‘Gender-Affirming Care’ Proponents Had a Chance to Pick Apart a Critical HHS Report. They Didn’t Have Much to Say

The Department of Health and Human Services published a rapid review in May of the academic literature focused on “gender-affirming care” for minors, and concluded 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.” On Wednesday, the HHS published responses to peer reviews of the report — and although some minor corrections have been issued, the report’s major medical findings were not disproven.

“They were given the chance to show mistakes, show errors. And they were not able to identify any,” Leor Sapir, one of the researchers who worked on the report, told the New York Post. “They had some minor comments here and there, but nothing that gets to the main findings about evidence and ethics.”

In an executive order issued on January 28, President Trump announced that the HHS would publish a review of “the existing literature on best practices for promoting the health of children who assert gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion” within 90 days.

The HHS report, released on May 1, evaluated 17 systematic reviews and concluded that the existing literature suffers from methodological flaws such as small sample sizes and a lack of appropriate comparison groups. Additionally, the HHS report found that the studies on medicalized transition for children often neglected to appropriately consider harms and long-term effects.

“The ‘gender-affirming’ model of care includes irreversible endocrine and surgical interventions on minors with no physical pathology,” the May 1 edition of the report said. “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.”

When the HHS report was published in May, it was quickly condemned by LGBTQ+ organizations and some medical associations. For example, the American Academy of Pediatrics issued a statement saying it was “deeply alarmed” by the “inaccurate” and “misleading” HHS report — just hours after the 400+ page document was released.

“Patients, their families, and their physicians — not politicians or government officials  — should be the ones to make decisions together about what care is best for them based on evidence-based, age-appropriate care,” the American Academy of Pediatrics said shortly after the HHS report was initially released. At its annual conference last month, the American Academy of Pediatrics held a breakout session focused specifically on promoting gender ideology to children,

In documents published on Wednesday by the HHS, the researchers say that the American Academy of Pediatrics, the American Psychiatric Association, and the Endocrine Society were among those invited to participate in the peer review — but of the three medical organizations, only the American Psychiatric Association accepted the opportunity.

In its review, the American Psychiatric Association suggests that the HHS report suffers from poor methodology and fails to clarify how the studies were selected for review; the association concludes its peer review by listing 16 studies for consideration. In its response, the HHS research team states that twelve of those 16 studies are in fact discussed in the report. Of the remaining four studies, three do not pertain to gender-related medicine and its outcomes in youth, while the fourth unmentioned study was published after the HHS report. The HHS report has been updated to include a discussion of the fourth study.

Contrary to the American Psychiatric Association’s arguments, other peer reviews acknowledged the methodological rigor of the HHS report. Jonathan Bester, a former medical practitioner and current academic focusing on bioethics, said in his review that the HHS report is “an important and timely work” that is “well written, methodologically rigorous, and makes a significant contribution to the discussion on this topic.” Richard Santen, former president of the Endocrine Society and current professor at the University of Virginia, offered praise for the umbrella review, writing that it is “particularly helpful as it covers an extensive volume of data and provides an assessment of the level of validity of each review,” and concludes that “the overall assessment of these studies was scientifically sound.” Two affiliates of the Belgian Centre for Evidence-Based Medicine, Patrik Vankrunkelsven and Trudy Bekkering, wrote in their review that the HHS report used “robust methods” and stated that “We have no major remarks on the study design, nor on the conclusions.”

Eight academics and medical professionals co-authored a review in the Journal of Adolescent Health and criticized the HHS report as “a dangerous example of government incursion into the provision of evidence-based medical care.” They further suggest the HHS report is an example of “violations of scientific norms,” “misrepresentation of scientific evidence,” “selective misuse of research,” and “mischaracterization of gender identity in youth and the standard of care.” The journal’s article also claims that the HHS report contains a “recommendation of nonevidence-based conversion practices.”

The HHS researchers responded by stating that the Journal of Adolescent Health article selectively quoted and mischaracterized the report; the HHS also pointed out that none of the contributors are employees of the Trump administration, the report’s conclusions resulted from a reproducible methodology, and that the paper adhered to scholastic standards. Furthermore, the HHS says “the claim that the Review recommends conversion practices is false,” and acknowledges that the American Psychiatric Association did not object to the psychotherapy discussions in its peer review.

Another unsolicited review, published in Sexuality Research and Social Policy, also suggests that the HHS report “promotes a harmful practice known as ‘exploratory therapy,’” which has been described elsewhere as “a form of conversion therapy encouraging a child or adolescent to accept the gender associated with their sex designated to them at birth.” The author cited for this claim in the Sexuality Research and Social Policy article is Florence Ashley, a self-described “biorg witch with flowers in their hair” and also a “transfeminine jurist, bioethicist, public speaker, and activist” whose academic articles include “Genderf***ing as a Critical Legal Methodology.” Ashley has previously endorsed expansive access to gender-related medical interventions for minors, writing that  “Unbounded social transition and ready access to puberty blockers [for “trans youth”] ought to be treated as the default option, and support should be offered to parents who may have difficulty accepting their youth.”

The researchers made minor clarifications and corrections to the original document, such as revising inaccurate citations and mislabeled graphs.

“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. in a press release. “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.”