The U.S. Department of Health and Human Services has released a 400-page report rejecting gender-affirming care for minors and recommending “exploratory psychotherapy” instead as the preferred way to treat transgender youth suffering from gender dysphoria.
Critics say “exploratory psychotherapy” is just conversion therapy by another name.
The report was crafted by unnamed authors in response to a Trump executive order prohibiting gender-affirming care for anyone under age 19 and using federal funds to cover the cost of such procedure.
It claims there’s a lack of evidence supporting medical interventions like puberty blockers, hormone therapy, and surgery and warns of the potential negative health consequences of pursuing such treatments.
The report notes in a forward that it does not serve as clinical guidance and does not make any policy recommendations.
It also notes its limitations, focusing only on the impact of gender-affirming treatments on minors rather than adults. However, it claims to have summarized and “critically evaluate[d]” the existing literature on “best practices” for treating youth with gender dysphoria.
An HHS statement said medical doctors, medical ethicists, and a methodologist contributed to the report but declined to reveal the names of those involved “to help maintain the integrity of this process.”
“Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions,” National Institutes of Health Director Dr. Jay Bhattacharya said in a statement. “We must follow the gold standard of science, not activist agendas.”
The HHS report also attacked the World Professional Association for Transgender Health and several major U.S. medical associations for their statements supporting gender-affirming care, accusing those organizations of “creating a perception of professional consensus” where one does not exist, and of suppressing the views or opinions of opponents of gender-affirming care.
The report cites the Cass Review, a United Kingdom report that concluded there was a lack of evidence to support using medical interventions like puberty blockers and hormone therapy to treat gender dysphoria among youth.
That landmark report led the National Health Services England to stop prescribing such treatments for adolescents, except in rare clinical trials. Experts have expressed concerns with the methodology of the Cass Report and have criticized it for omitting other studies that purport to show the benefits of hormonal interventions.
Critics of the HSS report claim it presents a stilted and biased view of gender-affirming care and is really more of a political document than a scientific one.
Dr. Susan Kressly, the president of the American Academy of Pediatrics, said the report “misrepresents the current medical consensus and fails to reflect the realities of pediatric care.”
Other critics have criticized the HHS report for claiming that pursuing gender-affirming care is a “child-led” process in which mental health assessments are “often minimized or omitted.” Rather, some practitioners say that most doctors are cautious and take a conservative, deliberate approach to treating youth with gender dysphoria before starting them on the path to hormonal or surgical intervention.
Critics also take issue with the HHS reports assertion that “many” transgender youth have received gender-affirming care, noting that a recently published five-year study of youth on commercial insurance found that fewer than 0.1% of adolescents in the United States received either puberty blockers or hormones.
A separate study looking at the frequency of gender-affirming surgeries found that fewer than 1,200 youth received gender-affirming surgeries in a single year, prior to the COVID-19 pandemic.
The HHS report has drawn comparisons to 2022 guidance from the Florida Department of Health that recommended against connecting minors with treatments used to assist in a gender transition, even going so far as to discourage “social transition,” in which no medical procedures are undertaken.
That guidance was subsequently used as the basis for both legislation and Department of Health rules aimed at limiting access to, and taxpayer funding for, hormonal and surgical interventions — with the latter not only applying to youth but to adults seeking out such care.
“It’s very chilling to see the federal government injecting politics and ideology into medical science,” Shannon Minter, the legal director at the National Center for Lesbian Rights, told the Associated Press, suggesting that the report is intended to intimidate doctors from treating transgender minors and families from pursuing gender-affirming interventions.
“It’s Orwellian. It is designed to confuse and disorient.”
Casey Pick, the director of law and policy at The Trevor Project, the nation’s top suicide prevention and crisis intervention organization for LGBTQ youth, blasted the HHS report’s recommendations for “exploratory psychotherapy” for transgender youth.
Notably, the report’s authors go out of their way to insist that exploratory psychotherapy is not the same as conversion therapy, arguing that therapists who engage in the practice are only “trying to help children and adolescents come to terms with their bodies.”
“Discomfort with the sexed body or with societal sex-based expectations is common during puberty and adolescence. For this and other reasons, characterizing as ‘conversion therapy’ any approach focused on reducing a minor’s distress about their body or social role is a problematic and potentially harmful rhetorical device,” the report reads.
Pick says that practitioners often go in with their own biases and intentions, with a predetermined outcome in mind for patients — namely, convincing dysphoric youth to remain in and adhere to gender norms based on their assigned sex at birth.
“This report not only rejects health care best practices for transgender people — it goes a step further by recommending conversion therapy, though under a new, rebranded name,” Pick told USA Today. “Despite the report’s claims, this is, in fact, the same harmful practice of conversion therapy, just using friendlier language.”
President Donald Trump falsely claimed on Friday that American hospitals are performing "reverse surgery" on transgender people at his direction.
"ospitals now are doing reverse surgery at my order," Trump told supporters during an August 21 rally for Republican U.S. Senate candidate Darline Graham at the Myrtle Beach Convention Center in South Carolina. "They're doing reverse surgery. Nobody ever heard about it."
It is unclear what Trump meant. Upon taking office last year, he issued an executive order prohibiting federal funds from being used to cover gender-affirming treatments for people under age 19.
Point of Pride, a trans-led nonprofit that provides financial aid and direct health services to transgender youth and adults, has opened applications for its Thrive Fund, which helps trans people with expenses not covered by the organization's other programs.
Established in 2024, the Thrive Fund helps cover expenses beyond the nonprofit's existing services, which range from free chest binders and femme shapewear to financial assistance for transition-related surgery, hormone therapy, and electrolysis.
Thrive Fund grants can cover non-medical transition-related expenses, including legal fees for name and gender marker changes, fertility preservation, vocal therapy, and medical tattooing used to restore skin pigmentation or conceal scars from gender-affirming surgery. Applicants may request up to $2,500 at a time.
New Jersey Gov. Mikie Sherrill has signed a "shield law" protecting people who seek reproductive and transgender health care. The law also bars state officials from assisting with out-of-state investigations of those who travel to New Jersey for such care.
The bill passed the New Jersey General Assembly and State Senate on party-line votes in June. It prohibits state officials from extraditing people who are under investigation in other states for accessing or allowing their children to access abortion-related or transgender-related health services.
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