President Donald Trump’s administration released a lengthy review of transgender health care on Thursday that advocates for a greater reliance on behavioral therapy rather than broad gender-affirming medical care for youths with gender dysmorphia.
The Health and Human Services report questions standards for the treatment of transgender youth issued by the World Professional Association for Transgender Health and is likely to be used to bolster the government’s abrupt shift in how to care for a subset of the population that has become a political lightning rod.
This new “best practices” report is in response to an executive order Trump issued days into his second term that says the federal government must not support gender transitions for anyone under age 19.
“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.”
HHS said its report, however, is not clinical guidance and does not make any policy recommendations. The report is also limited to children and does not address treatment for adults.
Gender-affirming care for transgender youth under standards widely used in the U.S. includes supportive talk therapy and can — but does not always — involve puberty blockers or hormone treatment. Gender-affirming surgeries for transgender minors are rare.
A judge has blocked key parts of Trump’s order, which includes denying research and educational grants for medical schools, hospitals and other institutions that provide gender-affirming care to people 18 or younger. Several hospitals around the country ceased providing care. The White House said Monday that since Trump took office, HHS has eliminated 215 grants totaling $477 million for research or education on gender-affirming treatment.
Most Republican-controlled states have also adopted bans or restrictions on gender-affirming care. A U.S. Supreme Court ruling is pending after justices heard arguments in December in a case about whether states can enforce such laws.
The Jan. 28 executive order is among several administration policies aimed at denying the existence of transgender people. Trump also has ordered the government to identify people as either male or female rather than accept a concept of gender in which people fall along a spectrum, remove transgender service members from the military, and bar transgender women and girls from sports competitions that align with their gender. This month, HHS issued guidance to protect whistleblowers who report doctors or hospitals providing gender-affirming care. Judges are blocking enforcement of several of the policies.
This latest HHS report, which Trump called for while campaigning last year, represents a reversal in federal policy. The U.S. Substance Abuse and Mental Health Services Administration, which is part of HHS, found that no research had determined that behavioral health interventions could change someone’s gender identity or sexual orientation. The 2023 update to the 2015 finding is no longer on the agency’s website.
The administration says this new report will go through a peer-review process. In the meantime, it’s not saying who contributed to it, “in order to help maintain the integrity of this process.”
The report says that medical groups have relied on medical treatment rather than behavioral therapy for transgender youth partly because of a “mischaracterization of such approaches as ‘conversion therapy,’” which about half the states have banned for minors.
The American Academy of Child & Adolescent Psychiatry has said that evidence shows conversion therapies inflict harm on young people, including elevated rates of suicidal ideation. And the American Medical Association has urged states not to ban gender-affirming care for minors, saying that “empirical evidence has demonstrated that trans and non-binary gender identities are normal variations of human identity and expression.”
