Youth Trans Health Care Report HHS Pushes Conversion Therapy

The Trump administration’s top health agency released an extensive review of transgender health care on Thursday, falsely declaring that available scientific evidence does not support providing gender-affirming care to trans youth.

The 409-page review commissioned by the Department of Health and Human Services promoted psychotherapy as a “noninvasive” alternative, which LGBTQ+ advocates have denounced as “conversion therapy.”

The new report contradicts decades of research and also challenges the guidance of major U.S. medical associations, including the World Professional Association for Transgender Health (WPATH) and the American Medical Association, about established protocols for treating gender dysphoria among transgender youth.

Gender dysphoria is the severe distress one feels when one’s body does not align with one’s gender identity, and it is the reason many trans people decide to undergo gender-affirming treatments like hormone therapy and surgery in the first place. Yet the HHS review instead proposes talk therapy to treat this condition in youth.

The review follows President Donald Trump’s January executive order that threatened to withhold federal funding from hospitals and clinics that provide gender-affirming care to people under 19. The order instructed HHS to publish a report on “best practices” for treating children with gender dysphoria and asked agencies to rescind policies that rely on WPATH guidance within 90 days.

Now, HHS has provided that report, which it insists is not “a clinical practice guideline,” but rather “intended for policymakers, clinicians, therapists, medical organizations, and … patients and their families.”

“The evidence for benefit of pediatric medical transition is very uncertain, while the evidence for harm is less certain,” the report’s executive summary reads. “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.”

The government did not disclose who compiled the research and cited the need to “maintain the integrity of the process.”

“Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions,” National Institutes of Health Director Jay Bhattacharya said in a statement accompanying the report’s release. “We must follow the gold standard of science, not activist agendas.”

Critics of the report say that its purpose is to intentionally mischaracterize existing evidence about gender-affirming care, which shows the exact opposite of the HHS theory: When trans youth have access to these medical treatments, they experience low to no rates of regret and high rates of improved mental health and body image.

The agency itself admits in the report that research on harm is “sparse” and that evidence on the long-term health, psychological outcomes, quality of life or regret is “very low.” But still, the report touts the benefits of psychotherapy, including “exploratory therapy,” which it describes as helping “children and adolescents come to terms with their bodies.”

Several LGBTQ+ and reproductive health organizations have denounced the review’s recommendation for psychotherapy. They see this as the agency trying to rebrand conversion therapy — a dangerous and long discredited practice built on the belief that being gay or trans is an illness to be cured — as an alternative to current medical treatments.

“The ultimate goal of this report is to impose a political agenda in place of science and to insert the federal government where it does not belong — between healthcare providers and the families and patients they care for,” Dr. Kellan Baker, the executive director of the Institute for Health Research and Policy at Whitman-Walker Health, an LGBTQ+ community health center, said in a statement.

Stephen Miller, Trump’s deputy chief of staff for policy, praised the report in the White House briefing room on Thursday, comparing the idea of being transgender to a “cancerous communist woke culture” that is “destroying the country.”

The report foregrounds itself heavily on an unscientific and discredited theory known as “rapid-onset gender dysphoria,” a claim that more and more adolescents assigned female at birth identify as transgender because of peer influence and “social contagion.” The theory was initially proposed by physician and researcher Lisa Littman in a 2018 paper. In a survey, Littman asked parents — largely recruited from anti-trans websites — to describe “a process of immersion in social media” and to link that with their child’s gender dysphoria.

However, a 2021 study published in the Journal of Pediatrics found no such evidence to support the theory. That same year, the American Psychological Association and 61 other organizations of health care providers signed a letter denouncing the theory for a “lack of rigorous empirical support for its existence.”

While Littman later issued a correction updating her methodology and noting that rapid-onset gender dysphoria was not a formal diagnosis, the concept has gone viral in certain conservative corners of the internet. Littman’s paper was cited widely in policies to restrict gender-affirming care in states like Florida and Texas, and now by the White House to further legitimize its attempts to restrict trans youth’s access to health care.

Trump called on Congress during his joint address in March to pass a bill “permanently banning and criminalizing sex changes on children and forever ending the lie that any child is trapped in the wrong body.”

The review released Thursday also repeatedly references the Cass Review, a similar report commissioned by the U.K.’s National Health Service, which found that there wasn’t “reliable evidence” for gender-affirming medicine. The Cass Review was published in April 2024, one month after the closure of the Tavistock Clinic’s Gender Identity Development Service, the U.K.’s only national care service for transgender youth. Several trans health organizations and researchers said the review had significant shortcomings, questioning its scientific methodology and the appearance of discriminatory bias against trans people.

The Cass Review, like the HHS report, advocates for the use of psychotherapy over medical interventions. Both reports argue that the practice is unfairly dismissed as conversion therapy and is the “least invasive intervention for addressing psychological distress” among trans youth.

Throughout the review, HHS maintains that with psychotherapy, a child’s gender dysphoria will usually “resolve without medical intervention,” and that many of these children end up identifying as gay later in life.

But available science demonstrates that being trans is not a phase or a product of peer pressure. A 2022 study in the journal Pediatrics illustrated that the vast majority of trans youth continued to identify as transgender five years after coming out — and that stripping access to essential health care did not help trans youth grow into adults. In fact, trans youth face higher rates of anxiety, depression and suicidal ideation than their cisgender peers. Research also shows that a lack of support by family and schools, bullying and harassment, and discrimination are the primary factors for poor mental health outcomes.

Other studies have shown that the rise in anti-trans legislation at the state level over the past five years could pose a public health risk to transgender youth. So far, 25 states have passed bans on gender-affirming hormones and surgery for trans youth, according to the Movement Advancement Project.

By contrast, several studies suggest that medical interventions like puberty blocks and hormone replacement therapy can greatly improve mental health outcomes for transgender youth. A 2023 study in The Lancet found that when trans youth were able to access hormone therapy for two years, they reported a lower rate of suicidal ideation than the general population of the United States.

Many advocates see the HHS report as an expression of politics, not scientific evidence, and as the latest effort by the Trump administration to curtail access to gender-affirming care for transgender youth.

“This report is clearly trying to build a case for conversion therapy,” Dr. Aisha Mays, a California physician and board member with Physicians for Reproductive Health, said in a statement.

“Today’s report is propaganda aiming to delegitimize the perfectly safe, effective, and evidence-based health care that trans people access to be who they are. Being transgender, just like being cisgender, is not a choice nor can it be reversed by any medical or social method.”