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A 400-page review of all available data and studies to date finds no evidence of benefit from so-called “gender-affirming” interventions in youth but plenty of potential harms — and slams the medical establishment for abandoning sound clinical judgment.
On May 1 the Department for Health and Human Services (HHS) released a sweeping 409-page review of treatment protocols for adolescents diagnosed with gender dysphoria. The report’s authors remain anonymous, with HHS claiming their identities are withheld to protect them from “intimidation tactics” and to preserve the objectivity of the findings.
The report evaluated existing systematic studies related to so-called “gender affirming care,” including social transitioning (such as adopting a preferred name and pronouns), puberty blockers, cross sex hormones, and sex-change surgeries. Its conclusion was blunt: The overall quality of evidence supporting these practices is “very low,” and none of these interventions demonstrated reliable improvement in gender dysphoria or so-called gender incongruence.
Researchers cited serious methodological flaws and an alarming absence of the long-term effects of puberty blockers, cross-sex hormones, and surgeries. Most studies failed to follow patients beyond the initial stages of transition, and few accounted for complications or regrets that often arise later.
In the absence of reliable clinical trials, the HHS review turned to observational studies and basic physiology. Even without definitive randomized studies, the findings revealed deeply troubling risks:
“These interventions carry risk of significant harms including infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret,” the authors wrote.
The physical harms were particularly acute for adolescent females prescribed testosterone.
“Testosterone can cause reproductive organ atrophy, including thinning and atrophy of vaginal epithelium [leading to severe bleeding], persistent pelvic pain and discomfort, and pelvic floor dysfunction,” the study explains.
The report also noted a heightened risk of cardiovascular events — including heart attacks and strokes — in females undergoing testosterone treatment.
Among biological males administered estrogen, researchers observed “Widespread structural reconfiguration of testicular tissue.” Males also faced a higher risk of blood clots and strokes.
In addition, the report noted concerns about an increased risk of cancer for both sexes who take cross-sex hormones.
“In males, some studies suggest that estrogen may increase risk of developing multiple sclerosis and thyroid cancer, and that it may lead to a decrease in brain volume,” the researchers said.
The report documented numerous psychiatric risks associated with testosterone use and sex-change surgeries. For females using testosterone, the listed harms included “Anxiety, depression, mood swings, suicidal ideation and behavior, aggression, dissociation, and self-harm.”
In more extreme cases, females reported antisocial behavior and homicidal ideation.
The report cited a Swedish study which found that females who received testosterone and underwent transition surgery had a significantly higher risk of criminal convictions. The same study also reported a suicide rate at 19 times higher than the general population and an overall mortality rate three times higher than the control group.
The U.K.’s “Cass Review” also featured prominently in the report. The independent investigation, conducted by Dr. Hilary Cass, a renowned pediatrician, found little evidence supporting gender transitions in minors and instead recommended a “holistic approach” for children struggling with gender dysphoria.
The Cass Review led to the U.K.’s National Health Service ending the use of cross-sex hormones and puberty blockers in minors.
The HHS report cites the Cass Review 149 times.
The authors also criticized America’s leading medical associations for suppressing dissent and promoting a single narrative on gender dysphoria treatments for youth. Rather than pushing irreversible medical interventions, the report favored psychotherapy as the appropriate response to gender incongruence.
Though the report doesn’t offer political policy recommendations, it issued a pointed rebuke for the medical profession:
“The delegation of authority to the medical profession rests on an implicit social contract: Doctors as a profession receive the ‘privilege of self-regulation’ and financial awards on the expectation that they will serve the health needs of individual patients and society.
A central theme of this Review is that many U.S. medical professionals and associations have fallen short of their duty to prioritize the health interests of young patients.
The report noted four ways U.S. medical professionals and medical associations are failing their patients:
1)The rapid expansion and implementation of a clinical protocol that lacked sufficient scientific and ethical justification.
2) A failure to reconsider the “gender-affirming approach” even “when confronted with compelling evidence that this protocol did not deliver the health benefits it promised, and that other countries were changing their policies appropriately.
3) Mischaracterizing, failing to acknowledge, or outright ignoring “conflicting evidence—evidence that challenged the foundational assumptions of the protocol and the professional standing of its advocates.”
4) Marginalizing dissenting perspectives and disparaging “those who voiced them.”
The report offers a sobering conclusion:
“While no clinician or medical association intends to fail their patients—particularly those who are most vulnerable—the preceding chapters demonstrate that this is precisely what has occurred.”
In a press release, HHS Secretary Dr. Jay Bhattacharya stated,
“Our duty is to protect our nation’s children—not expose them to unproven and irreversible medical interventions. We must follow the gold standard of science, not activist agendas.”
Predictably, major medical associations have criticized the review. Susan J. Kressly, president of the American Academy for Pediatrics (AAP), argued, “For such an analysis to carry credibility, it must consider the totality of available data and the full spectrum of clinical outcomes rather than relying on select perspectives and a narrow set of data. This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care.”
But not all experts agree with the APP’s defense, Dr. Cass told the New York Times that the American Academy of Pediatrics is “misleading the public” and failing to follow the science. She added that the organization is “fairly left-leaning,” is “fearful of making any moves that might jeopardize trans health care right now,” and is feeling “political duress” to go along with transgender ideology.
This 400-page report is not groundbreaking. It simply pulls together all the existing data on gender transition treatments and outcomes in children, and it is largely uncommitted on whether these treatments definitively cause any particular harms. Much of the report speculates based on current studies, observations, and data, preferring to say that data “suggests” that harms are possible.
While that doesn’t make for strong reading or catchy headlines, what it does show quite clearly is the truly experimental nature of gender transitions.
We do not definitively know what these drugs and surgeries will do to children over the rest of their lives because there are very few long-term studies on the effects of child gender transitions.
Child gender confusion is not a single, clear-cut, cause-and-effect issue. Most children with gender dysphoria have other mental health comorbidities, including anxiety, autism, obsessive compulsive disorder, previous trauma, or any of a number of different psychiatric complications.
The fact is that the human body is complex, and we really don’t know what the effects of hormones and surgeries will be — especially on children who are still growing and developing.
However, the data we do have is overwhelmingly negative.
While studies are limited, there is more than enough evidence to definitively say that gender transition treatments do harm children. And anyone with a medical or psychology degree should have known that anyway and exercised extreme caution before jumping in with off-label drugs and surgeries to treat a condition that historically has called for time and psychotherapy.
Unfortunately, doctors who prescribe puberty blockers and cross-sex hormones or who perform barbaric and irreversible surgeries to remove healthy body parts from children or attempt to create fake reproductive organs have either bought into a destructive ideology or they want to play God.
Either way, it is clear that they have little to no concern for the ill effects of their experiments or the well-being of their patients.
This should not be a political issue — it should be a commonsense issue. Children need to be protected from predatory and mercenary ideologues who would profit off their confusion through procedures that will ruin their bodies and lead to a lifetime of pain and regret.
Quite frankly, HHS should speak with more conviction and certitude on this issue and take steps to help Americans understand that performing such mutilating procedures on children are criminal and a gross violation of medical ethics—and then it should lead the charge to make sure that the medical license of any healthcare professional who participates in such abominations is revoked.
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