Trump Administration Releases Gender Dysphoria Report Without Disclosing Authors

(CNN) — The US Department of Health and Human Services on Thursday released a 400-page review of treatment for gender dysphoria in children but did not disclose who authored or reviewed the report.

The report follows several actions by President Donald Trump’s administration to halt gender-affirming treatment of transgender children and adolescents and cancel research about the transgender community.

“Contributors to the review include medical doctors, medical ethicists, and a methodologist. Contributors represent a wide range of political viewpoints and were chosen for their commitment to scientific principles,” HHS said in a news release about the review, adding that contributors’ names are not initially being made public “in order to help maintain the integrity of this process.” On Monday, the White House said that “a team of eight distinguished scholars” worked on the report.

The agency said chapters of the report underwent peer review but did not specify who reviewed it. The agency also said it will undergo additional review “involving stakeholders with different perspectives” in the days ahead.

The document, which includes sections on evidence, ethical considerations, psychotherapy and “clinical realities,” focuses on treatment of gender dysphoria in youths, not adults. HHS said the review finds that science and evidence do not support “these drastic medical interventions for our nation’s youth.”

Gender dysphoria is a term that mental health professionals use to describe clinically significant distress someone feels because their sense of their gender does not match the sex they were assigned at birth. It is an official diagnosis in the DSM, a book published by the American Psychiatric Association that classifies mental disorders, but not everyone who identifies as transgender or gender-diverse has this diagnosis.

Gender-affirming care is a wide range of treatments offered by a multidisciplinary team that is tailored to the individual.

For years, major mainstream medical associations – including the American Medical Association, the American Psychiatric Association, the Endocrine Society, the American Psychological Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry – have affirmed the practice of gender-affirming care and agree that it’s clinically appropriate care that can provide lifesaving treatment for children and adults.

The process typically starts with a conversation between the person and the clinician. If the patient is a child, the conversation will also involve the family when possible. Once the clinician understands what the person needs, they will design a plan with a team of providers. Care can include mental health and support groups or legal help. When a person is past the start of puberty, care may include hormones.

Professional medical organizations do not recommend surgery for children as a part of gender-affirming care, and research shows that it’s rare among transgender or gender-diverse teens.

A 2024 study of medical insurance claims in the US from 2019, the latest year available, found that there were no gender-affirming surgeries performed on transgender youth 12 and younger. For older teens and adults, the rates of gender-affirming surgery with a trans or gender diverse-related diagnosis were 2.1 per 100,000 and 5.3 per 100,000, respectively, the study said.

Dr. Susan Kressly, president of the American Academy of Pediatrics, said the group was “deeply alarmed” by the report and suggested that it relied 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,” Kressly said in a statement.

The American Psychological Association said Thursday that it supports access to psychological care and evidence-based treatment for treatment for transgender, gender-diverse and nonbinary children, teens and adults.

“Research clearly shows that supportive mental health care greatly reduces the risk of depression, suicide, and other negative outcomes for transgender and nonbinary youth,” the association said. “Psychotherapeutic treatment for transgender and nonbinary youth should aim to help children and adolescents explore and understand, rather than change, their gender identity.”

A joint statement from major medical associations said Thursday that “the trusted relationship between a physician and their patient should never be jeopardized by the actions of policymakers, that physicians should not be criminalized or penalized for providing care and that medical standards of care and physician education training and education must remain evidence-based and free from political interference.”

The statement came from the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association and the American Psychiatric Association, which represent 600,000 physicians and medical students.

The Endocrine Society also said that it is “carefully reviewing the report” and that it “believes in access to health care, and that medical decisions should be made by the clinician and the patient’s family based on scientific evidence.”

Dr. Meera Shah, a family medicine physician in New York and a board member with Physicians for Reproductive Health, emphasized that “medical professionals do not question the safety of this care.”

“The fact that this was published by a government agency is really scary. The way that it’s written is very harmful, and it’s very obvious that this is all politically driven and not rooted in fact or science,” Shah said. “People tend to trust government. They think government agencies are out to protect people and to help people, so the default is to believe what they say.”

The Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ+ youth, said it is concerned that the report will be used by the Trump administration to justify restrictions on care and adds to actions that have already hurt the community’s mental health.

“They are reaching out to our crisis services lines in record-breaking numbers,” said Casey Pick, Trever Project’s director of law and policy. “They are afraid.”

In January, Trump signed an executive order to end federal support for medical procedures aimed at altering sex or gender that involve surgical interventions or the use of puberty blockers or sex hormones in those under 19 years old. Trump then signed another executive order that said only two sexes, “male and female,” would be recognized by the federal government.

In February, in one of his first moves as secretary of HHS, Robert F. Kennedy Jr. released a video defending the ban on transgender women participating in sports and issued a website and guidance for the US government to use narrower definitions of sex than ones used by many scientists.

The Trump administration said it has canceled $477 million in research and education grants that focused on the transgender community. Trump also issued an executive order in February titled “Keeping Men Out of Women’s Sports,” stating that the administration would halt federal funding to elementary, secondary and post-secondary institutions that permitted transgender girls or women to compete on girls or women’s teams.

A growing number of states have enacted laws or policies that limit the kind of care young people can get. As of March, 27 states have enacted restrictions, meaning about 40% of trans youth live in a state with limited gender-affirming health care options, according to KFF, a health policy organization.

Of the states with restrictions, 24 also impose legal or professional penalties on clinicians who provide minors with certain kinds of gender-affirming care. Most restrictions apply to medication and surgery rather than mental health care.

There have been shifts in care provided in other countries, too.

Last year, an extensive but controversial research review in the UK said that the rationale for early puberty suppression was “unclear” and that any benefit for mental health was supported by “weak evidence.” The review – known as the Cass Review for Dr. Hilary Cass, the pediatrician who conducted it – and its methodology have come under sharp criticism from some scholars and practitioners. However, the report prompted policy changes, including banning prescriptions of puberty blockers for gender dysphoria in adolescents.

CNN’s Elizabeth Wolfe contributed to this report.

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