Health and Human Services Report on "Treatment for Pediatric Gender Dysphoria." Good & Bad in the report.
A study drawing many of the same conclusions as the Cass Report in Britain. However, pushing psychotherapy is questionable and opens the door to having conversion therapy for Gays.
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Department of Health and Human Services report, “Treatment for Pediatric Gender Dysphoria.”
This is much the same assessments and conclusions as reached in Britain, but the LGBTQXYZ+ are making it all about right wingers. There are some legitimate concerns. The authors aren’t listed. I don’t think there is a real need for psychotherapists either.
This is the HHS press release of May 1, 2025.
https://www.hhs.gov/press-room/gender-dysphoria-report-release.html
This is the page with the links to reports. There is the full report, the appendixes and a third link to the Forward Executive Summary.
https://opa.hhs.gov/gender-dysphoria-report
This is the link to the Forward and Executive Summary.
https://opa.hhs.gov/sites/default/files/2025-05/gender-dysphoria-report-exec-summary.pdf
This is the link to the full report. It is 409 pages.
https://opa.hhs.gov/sites/default/files/2025-05/gender-dysphoria-report.pdf
You can see that it draws much the same conclusions as the Cass Report in Britain about so-called “gender affirming care.” [I have a link to my review of the Cass Report after the following “Forward and Executive Summary.”]
This is from the White House webpage.
There has been hostile reactions, but again, in Britain and other places that has been concerns what is happening with so-called “gender affirming” care.
I have a section reporting on reactions following the report.
BEGINNING OF REPORT
Foreword
Over the past decade, the number of children and adolescents who question their sex and identify as transgender or nonbinary has grown significantly. Many have been diagnosed with a condition known as “gender dysphoria” and offered a treatment approach known as “gender-affirming care.” This approach emphasizes social affirmation of a child’s self-reported identity; puberty suppressing drugs to prevent the onset of puberty; cross-sex hormones to spur the secondary sex characteristics of the opposite sex; and surgeries including mastectomy and (in rare cases) vaginoplasty. Thousands of American children and adolescents have received these interventions.
While sex-role nonconformity itself is not pathological and does not require treatment, the use of pharmacological and surgical interventions as treatments for pediatric gender dysphoria has been called “medically necessary” and even “lifesaving.” Motivated by a desire to ensure their children’s health and well-being, parents of transgender-identified children and adolescents often struggle with how best to support them. Many of these children and adolescents have co-occurring psychiatric or neurodevelopmental conditions, rendering them especially vulnerable. When they seek professional help, they and their families should receive compassionate, evidence-based care tailored to their specific needs.
Society has a special responsibility to safeguard the well-being of children. Given that the challenges faced by these patients intersect with deeply contested issues of moral and social significance—including social identity, sex and reproduction, bodily integrity, and sex-based norms of expression and behavior—the medical practices that have recently emerged to address their needs have become a focus of significant controversy.
This Review is published against the backdrop of growing international concern about pediatric medical transition. Having recognized the experimental nature of these medical interventions and their potential for harm, health authorities in a number of countries have imposed restrictions. For example, the UK has banned the routine use of puberty blockers as an intervention for pediatric gender dysphoria.
Health authorities have also recognized the exceptional nature of this area of medicine. That exceptionalism is due to a convergence of factors. One is that the diagnosis of gender dysphoria is based entirely on subjective self-reports and behavioral observations, without any objective physical, imaging, or laboratory markers. The diagnosis centers on attitudes, feelings, and behaviors that are known to fluctuate during adolescence.
Additionally, the natural history of pediatric gender dysphoria is poorly understood, though existing research suggests it will remit without intervention in most cases. Medical professionals have no way to know which patients may continue to experience gender dysphoria and which will come to terms with their bodies.
Nevertheless, the “gender-affirming” model of care includes irreversible endocrine and surgical interventions on minors with no physical pathology. These interventions carry risk of significant harms including infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret. Meanwhile, systematic reviews of the evidence have revealed deep uncertainty about the purported benefits of these interventions.
