Trump administration HHS gender dysphoria report

Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices
Created	May 1, 2025
Commissioned by	Donald Trump's Executive Order 14187
Author(s)	Unknown
Subject	Transgender health care for minors
Official website
https://opa.hhs.gov/gender-dysphoria-report
Full text
File:Treatment for Pediatric Gender Dysphoria.pdf at Wikisource

Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices is a report published on May 1, 2025 by the United States Department of Health and Human Services (HHS) at the direction of US President Donald Trump's Executive Order 14187^[1] which explicitly called for limiting access to many types of gender-affirming care for young people. The report was immediately characterized by the American Academy of Pediatrics as "misrepresent[ing] the current medical consensus"^[2].

As of May 4, 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 the American Psychological Association as "...undermin[ing] scientific rigor and contradict[ing] standards for evidence-based policymaking."^[7]

The report promotes gender exploratory therapy, a form of conversion therapy intended to delay or prevent transition. Advocates as well as medical and psychological experts have said the report contains misinformation about transgender health care.^[8] The report was commissioned by the Trump Administration in Trump's January 2025 Executive Order 14187, which seeks to limit gender-affirming care for minors.^[8] Because of this, the administration has been asserted 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]

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 from LGBTQ advocacy groups and medical professionals.^[2]

On January 28, 2025, Donald Trump signed Executive Order 14187, "Protecting Children from Chemical and Surgical Mutilation", which directed the HHS to oppose the WPATH standards of care, cease all support for transition of transgender people under the age of 19, and cut federal funding for hospitals that offer transition-related treatments.^[8] The order was released one week into Trump's second term, as part of a series of policies targeting LGBTQ rights and transgender healthcare and gave the HHS just 90 days to complete the report.^[9][10]

Various organizations, including the World Professional Association for Transgender Health (WPATH), American Academy of Pediatrics, and American Medical Association, support access to gender-affirming care for youth.^[11]

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."^[12]

The report claims that gender-affirming care is experimental without evidence of benefits, and that treatments such as puberty blockers and gender-affirming hormone therapy are unethical interventions pushed by activists.^[8] It supports "gender exploratory therapy", generally considered a form of conversion therapy, as the only "safe" treatment for gender dysphoria and argues it is not the same as conversion therapy.^[10][8][13] 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."^[13][9] Additionally, it promotes misinformation that being transgender is caused "social contagion" and the discredited "rapid-onset gender dysphoria".^[10] The report also says autism is a possible "cause" of transgender identity, citing sources such as conversion therapist Kenneth Zucker.^[14]

The report heavily references the UK's Cass Review as Cass is cited 149 times in the report.^[15] It also cites anti-trans sources such as the Society for Evidence-Based Gender Medicine (SEGM) and Jesse Singal, who it said was a victim of "silencing tactics and reputational attacks". It also cited SEGM member Lisa Marchiano, who developed the debunked theory of rapid onset gender dysphoria and is a board member of Therapy First, formerly called the Gender Exploratory Therapy Association.^[14] It also deadnames and misgenders transgender historical figures such as Lili Elbe and Christine Jorgenson.^[14]

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."^[15]

Shannon Minter, legal director of the National 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.^[16] Human Rights Campaign president Kelley 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."^[11] GLAAD CEO Sarah Kate Ellis said that the report is "grossly misleading and in direct contrast to the recommendation of every leading health authority in the world."^[17]

The American Academy of Pediatrics swiftly rejected the review as "bypassing medical expertise and scientific evidence" in a manner comparable to anti-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.^[18]

The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association and the American Psychiatric Association released a joint statement criticizing the report and condemning attempts by lawmakers to ban gender affirming care.^[4][19]

The American 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]

The World Professional Association for Transgender Health (WPATH) and United 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."^[20]

The Endocrine Society 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]

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 to DSM-5 and ICD-11 guidance on gender dysphoria, said the report "magnifies the risks of treatments while minimizing benefits of the treatments".^[21]

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 at Whitman-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]

Doug Haldeman, a psychologist and professor of clinical psychology 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, saying "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."^[22]

Sean Cahill, the director of health policy research at the Fenway 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]

Daniel Aaron, a physician and associate professor of law at University of Utah called the report "marked with the signature of politics, which is antithetical to the way that science is normally conducted."^[23]

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, 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.^[23]

Gordon Guyatt, a professor of medicine and expert in research methods at McMaster University in Canada and was one of the key developers of the GRADE approach said that "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."^[23]

Harry Dayantis, a spokesman for the Cochrane 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]

The Autistic Self Advocacy Network released a statement that the report's hypothesis that autism causes transgender identities are false and linked to the history of conversion therapy and applied 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".^[14]

Roger Severino, vice president of the conservative think tank The 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 of Do 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 group Alliance 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."^[15]

• 2020s anti-LGBTQ movement in the United States
• Evaluation of Transsexual Surgery (1981)