transition-related services to youth.
The names of the new review’s contributors would not initially be made public, HHS said Thursday, “in order to help maintain the integrity of this process.” A department spokesperson did not immediately return a request for additional comment on the decision to withhold the authors’ names.
In a fact sheet released earlier this week, the White House said HHS had coordinated with “a team of eight distinguished scholars” to publish the review. The department said Thursday that contributors include medical doctors, ethicists and a methodologist and represent “a wide range of political viewpoints.”
The report was subject to peer review before publication, the department said, and a postrelease peer review, set to begin in the coming days, will involve “stakeholders with different perspectives.”
Transgender rights advocates decried the review as one-sided and politically motivated. Some pointed to Trump’s campaign promise to ban gender-affirming care for youth, which he has equated to child abuse.
The Trump administration has also broadly denied the existence of trans people.
In a statement, Susan J. Kressly, president of the American Academy of Pediatrics (AAP), said her organization is “deeply alarmed” by the report, which she said “misrepresents the current medical consensus and fails to reflect the realities of pediatric care.”
“Patients, their families, and their physicians—not politicians or government officials —should be the ones to make decisions together about what care is best for them based on evidence-based, age-appropriate care,” Kressly said.
“AAP was not consulted in the development of this report, yet our policy and intentions behind our recommendations were cited throughout in inaccurate and misleading ways. The report prioritizes opinions over dispassionate reviews of evidence,” she added.
Sinead Murano Kinney, a health policy analyst at Advocates for Trans Equality, a Washington-based nonprofit, called the review “a willful distortion” of medical evidence “intended to stoke fear about a field of safe and effective medicine that has existed for decades.”
She said the report is meant to “justify dangerous practices which amount to conversion therapy,” a discredited practice that aims to change a person’s sexual orientation or gender identity to align with heterosexual or cisgender norms.
“Today’s report seeks to erase decades of research and learning, replacing it with propaganda,” said Shannon Minter, legal director of the National Center for Lesbian Rights. “The claims in today’s report would rip health care away from kids and take decision-making out of the hands of parents. It promotes the same kind of conversion therapy long used to shame LGBTQ+ people into hating themselves for being unable to change something they can’t change.”
Minter, himself transgender, has litigated cases on conversion therapy across the country for more than 30 years. He testified in support of access to gender-affirming care at a 2023 congressional hearing chaired by now-Speaker Mike Johnson (R-La.) on the alleged “dangers and due process violations” of such care for minors.
“Like being gay or lesbian, being transgender is not a choice — it’s rooted in biology and genetics,” Minter said Thursday. “No amount of talk or pressure will change that.”
Others applauded Thursday’s review.
Stanley Goldfarb, chair of the organization Do No Harm, which advocates against gender-affirming care for youth, said it “rightfully exposes a number of serious risks in the medical transition of young people,” which he called “misguided.”
“Do No Harm, its fellows, researchers, and members have been warning about the experimental and irreversible sex change interventions on children, and we are grateful and encouraged HHS is bringing needed scrutiny to the gender industry,” said Goldfarb, a retired kidney specialist and former associate dean at the University of Pennsylvania’s medical school.
Goldfarb and Do No Harm, which he founded in 2022, have been influential in arguing that transition-related treatments are medically harmful to minors, supplying model legislation banning such care to state lawmakers and lobbying conservative leaders in Congress.
Half the nation since 2021 has adopted laws that ban or heavily restrict access to gender-affirming health care for transgender youths — and adults, in some cases.
Trump has called for federal legislation to that effect, telling Congress during his joint address in March to pass a bill “permanently banning and criminalizing sex changes on children and forever ending the lie that any child is trapped in the wrong body.”
In its fact sheet released Monday, the White House said HHS had eliminated approximately 200 grants totaling $477 million in research or education on gender-affirming treatment since Trump took office in January.
—Updated at 2:22 p.m. EDT
