HHS and CMS Urge Changes to Gender-Affirming Care for Minors; Clinics Face Potential Loss of Federal Funding

HHS Secretary Robert F. Kennedy Jr. wrote a letter addressed to healthcare providers saying he expects them to update their “treatment protocols and training to ensure that care for children with gender dysphoria is evidence-based.” The letter was also addressed to healthcare risk managers and state medical boards. The letter refers to the report published earlier this month titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.”

Kennedy discusses the findings of the report and refers to “weak evidence” supporting the use of cross-sex hormones and surgeries to treat gender dysphoria in children. The letter states, “The Review documents significant risks associated with these interventions, including sterilization, and finds the evidence of benefit to be of poor quality.”

On January 28, President Donald Trump signed an executive order titled “Protecting Children from Chemical and Surgical Mutilation,” which called for a review to be published within 90 days of the order. That report was published on May 1, 2025. The executive order also called upon Secretary Kennedy to “take all appropriate actions to end the chemical and surgical mutilation of children, including regulatory and sub-regulatory actions.”

Kennedy encourages medical professionals to read the 400-page report and states, “These interventions do not meet the standard of care in evidence-based medicine.” It refers the readers to page 247 of the report, which discusses the policies of Sweden, Finland, and England. The report states, “All three [countries] concluded that the risks of medicalization may outweigh the benefits for children and adolescents with GD at the population level, and subsequently sharply restricted access to medical gender transition interventions for minors.” The authors of the report also note that psychotherapy is the least invasive option for treating gender dysphoria in minors.

The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC-8) document largely guides care providers in the United States. Secretary Kennedy wrote the creation of this document “was a fraudulent and misleading process that failed to meet accepted standards for evidence-based guideline development.” He refers care providers to the report, which lays out a full critique of WPATH’s approach to developing the standards of care guidance.

The HHS report notes that “most international guidance documents have relied heavily on WPATH and Endocrine Society.” The report further describes a pattern of “circular referencing and mutual endorsements between guidelines recommending pediatric medical treatment for routine care, with WPATH and the ES guidelines influencing all other guidelines and guidance documents.” The report authors note that this circular referencing allows the document to recommend medical treatment for minors with gender dysphoria with a weak evidence base.

Kennedy’s letter also directs the medical professionals to pages of the report that explain the Cass Report’s influence on international debates about treatment for minors with gender dysphoria. The Cass Report recommends that puberty blockers only be used as part of a clinical trial until further data is collected. The report also defends the Cass Report against critiques that it does not meet the standards of clinical practice guidelines. The report’s authors note that the Cass Review was “intended to inform policy, not prescriptive clinical decisions,” and thus, the critiques “reflect a misunderstanding of the Cass Review’s purpose and scope.”

Kennedy’s letter mentions “evidence of significant harm associated with the use of puberty blockers and cross-sex hormones for the treatment of children and adolescents with gender dysphoria, including sterilization.” Kennedy said non-medical interventions, including therapy and social support, “have a stronger evidence base and are associated with lower risks.” He adds that many children experiencing gender dysphoria also have depression, anxiety, and other mental health conditions that are not treated before pursuing medical treatment.

Kennedy references the Hippocratic Oath, which is a moral guide for medical professionals to “do no harm.” Kennedy references the guidelines of Finland, Sweden, and Norway that recognize the evidence-base showing benefits of medical treatments is of poor quality and that the risk of harm outweighs the benefits.

Kennedy reminds care providers of the Quality & Safety Memo issued by the Center for Medicare & Medicaid Services on March 5, 2025 that risk managers should be “aware of the risks associated with medical interventions for children and adolescents with gender dysphoria.” Kennedy said HHS has issued guidance to protect whistleblowers who “report misconduct related to these interventions” and has created a portal for complaint submissions at www.hhs.gov/protectkids.”

Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz also sent a letter to care providers asking for details within 30 days regarding medical interventions for children with gender dysphoria performed at each clinic. Dr. Oz asks for “The adequacy of informed consent protocols for children with gender dysphoria, including how children are deemed capable of making these potentially life-changing decisions and when parental consent is required.”

Dr. Oz also asks clinics for information about “any adverse events related to these procedures, particularly children who later look to detransition.” President Trump’s executive order calls for CMS to cut funding to institutions that provide medical treatments to children with gender dysphoria.