The controversies surrounding the medical transition of minors extend beyond scientific debate; they are deeply cultural and political. Public discourse is dominated by intensely polarizing narratives. Some view the medical transition of minors as a pressing civil rights issue, while others regard it as a profound medical failure and a sobering reminder that even modern medicine is vulnerable to serious error. In the midst of this highly charged debate, children and adolescents, and their families—who seek only to support their flourishing—have found themselves caught between competing perspectives. They require, and are entitled to, accurate, evidence-based information to guide their decisions.
This Review of evidence and best practices was commissioned pursuant to Executive Order 14187, signed on January 28, 2025. It is not a clinical practice guideline, and it does not issue legislative or policy recommendations. Rather, it seeks to provide the most accurate and current information available regarding the evidence base for the treatment of gender dysphoria in this population, the state of the relevant medical field in the United States, and the ethical considerations associated with the treatments offered.
The Review is intended for policymakers, clinicians, therapists, medical organizations and, importantly, patients and their families. It summarizes, synthesizes, and critically evaluates the existing literature on best practices for promoting the health and well-being of children and adolescents with distress related to their sex or to social expectations associated with their sex. Treatment of adults constitutes a separate topic and is not addressed in this Review. A summary of the Review’s main findings is presented below.
Executive Summary
Part I: Background
• Gender dysphoria is a condition that involves distress regarding one’s sexed body and/or associated social expectations. Increasing numbers of children and adolescents in the U.S. and other countries are diagnosed with gender dysphoria. Internationally, there is intense disagreement about how best to help them.
• The term “rapid onset gender dysphoria” (ROGD) has been suggested to describe a new clinical presentation of gender dysphoria. Despite sharp disagreement about the concept’s validity, symptoms consistent with ROGD have been recorded in clinics in the U.S. and other countries.
• In the U.S., the current approach to treating pediatric gender dysphoria aligns with the “gender-affirming” model of care recommended by the World Professional Association for Transgender Health (WPATH). This model emphasizes the use of puberty blockers and cross-sex hormones, as well as surgeries, and casts suspicion on psychotherapeutic approaches for management of gender dysphoria.
• The understandable desire to avoid language that may cause discomfort to patients has, in some cases, given rise to modes of communication that lack scientific grounding, that presuppose answers to unresolved ethical controversies, and that risk misleading patients and families. This Review uses scientifically accurate and neutral terminology throughout.
• In many areas of medicine, treatments are first established as safe and effective in adults before being extended to pediatric populations. In this case, however, the opposite occurred: clinician-researchers developed the pediatric medical transition protocol in response to disappointing psychosocial outcomes in adults who underwent medical transition.
• The protocols were adopted internationally before the publication of the first outcome studies. In recent years, in response to dramatic shifts in the number and clinical profiles of minor patients, as well as to multiple systematic reviews of evidence, health authorities in an increasing number of countries have restricted access to puberty blockers and cross-sex hormones, and, in the rare cases where they were offered, surgeries for minors. These authorities now recommend psychosocial approaches, rather than hormonal or surgical interventions, as the primary treatment.
• There is currently no international consensus about best practices for the care of children and adolescents with gender dysphoria.
Part II: Evidence Review
• Evidence-based medicine is widely recognized by health authorities worldwide as the foundation of high-quality care. Consistent with its principles, this Review undertook a methodologically rigorous assessment of the evidence underpinning pediatric gender medicine.
• Specifically, this Review conducted an overview of systematic reviews—also known as an “umbrella review”—to evaluate the direct evidence regarding the benefits and harms of treatment for children and adolescents with gender dysphoria. Existing systematic reviews of evidence, including several that have informed health authorities in Europe, were assessed for methodological quality. The umbrella review found that the overall quality of evidence concerning the effects of any intervention on psychological outcomes, quality of life, regret, or long-term health, is very low. This indicates that the beneficial effects reported in the literature are likely to differ substantially from the true effects of the interventions.
• Evidence for harms associated with pediatric medical transition in systematic reviews is also sparse, but this finding should be interpreted with caution. Inadequate harm detection in pediatric gender medicine may reflect the relatively short period of time since the widespread adoption of the medical/surgical treatment model; the failure of existing studies to systematically track and report harms; and publication bias. Despite the lack of robust evidence from population level studies, important insights can be drawn from established knowledge about human physiology and the effects and mechanisms of the pharmacological agents used.
