| Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices | |
|---|---|
 | |
| Created | May 1, 2025 |
| Commissioned by | Donald Trump'sExecutive Order 14187 |
| Author | Unknown |
| Subject | Transgender health care for minors |
| Official website | |
| opa | |
| Full text | |
 File:Treatment for Pediatric Gender Dysphoria.pdf atWikisource | |
Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices is a report published on May 1, 2025, by the United StatesDepartment of Health and Human Services (HHS). It was produced at the direction of PresidentDonald Trump'sExecutive Order 14187[1] which explicitly called for limiting access togender-affirming care for young people. The report was characterized by theAmerican Academy of Pediatrics as "misrepresent[ing] the current medical consensus".[2]
As of October 2025, HHS has not disclosed who wrote and reviewed the report, stating in its press release that "Names of the contributors to the review are not initially being made public, in order to help maintain the integrity of this process."[3] HHS has referred to its authors as "eight scholars including doctors, ethicists and a methodologist who represent a wide range of political viewpoints".[4][5][6] This nondisclosure was characterized in a statement by theAmerican Psychological Association as "... undermin[ing] scientific rigor and contradict[ing] standards for evidence-based policymaking".[7]
The report promotesgender exploratory therapy, a form ofconversion therapy intended to delay or preventtransition. Advocates as well as medical and psychological experts have said the report containsmisinformation about transgender health care.[8]
According to the HHS, a post-publication review process would start in "the coming days", but they did not say what this review process would be.[5]
The report drew immediate criticism fromLGBTQ advocacy groups and medical professionals.[2]
On January 28, 2025, President Trump signedExecutive Order 14187, "Protecting Children from Chemical and Surgical Mutilation", which directed the HHS to oppose theWPATH standards of care, cease all support fortransition oftransgender people under the age of 19, and cut federal funding for hospitals that offer transition-related treatments.[8] Because of this, the administration has been noted to have had a predetermined conclusion about gender-affirming care for minors as the executive order called the treatment "blatant harm" and a "stain on our nation's history".[5] The order was released one week into Trump's second term, as part of aseries of policies targetingLGBTQ rights andtransgender healthcare and gave the HHS just 90 days to complete the report.[9][10]
Beginning on January 31, 2025, agencies and research institutions under the purview of the HHS were ordered to remove content with "forbidden terms", including "gender, transgender, pregnant person, pregnant people, LGBT, transsexual, non-binary, nonbinary, assigned male at birth, assigned female at birth, biologically male, biologically female".[11][12][13] Editors ofThe BMJ (a British medical journal) published an opinion article in reaction to the order, stating that medical journal editors should resist the US government's order to retract scientific papers for containing certain words.[14][15][16] TheEuropean Journal of Public Health published an editorial in agreement withThe BMJ.[15] Researchers have criticized the Trump administration for censorship of science,[17][18] and a letter signed by "nearly 2,000 leading scientists" argued this created a "climate of fear" in scientific fields.[17]
Various organizations, including theWorld Professional Association for Transgender Health (WPATH),American Academy of Pediatrics, andAmerican Medical Association, support access to gender-affirming care for youth.[19]
The report is limited to children, and does not address treatment for adults. HHS said its report is not clinical guidance and does not make any policy recommendations.[9] In a press release, the HHS highlighted that the report's authors would be confidential.[8]
The report is around 400 pages and outlined 17 systematic reviews which studied the outcomes of gender-affirming care in minors, but also excluded "thousands of others for not meeting study criteria – including some excluded for publication bias."[20]
The report claims thatgender-affirming care is experimental without evidence of benefits, and that treatments such aspuberty blockers andgender-affirming hormone therapy are unethical interventions pushed by activists.[8] It supports "gender exploratory therapy", generally considered a form ofconversion therapy, as the only "safe" treatment for gender dysphoria and argues it is not the same as conversion therapy.[10][8][21][22] The report states that medical groups support medical treatment over psychological treatment due to a "mischaracterization of such approaches as 'conversion therapy'", and states that "Psychotherapy is a noninvasive alternative to endocrine and surgical interventions for the treatment of pediatric gender dysphoria."[21][9] Additionally, it promotes misinformation aboutrapid-onset gender dysphoria, a discredited hypothesis that being transgender is caused by asocial contagion.[10] The report also says autism is a possible "cause" of transgender identity, citing sources such as gender exploratory therapistKenneth Zucker.[23]
The report references controversial sources, including the UK'sCass Review, which it cites 149 times,[24] as well as publications bySociety for Evidence-Based Gender Medicine (SEGM), journalistJesse Singal, and SEGM member Lisa Marchiano.[23]Them writer Samantha Riedel described the report as citing "debunked and discredited anti-transgender sources".[24] It alsodeadnames andmisgenders transgender historical figures such asLili Elbe andChristine Jorgensen.[23]
