On Thursday, the Department of Health and Human Services published a 400-page document entitled "Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices."
The review's authors are not being named by HHS. According to a press release, the names "are not initially being made public in order to help maintain the integrity" of a post-publication peer review process. HHS did not immediately respond to NPR's questions about the number of authors, their professional backgrounds, and their affiliations.
The current approach for transgender youth, endorsed by all major medical associations in the U.S., is to affirm a young person's gender identity and give their family the option of medical interventions like puberty blockers and hormone therapy.
The report describes that approach as fundamentally misguided. Its authors conclude that doctors and clinics that provide gender-affirming care have "fallen short of their duty to prioritize the health interests of young patients."
White House Deputy Chief of Staff Stephen Miller used the term "barbaric" when describing gender-affirming medical interventions at the White House on Thursday. "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," he said during a press conference on Thursday.
In a statement, Dr. Susan Kressly, president of the American Academy of Pediatrics, wrote that the organization is "deeply alarmed" by the new HHS document. "This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care," she wrote. She asserted that the report was not credible because it relied "on select perspectives and a narrow set of data."
She added that AAP was not consulted on the report, but that its recommendations were "inaccurately" characterized throughout. (The official AAP recommendation says, in part, that transgender youth should "have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space.")
The report's conclusion that gender-affirming care for youth should be curtailed is not surprising given that the report was commissioned in an executive order entitled "Protecting Children From Chemical and Surgical Mutilation." It reads: "Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child's sex through a series of irreversible medical interventions." This trend, it continues, "must end."
On the campaign trail, President Trump and the Republican party spent more than $200 million on anti-trans television ads. Since taking office, Trump has moved swiftly to target schools and hospitals that affirm transgender youth, to limit the participation of trans people in sports and the military, to require that passports reflect a person's sex at birth and to cancel millions in funding for LGBTQ+ health research. Some of these efforts have been blocked in the courts.
The HHS report describes transition-related medical care for young people as being too readily available, but more than half of U.S. states have banned it. The Supreme Court is set to rule this spring on a challenge to Tennessee's ban on gender-affirming care for youth.
In tone and form, the HHS report mirrors the Cass Review, published in the U.K. last year and commissioned by the National Health Service. (The name "Cass" is cited 149 times in the HHS report.) Like the new HHS report, the review submitted by Dr. Hilary Cass, looks at available evidence and concludes the benefits of gender-affirming care are overstated. But Cass was also the public face of the review process, and she spent four years conducting interviews with transgender young people, parents and clinicians to prepare the report. HHS did not respond to NPR's questions about how long its lengthy report had been in the works.
"The purpose of this piece of propaganda is to give the veneer of science," says a physician who provides gender-affirming care in a state where it remains legal. NPR agreed not to name the doctor because they did not have permission from their employer to speak with the media, and because they fear for their safety.
The doctor added that the anonymous authors of the report and the politicians who commissioned it "have already said what they think — they don't think being trans is real, they don't think that trans people should be allowed to do what they want with their bodies, they think that gender is this immutable concept, and they have absolutely no curiosity about whether that might not be true for everybody."
On social media, Kristen Waggoner, president of the Christian legal group Alliance Defending Freedom, praised the report and said 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."
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