• The risks of pediatric medical transition include infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret.
Part III: Clinical Realities
• In the U.S., the most influe influential clinical guidelines for the treatment of pediatric gender dysphoria are published by WPATH and the Endocrine Society. A recent systematic review of international guideline quality did not recommend either guideline for clinical use after determining they “lack developmental rigour and transparency.”
• Problems with the development of WPATH’s Standards of Care, Version 8 (SOC-8) extend beyond those identified in the systematic review of international guidelines. In the process of developing SOC-8, WPATH suppressed systematic reviews its leaders believed would undermine its favored treatment approach. SOC-8 developers also violated conflict of interest management requirements and eliminated nearly all recommended age minimums for medical and surgical interventions in response to political pressures.
• Although SOC-8 relaxed the eligibility criteria for access to puberty blockers, cross-sex hormones, and surgeries, there is compelling evidence that U.S. gender clinics are not adhering even to those more permissive criteria.
• The “gender-affirming” model of care, as practiced in U.S. clinics, is characterized by a child-led process in which comprehensive mental health assessments are often minimized or omitted, and the patient’s “embodiment goals” serve as the primary guide for treatment decisions. In some of the nation’s leading pediatric gender clinics, assessments are conducted in a single session lasting two hours.
• The voices of whistleblowers and detransitioners have played a critical role in drawing public attention to the risks and harms associated with pediatric medical transition. Their concerns have been discounted, dismissed, or ignored by prominent advocates and practitioners of pediatric medical transition.
• U.S. medical associations played a key role in creating a perception that there is professional consensus in support of pediatric medical transition. This apparent consensus, however, is driven primarily by a small number of specialized committees, influenced by WPATH. It is not clear that the official views of these associations are shared by the wider medical community, or even by most of their members. There is evidence that some medical and mental health associations have suppressed dissent and stifled debate about this issue among their members.
Part IV: Ethical Considerations
• The principle of autonomy in medicine establishes a moral and legal right of competent patients to refuse any medical intervention. However, there is no corollary right to receive interventions that are not beneficial. Respect for patient autonomy does not negate clinicians’ professional and ethical obligation to protect and promote their patients’ health.
• The evidence for benefit of pediatric medical transition is very uncertain, while the evidence for harm is less uncertain. When medical interventions pose unnecessary, disproportionate risks of harm, healthcare providers should refuse to offer them even when they are preferred, requested, or demanded by patients. Failure to do so increases the risk of iatrogenic harm and reduces medicine to consumerism, threatening the integrity of the profession and undermining trust in medical authority.
• Proponents of pediatric medical transition claim that regret is vanishingly rare, while critics assert that regret is increasingly common. The true rate of regret is not known and better data collection is needed. That some patients report profound regret after undergoing invasive, life-changing medical interventions is clearly of importance. However, regret alone (just like satisfaction alone) is not a valid indicator of whether an intervention is medically justified. Patients may regret medically justified treatments or feel satisfied with unjustified ones.
• A natural response to the absence of credible evidence is to call for more and better research. Even if high quality research such as randomized controlled trials on pubertal suppression or hormone therapy were feasible, however, conducting it may conflict with well-established ethical standards for human subjects research.
Part V: Psychotherapy
• The rise in youth gender dysphoria and the corresponding demand for medical interventions have occurred against the backdrop of a broader mental health crisis affecting adolescents. The relationship between these two phenomena remains a subject of scientific controversy.
• Suicidal ideation and behavior are independently associated with comorbidities common among children and adolescents diagnosed with gender dysphoria. Suicidal ideation and behavior have known psychotherapeutic management strategies. No independent association between gender dysphoria and suicidality has been found, and there is no evidence that pediatric medical transition reduces the incidence of suicide, which remains, fortunately, very low.
• There is a dearth of research on psychotherapeutic approaches to managing gender dysphoria in children and adolescents. This is due in part to the mischaracterization of such approaches as “conversion therapy.” A more robust evidence base supports psychotherapeutic approaches to managing common comorbid mental health conditions. Psychotherapy is a noninvasive alternative to endocrine and surgical interventions for the treatment of pediatric gender dysphoria. Systematic reviews of evidence have found no evidence of adverse effects of psychotherapy in this context.
