Making Sense of the HHS Report Without Having to Read It
A Synthesis of the Responses to Trump et al.'s 400-page Anti-Trans Propaganda
You might have heard about the latest move from the Trump administration in their efforts to snuff out gender diversity and restrict bodily autonomy. I’m just going to quote journalist Erin Reed’s words here, because she nailed the description:
On Thursday, May 1, the Trump administration’s Department of Health and Human Services, now helmed by Robert F. Kennedy Jr., released a report masquerading as science but serving as a blunt instrument of ideological warfare against transgender youth. Commissioned under Trump’s Jan. 28 executive order, the report’s conclusions were preordained, its framing designed to validate a political agenda rather than present credible research.
There was some discussion on a listserv I’m on about whether or not we should be reading or sharing the actual report. I hold the perspective that for most of us, there is no value gained from reading the specifics of this. We need to know about its existence and have some awareness of its contents, but I believe the exposure to what Reed says reads like “an anti-trans screed” isn’t worth what might be gained from getting into the specifics. There are people whose jobs it is to read through this muck and challenge it. If this isn’t your job, I’d skip it and just check out the summaries, responses, and fact checks I link to below.
What you need to know
1. This is not a scientifically rigorous review and has been explicitly challenged by multiple highly regarded organizations as a departure from more accurate and less biased reviews of the literature.
(More on those responses further below). The press release from HHS claims some chapters of the report underwent peer review prior to publication and that post-publication peer review will be happening soon. However no names have been released in terms of authorship, consultation, or review, and no substantial details have been shared about the process of peer review. Additionally, it appears that the review was conducted and written in 90 days and after Trump and various executive branch appointees had already made clear what the report would conclude, using non-scientific and highly charged language like “barbaric” and “mutilation,” and describing gender-affirming behaviors as child abuse. As Kellan Baker, a health services researcher and executive director of the Whitman-Walker Institute for Health Research and Policy, stated “The finger was already on the scale when this report was commissioned.” Read more about the scientific challenges to the process and procedures leading to the report in this article from Science magazine: https://www.science.org/content/article/researchers-slam-hhs-report-gender-affirming-care-youth.
2. Many of the major claims made in this review are already being fact-checked and challenged.
Erin Reed has begun fact-checking on her substack and bluesky.
I wrote my own response contextualizing and challenging the claims in the psychotherapy sections. The misrepresentation of the data in those sections alone is shockingly obvious to anyone who looks closely.
Trans Formations Project, a trans-led nonprofit committed to informing the public about and advocating against anti-trans legislation, included a pretty detailed review and takedown of the report in their most recent newsletter. They also contextualized the misinformation and talking points with the administration and right wing’s nationwide efforts against trans people general authoritarianism.
I doubt much of anything in this report will hold up under scrutiny. As the Trans Journalists Association pointed out in their statement and guide on how to cover the report, this administration has demonstrated its lack of adherence to scientific consensus repeatedly in statements on other topics, like climate change and vaccinations. Misrepresentation of scientific facts is the norm in this Administration.
3. This further expands the foundation for the federal government and some states to do serious harm to trans young people (and just young people exploring their gender, trans or not) specifically and bodily autonomy broadly.
As the Trans Formations Project pointed out, “despite the trappings of science, medicine, ethics, and concern […] this document is [simply] ammo for the culture war.” The conclusion in the HHS report seems to be that any amount of affirmation of a young person’s sense of their gender is harmful if their gender diverges (or might diverge) from their assigned sex, and that this affirmation needs to be discouraged. In place of affirmation and openness they recommend psychotherapy that explores the “origins” of a young person’s discomfort with their sex assignment to disrupt this. This document will likely be used by the government to support increasingly aggressive efforts to curtail affirming approaches and medical interventions for youth, and I anticipate this will expand into more aggressive barriers to adult care and trans rights broadly.
The report’s treatment of social transition as “an active intervention” is an escalation in this administration’s march toward fascist control over our bodies and expressions. In the context of other actions like the horrific statements Trump made about affirmation as child abuse, I believe this government wants to mandate how our children dress, the names we use for them, and what they are allowed to call themselves. Ceding any ground on this creates a pathway for extreme governmental control over the people in this country.
4. This report is being released in the context of the Trump administration censoring and restricting meaningful research in this and other areas.
The government has demonstrated its hostility toward actual scientific inquiry both broadly and specifically as it relates to trans people’s wellbeing and the treatment of people with gender dysphoria. Between the National Institutes of Health (NIH) and the National Science Foundation (NSF), the Trump administration has made the unprecedented decision to fully terminate thousands of grants, without an appeals process. A document tracking terminated NIH grants lists 460 grants that include trans-related keywords — that’s more than half of the 810 terminated grants listed. The HHS report repeatedly names what the “low certainty” of the research on treatments for young people with gender dysphoria, and yet has created an environment where it is nearly impossible to do rigorous, high quality, large-scale research in this area. That is one of the bigger red flags that this is propaganda meant to squash gender diversity, rather than part of an effort to “help vulnerable youth.”
What Experts & Organizations Are Saying
“This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care.” - American Academy of Pediatrics
The president of the AAP, Dr. Susan Kressly, swiftly issued a sharp criticism of the report. She stated that “the report prioritizes opinions over dispassionate reviews of evidence” and used AAP recommendations in “inaccurate and misleading ways.” She re-asserted the evidence- and ethics-based AAP stance that “patients, their families, and their physicians—not politicians or government officials —should be the ones to make decisions together about what care is best for them based on evidence-based, age-appropriate care.”