During a press conference at the White House following the report's release,Stephen Miller, the White House Deputy Chief of Staff, called gender-affirming care "barbaric", further stating "They violate all sound medical ethics. They are completely unwarranted. They harm children for life irreversibly. It is child torture. It is child abuse. It is medical malpractice."[24]
The authors of the report were not named in the report and following the report's release, the HHS declined to identify them.[8][5][25] HHS has referred to its authors as "eight scholars including doctors, ethicists and a methodologist who represent a wide range of political viewpoints",[6] and that names were withheld "in order to help maintain the integrity" during post-publication peer-review.[26][5][25]
On June 26, 2025,Alex Byrne, a philosophy professor atMIT, wrote an opinion article inThe Washington Post claiming to be one of the authors, but did not identify the other eight authors he said were involved in the report.[27][28]
Shannon Minter, legal director of theNational Center for Lesbian Rights, said the report "seeks to erase decades of research and learning, replacing it with propaganda".The Trevor Project director Casey Pick warned that it could endanger transgender youth.[8]Human Rights Campaign presidentKelley Robinson said "It is deeply unfair to play politics with people’s lives and strip transgender young people, their families and their providers of the freedom to make necessary health care decisions."[19]GLAAD CEOSarah Kate Ellis said that the report is "grossly misleading and in direct contrast to the recommendation of every leading health authority in the world".[29]
Advocates for Trans Equality's health policy analyst, Sinead Murano Kinney, called the report "a willful distortion of medical evidence intended to stoke fear about a field of safe and effective medicine that has existed for decades" and said the report is meant to "justify dangerous practices which amount to conversion therapy".[30]
TheAmerican Academy of Pediatrics swiftly rejected the review as "bypassing medical expertise and scientific evidence" in a manner comparable toanti-vaccine activism. The AAP also criticized the HHS for not consulting any major medical organizations for the review and misrepresenting their policies on gender affirming care.[31]
TheAmerican Academy of Family Physicians, theAmerican Academy of Pediatrics, theAmerican College of Obstetricians and Gynecologists, theAmerican College of Physicians, theAmerican Osteopathic Association and theAmerican Psychiatric Association released a joint statement opposing "any legislation, regulation, or executive action that interferes in the confidential relationship between a patient and their physician or undermines the provision of evidence-based standards".[4][32]
TheAmerican Psychological Association released a statement saying it "supports access to psychological care and evidence-based treatment for treatment for transgender, gender-diverse and nonbinary children, teens and adults" and condemned the report's support of conversion therapy, saying "Psychotherapeutic treatment for transgender and nonbinary youth should aim to help children and adolescents explore and understand, rather than change, their gender identity."[4]
TheWorld Professional Association for Transgender Health (WPATH) andUnited States Professional Association for Transgender Health (USPATH) released a joint statement saying they are "deeply concerned" about the HHS report, which they say "misrepresents existing research and disregards the expertise of professionals who have been working with transgender and gender-diverse youth for decades".[33]
TheEndocrine Society initially released a statement saying it was reviewing the report, but continues to "believe in access to health care, and that medical decisions should be made by the clinician and the patient's family based on scientific evidence" as opposed to bans by politicians.[4] On May 29, 2025, The Endocrine Society responded to the report by saying their guideline development process "adheres to the highest standards of trustworthiness and transparence" and "The widely accepted view of the professional medical community is that medical treatment is appropriate for transgender and gender-diverse teenagers who experience persistent feelings of gender dysphoria. Medical studies show that access to this care improves the well-being of transgender and nonbinary people".[34]
Dr. Meera Shah, a physician and a board member for the Physicians for Reproductive Health, said that "medical professionals do not question the safety of this care." Shah further stated that "The fact that this was published by a government agency is really scary. The way that it's written is very harmful, and it's very obvious that this is all politically driven and not rooted in fact or science. People tend to trust government. They think government agencies are out to protect people and to help people, so the default is to believe what they say."[4]
Jack Drescher, a New York psychiatrist who contributed toDSM-5 andICD-11 guidance on gender dysphoria, said the report "magnifies the risks of treatments while minimizing benefits of the treatments".[26]
Erica Anderson, a child psychologist who has been critical of gender-affirming care for minors in the past, praised the report's conclusions, but also said "it was impossible to ignore the inflammatory executive order that led to the report."[5]
