Editorial: HHS gender report is harmful for trans youth

A new report commissioned by the U.S. Department of Health and Human Services on pediatric gender dysphoria does about what one would expect: muddies the science, cherry picks evidence and, most troublesome, does not disclose who wrote it. The report, completed to comply with President Donald Trump’s executive order that aims to restrict gender-affirming care for youth, also seems to promote conversion therapy, which has long been debunked by major medical associations.

“The evidence for benefit of pediatric medical transition is very uncertain, while the evidence for harm is less uncertain,” the report stated. “When medical interventions pose unnecessary, disproportionate risks of harm, health care providers should refuse to offer them even when they are preferred, requested or demanded by patients.”

“This Review is published against the backdrop of growing international concern about pediatric medical transition,” the report’s forward stated. “Having recognized the experimental nature of these medical interventions and their potential for harm, health authorities in a number of countries have imposed restrictions. For example, the UK has banned the routine use of puberty blockers as an intervention for pediatric gender dysphoria.”

HHS’ decision to withhold the names of the report’s authors is problematic. According to the agency, eight scholars contributed to the report, including doctors, ethicists, and a methodologist. They represented a “wide range of political viewpoints,” including liberal, according to HHS.

As the Washington Post reported, “Harry Dayantis, a spokesman for Cochrane Collaboration, an international nonprofit that produces what scientists consider the premier systematic literature reviews, said the lack of disclosure prohibits an assessment of possible conflicts of interests.”

Additionally, just because someone identifies as liberal does not mean they are trans-friendly. Witness California Governor Gavin Newsom, a liberal Democrat by any definition, who on his podcast bailed on trans girls and women playing sports on teams that match their gender identity. Trans issues have not gained the widespread public support among Democrats as have other LGBTQ issues, and that’s a problem that the party must address.

Conversion therapy by another name
One of the report’s most dodgy areas concerns conversion therapy, which the authors rebrand as “exploratory therapy.” But make no mistake, conversion therapy, which seeks to change a person’s sexual orientation or gender identity, has a long and hideous history. LGBTQ people who experience it, often at the insistence of their parents at a young age, generally have awful memories and trauma associated with it. And while states like California ban the practice for minors, the HHS report gives new life to this quack concept.

“Psychotherapy is one of five dedicated parts in the review and a theme that receives significant attention is support for gender identity conversion based practices, sometimes called ‘conversion’ or ‘reparative’ ‘therapy,’ which the report calls ‘exploratory therapy,’” noted the Kaiser Family Foundation in an article. “The report counters this description stating that equating ‘exploratory therapy’ with ‘conversion therapy’ is misguided and that equating any ‘approach focused on reducing a minor’s distress about their body or social role [with conversion therapy] is problematic.’ Other reasons provided are: pointing to Dutch practices, stating that all therapy is exploratory, and noting that the label ‘conversion therapist’ is damaging.”

The Kaiser Family Foundation noted, “The review describes ‘exploratory psychotherapy,’ in part, as ‘trying to help children and adolescents come to terms with their bodies’ and goes on to equate the distress related to gender dysphoria with general ‘discomfort with the sexed body or with societal sex-based expectations is common during puberty and adolescence.’ This goes against identified best practice, which ‘encourages an affirmation and acceptance of children’s expressed gender identity.’”

The World Professional Association for Transgender Health and the U.S. Professional Association for Transgender Health issued a critical joint statement on the report. The organizations stated the report “misrepresents existing research and disregards the expertise of professionals who have been working with transgender and gender-diverse youth for decades.”

“The HHS report claims that psychotherapy is the only viable treatment for youth with gender dysphoria – a position we firmly reject,” WPATH and USPATH stated. “Moreover, it misrepresents WPATH by suggesting that it equates conversion therapy with psychotherapy, a notion we unequivocally oppose. WPATH supports a comprehensive, multidisciplinary assessment, ensuring that mental health professionals evaluate and address any co-occurring mental health conditions in youth who are exploring their gender identity and options for treatment.”

WPATH noted that its clinical practice guidelines, including its Standards of Care Version 8 (SOC8), are developed through evaluation of evidence, clinical expertise, patient values and preferences, and cultural and contextual considerations.

“SOC8 emphasizes ongoing research into outcomes for transgender youth while advocating for developmentally appropriate clinical services,” the organization stated. “Efforts to halt research funding and ban gender-affirming interventions threaten the health and dignity of transgender individuals and hinder medical progress. Health care decisions should remain in the hands of patients, their families, and qualified clinicians – not politicians.”

And that bottom line is exactly what the Trump administration and HHS Secretary Robert F. Kennedy Jr. don’t want. Already, hospitals that provide gender-affirming care scaled back their services dramatically after the executive order was issued. (Some services have since been reinstated.) But it’s that fear of running afoul of the president, who does not have a medical background – nor does Kennedy – that is potentially causing harm to trans kids and their families. Already, as the Kaiser Family Foundation noted, 27 states have banned gender-affirming care for youth.

While more evidence is needed on gender-affirming care, the only way that data will be compiled is to do rigorous, ethical studies with outcomes that patients experience. The HHS report is putting forward an agenda of preventing transgender youth from transitioning. We strongly disagree with that premise. Over the years covering the LGBTQ community, we have written countless stories and talked with trans and gender-nonconforming youth and the struggles they often face, even with supportive parents. These young people want to live their lives as they identify. The HHS report makes that all but impossible.