The Trump administration recently unveiled a comprehensive report concerning transgender healthcare, advocating for increased reliance on behavioral therapy for youths experiencing gender dysphoria instead of immediate gender-affirming medical treatments. Comprising 409 pages, the Health and Human Services document calls into question the treatment guidelines for transgender youth set by the World Professional Association for Transgender Health. This review is anticipated to support the administration’s sudden policy reversal on addressing transgender issues, a highly contentious subject in politics today.
Executive order-driven, this report emerged shortly into President Trump’s second term, emphasizing the government’s stance against gender transitions for individuals under 19. Dr. Jay Bhattacharya, Director of the National Institutes of Health, stated, “Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions.” He further insisted on adhering to scientific standards free from activist influence.
The report questions the ethical implications of medically intervening in the lives of transgender young people, highlighting their potential inability to consent to significant treatments that could lead to infertility. It also references a recent decision in England to limit the provision of puberty blockers outside of research parameters, suggesting a modeled approach.
Concerns have arisen over the suggestion that therapy alone is sufficient, with accusations that transgender care professionals dismiss psychotherapy, wrongly equating it with conversion therapy, a widely discredited practice for altering sexual or gender identity. Notably, nearly half of U.S. states have outlawed conversion therapy for minors. The American Academy of Child & Adolescent Psychiatry emphasizes that evidence of the harm of such therapies includes increased suicidal ideation.
While HHS assures the report is not clinical guidance nor policy-oriented, it targets policymakers, clinicians, and families for whom transgender care specialists purportedly fall short in caring for youths. This development is causing unease among families and providers, according to Shannon Minter, Legal Director at the National Center for Lesbian Rights, who expressed concern over the influence of politics and ideology in medical fields.
The absence of leading medical bodies’ involvement like the American Medical Association—whose guidance contradicts the report’s findings—raises questions. The administration remains silent on who contributed to the report, despite Health Secretary Robert F. Kennedy Jr.’s promises of “radical transparency.” Dr. Susan Kressly, President of the American Academy of Pediatrics, criticized the report as misrepresentative of pediatric care norms.
Dr. Jack Drescher, a psychiatrist specializing in gender identity, criticized the report, stating it emphasizes the risks of treatments while playing down their benefits, reflecting ongoing debates within the field. Importantly, talk therapy remains a central part of existing treatment plans, contrary to the report’s implications.
Despite the administration’s claims, the prevalence of surgeries or medications remains rare among transgender adolescents in the U.S. A study evidenced fewer than 1 in 1,000 adolescents receiving gender-affirming medication, with around 1,200 undergoing surgeries annually. Current standards for gender-affirming care emphasize involving both medical experts and families in crafting individualized support plans that often focus on supportive talk therapy before considering puberty blockers or hormone treatments. Many adolescents opt-out of medical procedures altogether.
Jamie Bruesehoff, whose 18-year-old daughter transitioned early in life, asserts her child is “thriving” due to access to supportive care and family backing, underscoring the importance of evidence-based healthcare to their wellbeing.
Politics continue to loom over medical offices as a judge recently blocked several components of Trump’s order, which intended to withdraw funding from institutions offering care to those under 18. This coincides with actions by multiple Republican-led states restricting gender-affirming care, with a Supreme Court decision pending on such legislation.
The executive order forms part of a broader strategy denying transgender identities, aligning with initiatives to categorize individuals strictly as male or female, exclude transgender individuals from military service, and prevent them from participating in gender-appropriate sports. While facing judicial blockages, this attempt at revising federal policy challenges previous scientific positions which found no behavioral health interventions altering inherent gender identities or orientations.