Kellan Baker, who studies transgender healthcare atWhitman-Walker Health said "the report was a departure from how health policy had typically been shaped in the United States. It is important that medicine be practiced by those with expertise in it, by trained clinicians operating according to standards of care that are set out by their respective medical fields – not by the federal government." Baker also expressed concern that the report would be used by the government to justify more restrictions on gender-affirming care.[5]
Sean Cahill, the director of health policy research at theFenway Health, criticized the report saying it "either downplays or dismisses studies that have found that access to these treatments leads to improved mental health. The report also claims these treatments are associated with significant harms even though it found 'sparse' to no evidence of such harm."[10]
Alex Dworak, a family medicine physician in Nebraska who treats transgender patients, said the report "contains inaccuracies, misleading language, and misrepresentations" of the care he provides his patients. Dworak points out that the report claims "[that] no independent association between gender dysphoria and suicidality has been found" – which Dworak calls "flatly incorrect", citing a systematic review that found the opposite.[35]
Doug Haldeman, a psychologist and professor of clinical psychology atJohn F. Kennedy University who is the author of "The Case Against Conversion 'Therapy': Evidence, Ethics, and Alternatives", criticized the report for attempting to claim exploratory therapy is not conversion therapy: "This is the argument they have been using for decades, and really it's conversion therapy ... 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 also said "there is years of research showing that trying to get trans people to 'accept' their birth sex has negative mental health outcomes."[25]
Daniel Aaron, a physician and associate professor of law atUniversity of Utah, called the report "marked with the signature of politics, which is antithetical to the way that science is normally conducted".[35]
Gordon Guyatt, a professor of medicine and expert in research methods atMcMaster University in Canada who was one of the key developers of theGRADE approach, said the report "accurately classifies the evidence around gender-affirming care for youth as low or very low in certainty, but that its discussion of ethical issues was unbalanced." Guyatt clarified the report "suggests that adolescents should be denied the gender affirming therapies under consideration and that people shouldn't be allowed to do research to address the possible outcomes. This seems unbalanced to me and raises the issue of how this report came about, how the team that put together the report was chosen, and the influence that players in the current administration had on the report."[35]
Arjee Restar, a social and legal epidemiologist atYale University, criticized the report for denying that exploratory therapy is the same as conversion therapy, saying "The report's framing of psychotherapy as an alternative to medical affirmation – especially in a way that delays or discourages access to competent gender-affirming care providers – echoes the same ideology and pathologizing practices that underpinned past conversion therapy practices."[22]
Meredithe McNamara, an assistant professor of pediatrics at theYale School of Medicine, criticized the report for concealing the names of the authors, saying the HHS's excuse that this was done to "maintain the integrity of this process" is "simply nonsense". McNamara further said: "That's not how scientific integrity works. If people are not willing to put their names on it, then it should not be taken seriously."[22]
Harry Dayantis, a spokesman for theCochrane Collaboration, an international nonprofit organization that makes what scientists consider the premier systematic literature reviews, criticized the lack of transparency regarding the authors of the report, saying "the lack of disclosure prohibits an assessment of possible conflicts of interests." Dayantis additionally criticized the conclusion of the report for not being supported by the report itself, saying the conclusion refers to "a growing body of evidence pointing to significant risks", but the report itself says evidence of harms in systematic reviews is "sparse", theorizing that it's too soon to identify the harms because widespread use of transition care is recent.[6]
TheAutistic Self Advocacy Network released a statement that the report's hypothesis that autism causes transgender identities is false and linked to the history ofconversion therapy andapplied behavioral analysis. They said "The report repeatedly implies that autism is a root cause of gender dysphoria, quoting known conversion therapy practitioners to do so" and that it "clearly dehumanizes both trans and autistic people. The suggestion that being trans comes secondary to being autistic is meant to discredit the real experiences of both autistic and non-autistic trans youth."[23]
Roger Severino, vice president of the conservative think tankThe Heritage Foundation, commended the report and reprimand what he called "profit-seeking doctors and ideological groups" for convincing families that a child's sex "is whatever they say it is".[5]
Stanley Goldfarb, chairman ofDo No Harm, an organization which advocates for bans on gender-affirming care, praised the report saying, "It is clearer now more than ever that we must end this misguided practice and replace it with evidence-based treatment for gender-confused kids."[6]
The president of the Christian legal groupAlliance Defending Freedom,Kristen Waggoner, applauded the report, saying that it "... should lead to the closure of every gender clinic in America. Doctors who perpetrate these experiments on children should lose their medical licenses and be sued for damages."[24]
