HHS Releases 400-page Gender Affirming Care Report Citing Weak Evidence For Medical Interventions in Minors

The Department of Health and Human Services (HHS) has released a 400-page umbrella review of systematic reviews of treatments for pediatric gender dysphoria in children and adolescents. The report cites 409 sources and concludes that there is weak evidence to support medical interventions for minors and there are significant risks. The report suggests more research needs to be done for psychological interventions, which are a non-invasive alternative that hasn’t been adequately studied for treating gender dysphoric youth.

The report states, “WPATH suppressed systematic reviews its leaders believed would undermine its favored treatment approach.” The HighWire reported that WPATH removed its age minimums after being pressured by Admiral Rachel Levine, a transgender woman who served as the previous assistant secretary for health in the Biden administration. WPATH removed minimums despite concerns about social contagion.

It mentions potential links to the rise in gender dysphoric youth and social influences. “The term ‘rapid onset gender dysphoria’ (ROGD) has been suggested to describe a new clinical presentation of gender dysphoria. Despite sharp disagreement about the concept’s validity, symptoms consistent with ROGD have been recorded in clinics in the U.S. and other countries.”

The report states that the absence of evidence to support any particular intervention for the treatment of gender dysphoria means that more robust studies should be conducted for this condition.

It also stresses the importance of evidence-based medicine and says patients are entitled to credible evidence to back their decisions. The list of serious side effects listed in the report includes “Infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret.”

“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. Failure to do so increases the risk of iatrogenic harm and reduces medicine to consumerism, threatening the integrity of the profession and undermining trust in medical authority.”

The United Kingdom stopped offering gender-affirming care to minors after the release of the Cass Report last year. The latest HHS report aligns with the findings of the Cass Report that there is weak evidence to support the safety and efficacy of medical treatments for gender dysphoric youth.

The report also points to the difficulty of accurately obtaining a diagnosis for gender dysphoria when the symptoms are all based on feelings. The report states, “Gender dysphoria is based entirely on subjective self-reports and behavioral observations, without any objective physical, imaging, or laboratory markers. The diagnosis centers on attitudes, feelings, and behaviors that are known to fluctuate during adolescence.”

The HighWire reported about a patient who goes by “Shape-Shifter,” who is in an active lawsuit against Fenway Community Health for falsely diagnosing him with gender dysphoria and initiating medical treatment. Shape-Shifter was experiencing “internalized homophobia,” which he clearly described to the practitioners according to the lawsuit complaint. Despite this, the practitioners didn’t recommend psychotherapeutic interventions before diagnosing him with gender dysphoria and initiating medical treatments.

The report also describes a social culture that stifles debate and conversation on this topic. The authors wrote, “There are few other areas of healthcare where professionals are so afraid to openly discuss their views … where name-calling echoes the worst bullying behavior.”

The HighWire has reported stories of detransitioners and whistleblowers on the topic of gender-affirming care. The report states, “The voices of whistleblowers and detransitioners have played a critical role in drawing public attention to the risks and harms associated with pediatric medical transition. Their concerns have been discounted, dismissed, or ignored by prominent advocates and practitioners of pediatric medical transition.”

The American Academy of Pediatricians released a statement saying they are “deeply alarmed” and accused the analysis of lacking credibility for not considering the totality of data. The statement, attributed to President Susan J. Kressly, MD, FAAP, also states that the report ignores the current medical consensus. The statement does not include any alternative research that HHS allegedly failed to consider when drafting its report. The AAP partners with pharmaceutical companies and receives significant funding but states that a partnership is not an endorsement of a company’s products.

Reuters reported in 2022 that several doctors asked AbbVie, Endo, and other puberty blocker manufacturers to get approved by the FDA so that clinical trials will be conducted to assess the safety profile of the drugs in children for this purpose. The companies said it costs a lot of money to get approval. Currently, there are no puberty blockers that are approved by the FDA for gender dysphoria treatment. The only products provided are prescribed off-label.

The cost of puberty blockers is between $20,000 and $45,000 per year and the number of children taking puberty blockers more than doubled from 2,394 in 2017 to 5,063 in 2021. Reuters noted that this is likely a significant undercount, because it only includes children who have a gender dysphoria diagnosis and treatment that is covered by insurance.

During the same time period, gender dysphoria diagnoses in children aged 6-17 increased from 15,000 to 42,000. Yahoo Finance estimated the global gender-affirming care market to be worth $2.9 billion in 2022, with expected growth to $6.26 billion by 2030, a compound annual growth rate of 10.1%.

Dr. Johanna Olson-Kennedy is one of the most well-known transgender clinicians in the United States and is currently facing a lawsuit for misdiagnosis and failure to provide informed consent. She is also the lead author of a nine-year study on puberty blockers that she refused to publish after the data did not show a mental health benefit, and she feared the results would be weaponized.

The HHS report also details comorbid mental health conditions that often predate the emergence of gender dysphoria. The report states, “The current patient population has a high rate (relative to the general population) of comorbid mental health problems, including depression, anxiety, suicidality, self-harm, and eating disorders, as well as neurodevelopmental conditions like autism spectrum disorder (ASD). Importantly, register-based research conducted in Finland, which has national databases, found that 75% of patients presenting to PGM clinics in the mid-2010s had severe mental health problems that appeared to have predated the emergence of GD. High rates of comorbid mental illness have been documented in the U.S. and other countries.”

The authors of the report have not been disclosed. The report notes that this review evaluates the medical literature regarding gender-affirming care protocols for minor children and not adults.

“Systematic reviews of the evidence have revealed deep uncertainty about the purported benefits of these interventions.  The controversies surrounding the medical transition of minors extend beyond scientific debate; they are deeply cultural and political. Public discourse is dominated by intensely polarizing narratives. Some view the medical transition of minors as a pressing civil rights issue, while others regard it as a profound medical failure and a sobering reminder that even modern medicine is vulnerable to serious error.”