U.S. Department Assesses the Evidence

In May 2025, the U.S. Department of Health and Human Services published a report on the treatment of gender dysphoria in minors. It was the first time the U.S. federal government had commissioned its own assessment of the evidence for this care.

The conclusions

The report assesses the existing literature reviews and concludes that the evidence for the benefits of puberty blockers, hormones, and surgery for minors is of low certainty, while the risks are real. It advocates psychotherapy as the first step.

The criticism

The report was commissioned by the Trump administration, and the authors’ names were not disclosed when it was first published. American medical professional organizations that support the existing standard of care rejected the report.

The U.S. context

In the United States, gender care for minors is highly politicized. More than twenty states have banned the treatment by law, while other states protect it. A month after the report was published, the Supreme Court ruled on those bans; see United States v. Skrmetti.

How the report came about

In late January 2025, one week after taking office, President Trump signed an executive order concerning the medical treatment of minors with gender dysphoria. It instructed the Department of Health and Human Services to publish an overview of the evidence within ninety days. The report, released on May 1, runs to more than four hundred pages. It is not new research involving patients, but an assessment of existing literature reviews, supplemented by chapters on the history of the treatment, ethics, and the role of psychotherapy.

The authors

The fact that the authors initially remained anonymous was unusual and fueled distrust. The department argued that it wanted to protect the writers from outside pressure while the peer-review process was underway. In November 2025, a final version was published with the authors’ names and comments from external reviewers. The authors included physicians, a philosopher, and researchers who had previously published critical views of the treatment.

The response from professional organizations

The American Academy of Pediatrics said that the report misrepresented the medical consensus and placed too much weight on a limited number of sources. The same organization had announced in 2023 that it would commission its own systematic review of the evidence. Critics of the organization point out that it continued to recommend the treatment without waiting for the outcome.

The consequences

The report did not stand alone. The federal government used it in measures targeting hospitals that treat minors, including through the conditions attached to federal funding and investigations by the Department of Justice. During 2025, several major children’s hospitals closed their gender clinics or stopped prescribing blockers and hormones to minors, including in states where the treatment is legally permitted. In 2026, a rule followed that ends Medicaid coverage of hormones and surgery for minors; see the news report on the Medicaid rule.

Significance

Until 2025, the U.S. federal government sided with professional organizations and defended the treatment in lawsuits against states that had banned it. With this report, it took a substantive position on the evidence for the first time—and that position was the opposite of its previous one. For readers outside the United States, it is therefore difficult to view the report separately from the political shift that produced it.

The conclusions about the evidence are consistent with those of European assessments, such as the Cass Review. The difference lies in the context: in Europe, the assessments led to changes in medical guidelines, while in the United States they play a role in a political and legal struggle.