END OF REPORT
Media responses
Science, May 2, 2025, “Researchers slam HHS report on gender-affirming care for youth.”
People who have a cash flow from trans research are upset is what the story really is.
Advocates for trans youth also expressed outrage at the report. The HHS report “is a rejection of decades of science, evidence, and direct experiences by young people, their doctors, and their families,” says Casey Pick, who serves as the director of law and policy at the Trevor Project—a nonprofit organization focused on suicide prevention efforts for LGBTQ young people.
I did a report on the Trevor Project and in a spot check of 4 published papers, all 4 were at journals with Author Publishing Charges, and one of the journals was known as a predatory journal by some. I have a link to the post at the end of this post.
There are some legitimate criticisms. The authors aren’t given, and I don’t know of psychotherapy is any good either for gender dysphoria.
https://www.science.org/content/article/researchers-slam-hhs-report-gender-affirming-care-youth
NPR, May 2, 2025, “Health care for transgender children questioned in 400-page Trump administration report.”
They pointed out that the professional medical societies reject this report.
CNN, May 1, 2025, “Trump administration releases 400-page review of gender dysphoria treatment for youths but won’t say who wrote it.”
https://www.cnn.com/2025/05/01/health/gender-affirming-care-trump-review
The Guardian reports on it using scare quotes. You can also see how the use of the term “LGBTQ+” is used to obscure. Is the Trump administration anti-Gay or just against Trans ideology.
https://www.theguardian.com/us-news/2025/may/01/gender-dysphoria-report-review-nih
https://publications.aap.org/aapnews/news/32145/AAP-speaks-out-against-HHS-report-on-gender
New York Post was supportive of the report.
LGBTQXYZ+ media responses
The Advocate, May 2, 2025, “Trump HHS posts ‘so-called report’ pushing conversion therapy for trans kids.”
The Advocate is correct here, it is conversion therapy. Just let the kids grow up and define themselves. It would be important that decisions aren’t driven by other factors, but they don’t need psychotherapy either. If they are under distress, more than normal for teenagers, then a person to listen to them would be good. But no one, gender therapist or psychologists need a cash flow.
The Advocate is motivated to defend gender ideology and the so-called “gender affirming care.”
https://www.advocate.com/politics/trump-gender-affirming-care-report
Human Rights Campaign also points out the psychotherapy issue.
May 1, 2025, “Medical Experts & LGBTQ+ People Agree - Conversion Therapy is No Replacement for Health Care.”
Rejecting psychotherapy doesn’t make surgical intervention health care. This is a false opposite and a misdirection. But conversion therapy isn’t good.
Reflections
This is a big step in the rejection of gender theory, but I don’t think psychotherapy is likely to work either. The history of the field of psychology is the history of follies as I point out in a long forward in my post on the Cass Review. {See towards the end of this post.}
The process of critically reviewing gender ideas in the United States is entangled in the extremely partisan politics of the present. If Trump said 2+2 = 4, we would see editorials about why wasn’t clock arithmetic considered. (There is a such a thing) Likewise if Harris said 2+2 = 4 there would be Trump supporters rejecting that conclusion.
Again, it should be remembered that many of the conclusions are also in reports in Britain which are not right wing. The Times, The Economist, and other bodies have come to the conclusion that the science behind gender care is shoddy at best.
I don’t think any report will convince the Democrats of anything. I think the prospect of electoral defeat is what will likely change their thinking. Surely they are aware of the recent victories of the Reform Party over the Labor Party in Britain. This involved many factors, but trans issues were a part of it.
The suggestion of psychotherapy is a serious concern. Conversion therapy for one group could be conversion therapy for another.
It seems none of the gender ideologues have considered a future in which hundreds or thousands of young people who were Gay ended up being transed. It would be a ghastly thing and there voices will be anguished and bitter.
So we are between the whirlpool and the rock. (Greek mythological reference.)
It might be thought that some questions are resolvable based on science, but science can be as politicized as any other human endeavor.
Background information posts.
This post was about the Cass Report with a history of the follies of psychology.
This was a report on a spot check of four published papers by the Trevor Project.
All the transmen related posts are here.
