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.”
Mayoral candidate Zohran Mamdani has pledged to make New York City a sanctuary city for transgender people.
In a new campaign ad honoring Latina trans activist Sylvia Rivera -- a pioneering figure in the early LGBTQ rights movement -- Mamdani sits at a desk near the Christopher Street Pier in Greenwich Village, recounting Rivera’s life and the pier’s significance as a haven for LGBTQ people in the city.
As photos and video clips of Rivera and other activists flash across the screen, Mamdani recounts her legacy of activism -- from her role in early gay and trans rights demonstrations to founding Street Transvestite Action Revolutionaries, which provided food and shelter for homeless trans people, and her push for LGBTQ-inclusive non-discrimination laws.
A Woburn, Massachusetts couple lost their foster license after refusing to sign a Department of Children and Families (DCF) form requiring them to support gender-affirming care for LGBTQ youth.
Lydia and Heath Marvin, whose license was revoked in April 2025, had fostered eight children under the age of four since 2020. The couple said their religious beliefs prevented them from promising a "safe, affirming, and discrimination-free environment" for LGBTQ children.
"We asked, is there any sort of accommodation, can you waive this at all?" Lydia told CBS Boston. "We simply can't agree to go against our Christian faith in this area."
A majority of the Supreme Court appeared poised to overturn Colorado's ban on licensed counselors attempting to change the sexual orientation or gender identity of minors, after 90 minutes of oral arguments on October 7. The decision could upend similar conversion therapy bans in 23 states and the District of Columbia.
Conversion therapy attempts to change a person's same-sex attraction or gender dysphoria by teaching patients to suppress their impulses or modify behavior to fit traditional notions of gender and sexuality. The practice is often wrongly described as "curing" a person of same-sex attraction or gender dysphoria -- when even many practitioners admit they cannot eliminate such feelings, only offer ways to manage or resist them.
These are challenging times for news organizations. And yet it’s crucial we stay active and provide vital resources and information to both our local readers and the world. So won’t you please take a moment and consider supporting Metro Weekly with a membership? For as little as $5 a month, you can help ensure Metro Weekly magazine and MetroWeekly.com remain free, viable resources as we provide the best, most diverse, culturally-resonant LGBTQ coverage in both the D.C. region and around the world. Memberships come with exclusive perks and discounts, your own personal digital delivery of each week’s magazine (and an archive), access to our Member's Lounge when it launches this fall, and exclusive members-only items like Metro Weekly Membership Mugs and Tote Bags! Check out all our membership levels here and please join us today!
You must be logged in to post a comment.