HHS Doubts Benefit of Gender-Affirming Care for Children (2)

Gender-affirming care for children is under heightened scrutiny by the Trump administration in a US Department of Health and Human Services review of treatment.

The HHS review released Thursday finds “very weak evidence of benefit” of medical interventions for adolescents and children with gender dysphoria, according to a statement from the department. The review, the HHS said, “makes clear” that evidence doesn’t support medical intervention for children.

“Our duty is to protect our nation’s children—not expose them to unproven and irreversible medical interventions,” Jay Bhattacharya, director of the HHS’ National Institutes of Health, said in a statement.

“We must follow the gold standard of science, not activist agendas,” Bhattacharya said.

The 400-plus page report, which drew a quick rebuttal from medical professionals and advocates, follows a host of actions since the Trump administration took actions seen by critics as targeting transgender people. It was commissioned via a January executive order blocking federal departments from facilitating gender-affirming treatment for children.

According to the report’s executive summary, gender-affirming care as practiced in the US is “a child-led process in which comprehensive mental health assessments are often minimized or omitted, and the patient’s ‘embodiment goals’ serve as the primary guide for treatment decisions.”

“U.S. medical associations played a key role in creating a perception that there is professional consensus in support of pediatric medical transition. This apparent consensus, however, is driven primarily by a small number of specialized committees,” the HHS said. “There is evidence that some medical and mental health associations have suppressed dissent and stifled debate about this issue among their members.”

The American Academy of Pediatrics pushed back on the HHS’ report.

Susan Kressly, AAP president, said in a statement that the report “misrepresents the current medical consensus and fails to reflect the realities of pediatric care.”

“AAP was not consulted in the development of this report, yet our policy and intentions behind our recommendations were cited throughout in inaccurate and misleading ways. The report prioritizes opinions over dispassionate reviews of evidence,” Kressly said.

Swift Backlash

Advocacy groups also decried the report as politically motivated, misrepresenting science, and harmful to transgender people.

The Human Rights Campaign, an LGBTQ interest group, said in a statement that the report “had a predetermined outcome dictated” by executive order.

The HRC also said the report tries laying “the groundwork to replace that best-practice medical care for transgender and non-binary people with ‘gender exploratory therapy,’” which it says is just another name for conversation therapy.

“They can slap another name on it, but we know conversion therapy, because many LGBTQ+ people have been subjected to it and still bear the consequences of it today,” HRC chief of staff Jay Brown said in a statement. “We cannot and will not allow another generation of young people to bear this burden.”

Casey Pick, director of law and policy at the Trevor Project, a nonprofit for LGBTQ youth suicide prevention, said in a statement that recommendations in the report “seemingly have no basis in following established health care best practices, science, or input from providers who actually administer the type of health care in question.”

“Gay people are gay. Transgender people are transgender. We urge this administration to respect and support people for who they are – and to let families and doctors make decisions based on what keeps people healthy, not government ideology,” Pick said.

The HHS in its report says there’s “a dearth of research on psychotherapeutic approaches to managing gender dysphoria in children and adolescents,” partially due “to the mischaracterization of such approaches as ‘conversion therapy.’”

The department also argues that therapists fear being labeled conversion therapists given “the profession’s history with the mistreatment of gay people,” and that equating conversion therapy with exploratory therapy is “misguided.”

Report Intentions

The HHS noted its review wasn’t a clinical practice guideline and that it didn’t issue policy or legislative recommendations. The department did, however, note that the target audience was therapists, policymakers, and others.

But Omar Gonzalez-Pagan, counsel and health-care strategist at Lambda Legal, saw the report, alongside other administration efforts, as indication the HHS wants “to eliminate coverage” for gender-affirming care.

“They want to regulate coverage as it pertains to Medicare and Medicaid. They want to eliminate funding for any entity that provides this care,” Gonzalez-Pagan said. Lambda Legal backed a lawsuit that secured a preliminary injunction blocking Trump’s health agencies from withholding federal money from entities providing gender-affirming care for people under 19.

Health policy research organization KFF says that 27 states have enacted laws or policies that limit gender affirming care access for youth.

Kellan Baker, executive director of the Institute for Health Research and Policy at community health group Whitman-Walker, said the HHS report serves as “one of the justifications that the federal government and the states will use to attempt to subvert the actual standards of care.”

For states that have bans rather than having “nuanced conversations between healthcare providers and families and patients and make really, really careful decisions on the basis of the evidence,” the HHS review “is the type of justification that the states will now point to retroactively to say, ‘See?’”