On Thursday, the Department of Health and Human Services (HHS) published a 400-page analysis of research on gender-affirming care for transgender youth, as directed by President Donald Trump. The agency used the release of the report to declare that available science does not support providing gender-affirming care to trans youth. LGBTQ+ advocacy groups worry the report will be used to further restrict gender-affirming care and to change medical guidelines in ways that harm trans youth.

The president mandated the report in an executive order condemning the medical treatment — without evidence — as a form of mutilation, amid a broader push by the administration to exclude trans people from public life. Trump’s order asked the health agency to review the “best practices for promoting the health of children who assert gender dysphoria,” while pressuring youth clinics to halt treatment or lose federal funding.

Now, the HHS has produced that report. The agency combed through research on the outcomes of puberty blockers, hormone replacement therapy, social transition, psychotherapy, and the rare cases of surgeries on adolescents and young adults diagnosed with gender dysphoria. 

Gender dysphoria, the reason that most trans people undergo gender-affirming care, is a strong and persistent distress felt when one’s body is out of sync with their gender identity. Without treatment, gender dysphoria can lead to severe negative impacts in day-to-day life. 

The agency states in its executive summary of the report that the document is not meant to provide clinical practice guidelines or issue legislative or policy recommendations. However, the report does imply that health care providers should refuse to offer gender-affirming care to adolescents and young adults on the basis that such care comes with the potential for risk — despite little evidence for that risk actually being found in the report. 

“The evidence for benefit of pediatric medical transition is very uncertain, while the evidence for harm is less uncertain,” the executive summary states. “When medical interventions pose unnecessary, disproportionate risks of harm, healthcare providers should refuse to offer them even when they are preferred, requested, or demanded by patients.”

In its research review, the HHS determined that evidence measuring the effects of gender-affirming care on psychological outcomes, quality of life, regret and long-term health is of “very low” quality. This conclusion ignores decades of research, as well as a recent survey of more than 90,000 transgender people in the United States that found an overwhelming majority report more life satisfaction after having transitioned. Access to gender-affirming care has been linked to lower odds of suicidality and depression in trans youth, while gender-affirming surgeries have been found to lower psychological distress for adults.

Even when analyzing research that the administration deemed low-bias, the HHS found “sparse” to no evidence of harm from gender-affirming care. What’s more, the report frequently found evidence demonstrating the benefits of gender-affirming care — though it ultimately downplays those findings as not significant. 

Available research on puberty blockers found high satisfaction ratings and low rates of regret. A systematic review of hormone replacement therapy described improved gender dysphoria and body satisfaction. Another found that hormone treatment leads to improved mental health. Two before-and-after studies reported reduced treatment needs or lower levels of suicidality and self-harm after hormone treatment. When measuring safety outcomes of hormone treatment, side effects did not have a major impact on treatment and complications were limited. 

Despite these findings, the Department of Health and Human Services advertised the report in a Thursday news release as one that “highlights a growing body of evidence pointing to significant risks” of gender-affirming care. At the White House briefing room Thursday, deputy chief of staff for policy Stephen Miller touted the new report and attributed the idea of being transgender as part of a “cancerous communist woke culture” that is “destroying this country.” 

There are side effects to many of the medications that transgender people — and cisgender people — take to receive gender-affirming care, as is the case with most medical treatments. These side effects, like the risk of decreased bone density when taking puberty blockers, are closely monitored and treated by doctors and communicated to patients.

LGBTQ+ advocacy organizations denounced the report as a political attack on transgender youth. Multiple groups said that the report’s endorsement of psychotherapy as a “noninvasive alternative” to puberty blockers and hormone treatment amounts to an endorsement of conversion therapy — a practice wherein mental health professionals try to change a youth’s sexual orientation or gender identity.

“It is already clear that this report is a willful distortion of the evidence intended to stoke fear about a field of safe and effective medicine that has existed for decades, in order to justify dangerous practices which amount to conversion therapy,” said Sinead Murano Kinney, health policy analyst at Advocates for Trans Equality. 

The Human Rights Campaign, the country’s largest LGBTQ+ rights organization, accused the HHS of producing a report that is attempting to lay the groundwork to replace medical care for trans and nonbinary people with conversion therapy. 

“Trans people are who we are. We’re born this way. And we deserve to live our best lives and have a fair shot and equal opportunity at living a good life,” said Jay Brown, chief of staff at the Human Rights Campaign. “This report … lays the groundwork to push parents and doctors aside and allow politicians to subject our kids to the debunked practice of conversion therapy.” 

No authors or contributors are named in the report or in its executive summary. The agency says these names are being initially withheld to “maintain the integrity of this process,” and states that chapters of the document were subject to peer review.