“The lack of transparency regarding authorship, expertise, and methodology in the recent HHS report undermines scientific rigor and contradicts standards for evidence-based policymaking.” - American Psychological Association
The APA was also swift in their condemnation of the report and an assertion that the organization “supports access to psychological care and evidence-based treatment for transgender, gender-diverse, and nonbinary children, teens and adults” and that “psychotherapeutic treatment for transgender and nonbinary youth should aim to help children and adolescents explore and understand, rather than change, their gender identity.” The APA statement also notes the risk of harm in preventing access to affirming care and calls for support for strong research. They also pointed to last year’s Policy Statement Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science — which I am proud to have co-authored with an amazing team of psychologists — and their 2021 resolution condemning gender identity change efforts.
“This so-called guidance is grossly misleading and in direct contrast to the recommendation of every leading health authority in the world. This report amounts to nothing more than forcing the same discredited idea of conversion therapy that ripped families apart and harmed gay, lesbian, and bisexual young people for decades.” - GLAAD
GLAAD’s President and CEO Sarah Kate Ellis released a statement accusing the report of leaning on “discredited junk science.” GLAAD describes itself as a media accountability and community engagement org “ensures authentic LGBTQ stories are seen, heard, and actualized.”
“Medical treatment for adolescents with gender dysphoria is well-established and widely accepted based on decades of scientific study and clinical experience… This report is part of the Trump Administration and RFK, Jr.’s anti-science agenda that reflects a biased effort by those with an intent to eradicate access to this care and lacks transparency and credibility.” - Lambda Legal
Omar Gonzalez-Pagan, Senior Counsel and Health Care Strategist at leading LGBTQ+ legal organization Lambda Legal, released a scathing statement on the HHS report. Gonzalez-Pagan highlighted the way this report fits into the administration’s agenda to curtail trans rights. “Ultimately, this report is part and parcel of the Trump administration’s agenda to discriminate against transgender people and erect barriers to their full participation in society.”
"The HHS report fails to meet established scientific standards.” - WPATH/USPATH
“Gender-affirming care is backed by rigorous research, expert consensus, and patient-centered values. Studies consistently show its positive impact, including improved mental health and overall quality of life. “ - WPATH/USPATH
The World Professional Association for Transgender Health and the United States Professional Association for Transgender Health issued a joint statement directly challenging multiple claims in the report and criticizing its lack of rigor. They also defended the WPATH Standards of Care which is misrepresented and maligned in the report, stating “Clinical practice guidelines, including WPATH’s Standards of Care Version 8 (SOC8), are developed thorough evaluation of evidence, clinical expertise, patient values and preferences, and cultural and contextual considerations.” They concluded by stating “Policies affecting transgender health must be informed by recognized experts and guided by clinical evidence, not ideology.”
“Their science and scientific rationale are not supported by the preponderance of the research in this field, which is why they are trying to silence that research at every turn. This is the authoritarian, political equivalent of putting their fingers into their ears and humming loudly, pretending that it doesn’t exist. Pretending that WE don’t exist. But we do exist, and we will always exist. And we will not be erased.” - Trans Formations Project
Although I mentioned the Trans Formations Project statement earlier, I wanted to also include its concluding paragraph here, because it is so powerful.
Expert Consensus Supports Access to Gender-Affirming Care
Any discussion of this report needs to include the context that experts from many many medical and mental health care associations and orgs have already done their own reviews of the evidence and issued reports or statements in support of gender-affirming approaches / approaches that give patients, families, and providers autonomy in collaborative decision-making.
For example:
American Medical Association: https://www.ama-assn.org/press-center/ama-press-releases/ama-states-stop-interfering-health-care-transgender-children
American Academy of Pediatrics: https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for
American Psychological Association: https://www.apa.org/news/press/releases/2024/02/policy-supporting-transgender-nonbinary
GLAAD compiled a list of all such statements that is an excellent reference point: https://glaad.org/medical-association-statements-supporting-trans-youth-healthcare-and-against-discriminatory/
Also it is important to note that a recent similarly large review of the literature conducted by German, Austrian, and Swiss experts reaffirmed the value and evidence in support of gender affirming approaches to youth:
And last year Rand Corp released a thorough systematic review on “interventions for trans and gender diverse youth,” which is cited but largely misrepresented in the HHS report. You can see from the evidence map below that affirming interventions were found to be beneficial to mental health. GICE interventions (conversion therapies) were the only interventions found to have clear negative impacts. You’ll also note that the systematic review rated these findings as all low or very low certainty, which is based on the GRADE system of evaluating research quality and stems from the fact that there are still relatively few studies in this area and there are not randomized control studies (RCTs). Many experts (including me) have noted that RCTs are both unethical and unnecessary in determining intervention efficacy in this particular area.
Other helpful resources in understanding the HHS report and responding to people's promotion of it are statements and evidence-grounded critiques of the Cass Report, a similarly politically-motivated and skewed review of the evidence solicited by the UK conservative government. The unnamed authors of the HHS report repeatedly reference the Cass Report. You can find a full list of the many critical statements and reviews of the report here: https://transactual.org.uk/advocacy/critiques-of-the-cass-review, but the most thorough is the Evidence-Based Critique of the Cass Review spearheaded by Yale Law School’s Integrity Project and conducted by eight established experts in the fields of trans medicine and medical research: https://law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf.
We have some fighting ahead of us, friends. But we are equipped with the evidence, and with the spirit of all who have been fighting these battles for generations before us.