The U.S. Health and Human Services released a report reviewing medical interventions for minors seeking gender-affirming care.
In the 400-page review published May 1, unnamed authors determined there's a lack of evidence supporting interventions such as puberty blockers, sex hormones and surgery and emphasized their potential risks despite most medical organizations and professionals backing their benefit.
An HHS statement said medical doctors, medical ethicists and a methodologist contributed to the report, however the agency declined to provide names for its contributors.
Gender-affirming care is a range of social, psychological, behavioral and medical interventions designed to support a person in affirming their gender identity, according to the World Health Organization.
The American Medical Association, which represents more than 250,000 U.S. doctors, passed a resolution in June 2023 calling for protection for this type of care. More than 30 major medical associations and health organizations worldwide support health care for transgender adults and youth, which they say can help prevent suicide in this vulnerable population.
Dr. Susan J. Kressly, president of the American Academy of Pediatrics, said in a statement that "this report misrepresents the current medical consensus and fails to reflect the realities of pediatric care."
In addition to reviewing the role of medical interventions, authors also claimed gender-affirming care in the United States is a "child-led" process in which mental health assessments are "often minimized or omitted."
While there is no routine protocol for gender-affirming care, doctors are generally cautious when treating transgender youth, according to Dr. Joshua Safer, an endocrinologist and executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York.
"The approach for young people is conservative," he said in a December 2024 interview. "We try to be thoughtful and conservative when we support parents and kids."
The HHS report also criticized the World Professional Association for Transgender Health and U.S. medical associations for "creating a perception of professional consensus" regarding how gender-affirming care should be practiced.
Authors claimed these organizations "suppressed dissent and stifled debate" on the topic. WPATH has yet to respond to USA TODAY's request for comment.
The Cass Review is cited throughout the HHS report. Named after British pediatrician Dr. Hilary Cass, who chaired the review, the April 2024 report concluded there was a lack of evidence supporting medical interventions like puberty blockers and hormone therapy to manage gender-related distress in teens.
Cass recommended that these interventions be used only for research purposes, which prompted the National Health Services England to stop prescribing puberty blockers for transgender adolescents outside of a clinical trial and open new gender centers that take a more "holistic" approach, according to a statement released in August. The U.K. Supreme Court recently said that the legal definition of woman relates to biological sex.
Many experts - from the United States and countries worldwide - have concerns about the Cass report, criticizing its methodology and how it didn't include other studies showing the benefits of puberty blockers and hormone therapy.
Conservative organizations like Do No Harm applauded the report and said in a statement they were "grateful and encouraged" by the agency's scrutiny of gender-affirming care.
But Casey Pick, director of law and policy at The Trevor Project, a national LGBTQ+ youth advocacy group focused on suicide prevention, said the report is "deeply troubling" and "rejects health care best practices for transgender people."
She also points to the authors' support of "exploratory therapy" and how it can align too closely with conversion therapy.
Also known as reparative therapy, conversion therapy is when a religious leader, licensed counselor, or peer support group tries to change someone's sexual orientation or gender identity. All major medical and mental health organizations vilify the practice and consider it harmful.
"This report not only rejects health care best practices for transgender people - it goes a step further by recommending conversion therapy, though under a new, rebranded name, 'exploratory therapy,'" Pick said. "Despite the report's claims, this is, in fact, the same harmful practice of conversion therapy, just using friendlier language.
GLAAD's President and CEO Sarah Kate Ellis, too, slammed the report. "This so-called guidance is grossly misleading and in direct contrast to the recommendation of every leading health authority in the world." Cathy Renna, director of communications at the National LGBTQ Task Force, added: "This is part of a larger set of attacks on LGBTQ people and our community and our allies will resist this and any attempt to hurt or silence us."
Doctors who work in transgender care argue that children and adolescents who identify as transgender should have gender-affirming treatments available to them as options.
Like other medications, experts say there are risks associated with taking puberty blockers and hormones. For example, the American Academy of Pediatrics says a child taking puberty blockers could experience stress or lower self-esteem as their peers reach puberty.
However, all the major medical organizations in the U.S. say studies show gender-affirming care for transgender youth leads to better mental health outcomes, including lower odds of depression and suicidality in the short term. The new HHS report claims there's no association between gender dysphoria and suicide.
Adrianna Rodriguez can be reached at adrodriguez@usatoday.com.