Oswald Clark:

On May 1, the Department of Health and Human Services (HHS) released a comprehensive 409-page review, “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” which found gender-affirming interventions such as puberty blockers, cross-sex hormones, and sex reassignment surgeries are supported only by low- or very low-quality evidence, while the potential for irreversible harm is substantial.

A review of 17 systemic and meta-studies on gender medicine, reviewed the evidence and ethical implications of pediatric gender medicine. The report was hailed by pro-family groups as a long overdue recognition that there is little scientific or medical evidence supporting so-called gender treatment.

The review found that studies that do support “gender-affirming care” have either small sample sizes or suffer numerous design flaws, and that without the evidence backing radical treatment for minors, it is irresponsible to proceed with interventions considering the serious long-term health implications.

HHS press secretary Vianca Rodriguez Feliciano told The Daily Signal that “HHS is committed to protecting children and restoring the federal government’s commitment to follow the gold standard of science.” She stressed that the report shows “there is extremely weak evidence that puberty blockers, cross-sex hormones, or surgeries have any benefits in children and adolescents with gender dysphoria” while at the same time, “the risks—particularly permanent harm like infertility—are becoming increasingly undeniable.”

Furthermore, the review says there is no high-quality evidence to support the common assertion that gender transition reduces suicidality among trans self-identifying youth.

The review found that most children will grow out of their gender dysphoria: “The natural history of pediatric gender dysphoria is poorly understood, though existing research suggests it will remit without intervention in most cases.” It added, “Medical professionals have no way to know which patients may continue to experience gender dysphoria and which will come to terms with their bodies.” Therefore, the HHS report said that the first line of treatment for youth with gender dysphoria should be psychotherapy, not a rush to affirm the gender confusion.

The review stated that gender-affirming model of treatment includes “irreversible endocrine (hormonal) and surgical interventions on minors with no physical pathology” and “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.”

Based on the existing systemic reviews, the HHS concluded the evidence has “revealed deep uncertainty about the purported benefits of these interventions.”

There is also a “dearth of research” on the alternatives to gender-affirming treatment, the HHS found, saying that “psychotherapeutic approaches to managing gender dysphoria in children and adolescents” are mischaracterized as “conversion therapy” which many jurisdictions have outlawed.

The review concluded, “while no clinician or medical association intends to fail their patients – particularly those who are most vulnerable – the preceding chapters demonstrate that this is precisely what has occurred.”

The review vaguely noted “thousands of American children and adolescents have received” the “gender-affirming care” based on no more than “social affirmation of a child’s self-reported identity.” In many cases, “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” are provided with minimal oversight. One number that is quoted is 3500 minors, which critics of gender-affirming care reckon is too low.

Colin Wright of the Manhattan Institute said, “The chapter on terminology is especially significant,” because it rejected “euphemistic language” and insisted “on terminological clarity.” For example, it “calls out the concept of ‘gender identity’ as scientifically ill-defined, noting that it lacks a stable, observable referent and is inconsistently used even within affirming literature.”

The HHS review also critiques terms such as “sex assigned at birth,” “cis,” and “trans.” The authors argued that describing a child as “trans” presupposes the correctness of the gender-identity claim.

The report pointed out that World Professional Association for Transgender Health (WPATH), held up as experts on gender medicine, is ideologically driven and ignores any sense of caution in its Standards of Care (Version 8) by supporting medicalization – that is hormonal or surgical interventions — based on self-declared identity.

The HHS review is not a clinical guideline and it does not make any legislative or policy recommendations. It provides ample evidence that experimental “gender-affirming care” likely causes more harm than good for minors.

Dr. Stanley Goldbarb of Do No Harm, said the HHS review brought “needed scrutiny to the gender industry.” He said children are used as pawns by “gender activists” and that the report “makes clearer now than ever that we must end this misguided practice and replace it with evidence-based treatment for gender-confused kids.”

In 2023, the Cass Report in the United Kingdom came to the same conclusion that gender medicine is not supported by high-quality research; the British government subsequently restricted gender-transitioning for youth.

The health ministries of countries including Finland, Norway, and Sweden have likewise curtailed facilitating gender transition treatments for youth considering there is little science to recommend it. Colin Wright of the Manhattan Institute said those four countries have “moved away from the ‘gender-affirming’ model and toward cautious psychological support for gender-dysphoric children,” because of “growing evidence of the harm and weak benefits.”

The report was widely criticized by groups that support gender medicine, including the American Academy of Pediatrics (AAP) and WPATH. AAP president Susan Kressly simply dismissed the report’s findings, saying it “fails to reflect the realities of pediatric care.”

Wright said, “If the HHS report has a major shortcoming, it is that it does not go far enough in dismantling the pseudoscience at the heart of gender medicine.” He said, “While it rightly criticizes the ill-defined notion of ‘gender identity,’ it could have said more about the deeply flawed concept of ‘brain sex’ that underpins much of gender-affirming care.” Wright, an evolutionary biologist, has argued, “studies claiming that transgender individuals have brains like those of the opposite sex suffer from serious flaws, particularly the failure to control for sexual orientation.”