Update on HHS Review of Gender Dysphoria in Youth
The U.S. Department of Health and Human Services (HHS) on Wednesday provided an update to its May evaluation of evidence and best practices concerning children and teens experiencing gender dysphoria. This revision comes in response to feedback from prominent medical organizations, including the American Psychiatric Association (APA).
The document, titled “Treatment of Childhood Gender Dysphoria: A Review of Evidence and Best Practices,” was released through the Office of the Assistant Secretary of Health. Initially published on May 1, it stemmed from a directive issued by President Donald Trump aimed at reviewing the existing literature on effective practices for supporting children’s health amid claims of gender dysphoria.
The HHS evaluation compiled existing systematic reviews of medical interventions for youth dealing with gender issues. It raised “serious concerns” regarding treatments like puberty blockers, cross-sex hormones, and surgical procedures, noting possible risks such as infertility, sexual dysfunction, impaired bone growth, adverse cognitive effects, and even surgical complications.
The updated report includes contributions from nine professionals, including physicians and ethicists, along with a supplement that summarizes responses to nine reviews published after the original paper. It also addresses minor edits for clarity and disclosures regarding conflicts of interest.
Leor Sapir, a senior fellow at the Manhattan Institute, and Alex Byrne, a philosopher at MIT—both of whom contributed to the review—shared with Fox News Digital that the principal findings from the May report remained unchanged after a month of peer review. They pointed out that while evidence for pediatric transition care is “very weak,” evidence indicating potential harm is “stronger.”
Both expressed concerns that much of the research on gender medicine for youth suffers from methodological flaws and biases. They specifically noted, “Aside from a few exceptions, like the Finnish study, the existing research in this field tends to exaggerate benefits and underreport harms,” adding that many studies originate from the very clinics offering these treatments.
They also cautioned that even hypothetical stronger evidence would not eliminate ethical and diagnostic challenges, explaining that distinguishing between minors with enduring identity conflicts versus temporary distress is complex.
The World Professional Association for Transgender Health (WPATH), along with other organizations such as the American Academy of Pediatrics and APA, criticized the May report, claiming it misrepresented medical consensus and lacked transparency in authorship.
In its update, HHS indicated it had invited the AAP and other groups to partake in the peer review of the report, but only the APA accepted the invitation. The APA’s review criticized HHS for its opaque methodology, arguing it makes the conclusions questionable.
HHS responded that its process, detailed in the report’s appendix, had been reviewed by two external experts who deemed the methodology “robust.” They also claimed that the APA overlooked some studies in its critique.
Sapir and Byrne expressed disappointment at the AAP and Endocrine Society’s decision not to collaborate, calling it a “missed opportunity” for engaging in the discussion. They emphasized the need for solid medical care for children and lamented the stance of medical associations that refuse to answer scientific critiques.
The report has sparked varied reactions in the medical community. While some emphasize the need for evidence-based care for transgender youth, concerns persist about the implications of certain treatments and the necessity of tailored health plans that consider individual needs fully.
The report highlights how rare these interventions are, revealing that less than 1 in 1,000 commercially insured adolescents in the U.S. received such treatments between 2018 and 2022, according to a January 2025 study from Harvard University.
A spokesperson from the Endocrine Society noted their support for accessible evidence-based healthcare for transgender youth while also emphasizing the importance of individualized treatment plans, taking into account that puberty-delaying drugs may be necessary for some.
In light of the recent developments, the conversation surrounding pediatric gender care continues, reflecting both a need for robust medical framework and the complex realities faced by transgender minors and their families.
