On Thursday, federal health authorities released a report stating there is no scientific basis for administering hormones or surgical interventions to young individuals experiencing gender dysphoria. This marks a significant shift from prior agency guidelines and the recommendations made by various US health organizations, highlighting concerns surrounding potential long-term harm.
The report emphasizes the importance of psychotherapy, which has sparked considerable debate, as some proponents equate it with conversion therapy aimed at altering gender identity.
Certain sections of the review appeared to challenge the very notion of a gender identity that diverges from one’s sex assigned at birth.
In January, President Trump issued an executive order titled “Protecting Children from Chemical and Surgical Amputations,” directing the Department of Health and Human Services to compile a report within 90 days on optimal treatment approaches for youth indicating a disconnect between their gender identity and their birth sex.
The executive order suggested that the administration had already drawn its conclusions about gender transition treatments for minors, denouncing the “blatant harm done to children” as a “stain on our country’s history.”
The report, spanning 400 pages, adopted a calmer tone yet arrived at a similar verdict. Notably, the report’s author remains unidentified as the post-publication review process is set to commence in “the coming days.”
Officials at HHS declined to comment on the review process, noting contributors included a diverse group of physicians, medical ethicists, and methodologists selected for their commitment to scientific integrity.
Importantly, the report clarified that it is not designed to establish standards for healthcare or formulate policy recommendations.
The findings were primarily based on analyses of scientific studies regarding adolescent blockers, hormone treatments, and surgical interventions conducted over the past few decades as these therapies became accessible to adolescents.
The assessment concluded that while the advantages of medical interventions remain unclear, potential harms, including erosion of birth rates, are deemed less substantial.
“Clinical practice in this area is exceptional and concerning,” the report asserts, pointing to American medical groups that advocate for an intolerant atmosphere where clinicians may feel compelled to self-censor.
The appropriateness of treatments such as adolescent blockers, hormone therapy, or surgery for young individuals remains a subject of vigorous debate.
Recently, several European nations have imposed restrictions on such treatments, with scientific reviews and discussions highlighting the insufficient quality of supporting evidence and uncertainties about long-term risks.
In the United States, 24 states have enacted legislation preventing doctors from offering such treatments to adolescents.
The American Academy of Pediatrics is conducting its own evidence review. The Academy and most significant medical organizations in the US continue to support these treatments as effective in relieving the psychological distress many transgender youth experience.
“This report misrepresents the prevailing healthcare consensus and fails to represent the realities of pediatric care,” stated Dr. Susan Cresley, chair of the Academy. “This document favors opinions over a rational examination of evidence.”
Advocates for transgender rights criticized the report for presenting ideological views disguised as scientific.
During Trump’s initial 100 days in office, his administration aimed to downplay transgender identities in public forums. The measures included cutting funding for hospitals that provide gender transition treatments to individuals under 19 and contemplating barring transgender individuals from military service.
The administration facilitated the transfer of transgender men and women from federal prisons to their homes and ceased recognizing the gender of transgender individuals on their passports.
“Is the administration’s animosity towards this healthcare grounded in genuine scientific insights or ideologically motivated by its disapproval of transgender individuals believing that transgender identity is fabricated?” questioned Shannon Minter, director of legal affairs at the National Center for Lesbian Rights.
The Center represents transgender plaintiffs in multiple lawsuits contesting the administration’s policies’ constitutionality.
“This is an ideological declaration, not a medical one,” stated Casey Pick, director of law and policy at the Trevor Project, an organization focused on suicide prevention among LGBTQ youth.
This report signifies a triumph for individuals who categorize this medical field within a broader agenda to deny the reality of biological gender.
Roger Severino, vice president of domestic policy at the Heritage Foundation, commended the HHS report while condemning “profit-driven physicians and ideological groups” for convincing families that “children’s sex aligns with everything they profess.”
According to government statistics, around 3% of high school students identify as transgender, a significant surge over the last decade. However, a much smaller percentage of these adolescents seek medical interventions.
Despite this, the topic of medical transition for minors has turned into a political battleground, with Trump making it a focal point of his campaign while some Democrats believe this strategy may aid his electoral prospects.
The new HHS report extends beyond similar assessments in Europe, which have initiated new limitations on gender-related treatments for adolescents.
Independent Clinical Services Reviews for UK youth reached a comparable conclusion, led by Dr. Hillary Cass, former president of the Royal College of Pediatrics. It noted the insufficient quality of evidence supporting the use of adolescent blockers and hormone treatments for minors, with surgery being unavailable to minors in the UK.
However, this review, conducted over four years, painted a broader picture of the medical landscape by consulting young patients, transgender adults, parents, and clinicians.
Dr. Kass concluded that evidence regarding the benefits and risks associated with treatment is “significantly weak,” but acknowledged that some young individuals are very likely to benefit from early interventions.
“Certain young people will undoubtedly reap the benefits of the medical pathway. As research evolves, we need to ensure that those individuals can access care under research protocols, but we mustn’t assume this is the right path for everyone,” Dr. Cass expressed in an interview last year.
This review concluded that the use of blockers in England should be restricted and that clinicians are encouraged to prescribe hormones to teenagers only with “extreme caution.”
Other clinicians who have expressed concern about the field of adolescent gender medicine are unclear about how the new report will be applied.
“We are pleased that in recent years US authorities are finally considering what is happening in Europe,” remarked Erica Anderson, a child psychologist and former president of the American Transgender Health Association.
She is outspoken about her concerns that adolescent gender clinics are shifting away from thorough mental health evaluations in light of the growing number of children seeking gender treatment.
However, Dr. Anderson supports the need for early intervention for certain young people, despite the inflammatory presidential order leading to the report.
“It’s akin to calling someone out on their rank and then expecting to engage in a meaningful conversation,” she stated. “This approach doesn’t work well with real individuals, who possess emotions and histories.”
Minter from the National Center for Lesbian Rights argued that by emphasizing psychotherapy over medical interventions, the HHS report effectively endorses conversion therapy aimed at altering minors’ gender identity or sexual orientation.
Various medical associations support prohibiting the practice, citing evidence that it leads to depression, anxiety, and feelings of self-loathing.
However, the Supreme Court has agreed to review a First Amendment challenge concerning Colorado’s conversion therapy regulations, initiated by a licensed professional counselor who contends that “individuals prosper when they align with God’s design, including their biological sex.”
Other therapists, including Dr. Anderson, advocate for what they term “exploratory therapy” which assists supportive clinicians in addressing mental health challenges related to adolescents’ gender identity.
Kellan Baker, a researcher focusing on transgender health policies at Whitman-Walker, a Washington-based nonprofit health center, remarked that the report signifies a divergence from customary health policy development in the US.
“It’s crucial that healthcare is administered by individuals with specialized knowledge, not dictated by the federal government, but by skilled clinicians operating according to the standards set by their respective healthcare fields,” Dr. Baker stated.
He voiced concerns that the report could be utilized by the government as a pretext for denying medical coverage for transgender youth.
The Centers for Medicare and Medicaid Services, a branch of HHS, issued a letter last month directing Medicaid agencies to refrain from using funds for gender transition care for minors.
Attorney General Pam Bondy instructed the Department of Justice to investigate doctors who provide such care, stating, “This document does not represent standard care and will likely be cited by the government as grounds for denying medical care coverage for transgender youth.”
Source: www.nytimes.com
