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Yesterday, the U.S. Department of Health and Human Services (HHS) published Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, its peer-reviewed study of the medical dangers posed to children from attempts to change their biological sex.
The report, released through the Office of the Assistant Secretary for Health, finds that the harms from sex-rejecting procedures — including puberty blockers, cross-sex hormones, and surgical operations — are significant, long term, and too often ignored or inadequately tracked. These conclusions confirm President Trump’s Make America Healthy Again Commission’s findings that unnecessary procedures and long-term health risks such as infertility are the byproduct of the overmedicalization of children.
“The American Medical Association and the American Academy of Pediatrics peddled the lie that chemical and surgical sex-rejecting procedures could be good for children,” said Health and Human Services Secretary Robert F. Kennedy, Jr. “They betrayed their oath to first do no harm, and their so-called ‘gender-affirming care’ has inflicted lasting physical and psychological damage on vulnerable young people. That is not medicine — it’s malpractice.”
“This report marks a turning point for American medicine,” said National Institutes of Health Director Jay Bhattacharya, MD, PhD. “The evidence in it meticulously documents the risks the profession has imposed on vulnerable children. At the NIH, we are committed to ensuring that science, not ideology, guides America’s medical research.”
“What are we going to tell the young people who can’t have children because the medical profession stole that from them?” said Assistant Secretary for Health Brian Christine, MD. “Our report is an urgent wake up call to doctors and parents about the clear dangers of trying to turn girls into boys and vice-versa.”
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.”
Unfortunately, many gender-confused children and adolescents have co-occurring psychiatric or neurodevelopmental conditions (e.g., autism), rendering them especially vulnerable.
On top of 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.
Making matters even worse, 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, and there has been inadequate research into the frequency and severity of these harms.
The controversies surrounding the medical transition of minors extend beyond scientific debate; they are deeply cultural and political. The polarizing narratives frame gender care either as a pressing "civil rights" issue or a profound medical failure and a sobering reminder that even modern medicine is vulnerable to serious error.
The current approach to treating pediatric gender dysphoria aligns with the discredited and controversial “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.
In many areas of medicine, treatments are first established as safe and effective in adults before being extended to pediatric populations. In case of "gender care," 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. Since then, many 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.
There is currently no international consensus about best practices for the care of children and adolescents with gender dysphoria, and there are problems with the development of WPATH’s Standards of Care, Version 8 (SOC8).
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.
SOC-8 relaxed the eligibility criteria for access to puberty blockers, cross-sex hormones, and surgeries. Furthermore, 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 warnings of gender clinic 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.
There is evidence that some medical and mental health associations have suppressed dissent and stifled debate about this issue among their members.
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.
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.
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.
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