US President Donald Trump‘s administration on Thursday released what it described as a comprehensive review of gender interventions for children and adolescents, raising alarms about “significant risks” with puberty blockers and surgeries.
The 400-page report was published without named authors — a decision that departs from standard scientific practice but was justified by the Department of Health and Human Services as a way “to help maintain the integrity of this process.”
Gender care for youth is a deeply polarizing issue in many countries, with medical professionals striving to balance competing priorities: alleviating psychological distress, respecting patient autonomy, and ensuring that any interventions are safe, evidence-based, and appropriate for developing bodies and minds.
The Trump administration’s well-documented hostility toward transgender people, and its frequent attacks on what it calls “woke gender ideology,” have raised questions about the objectivity of the study.
According to the report, gender-affirming treatments pose risks “including infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret.”
“Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions,” Jay Bhattacharya, director of the National Institutes of Health. “We must follow the gold standard of science, not activist agendas.”
But Aisha Mays, a family physician in California and member of the nonprofit Physicians for Reproductive Health, hit back by terming the report “propaganda.”
“Today’s report is propaganda aiming to delegitimize the perfectly safe, effective, and evidence-based health care that transgender people access to be who they are,” she said.
“Being transgender, just like being cisgender, is not a choice nor can it be reversed by any medical or social method. The same way cisgender people know who they are, so do trans people. The same way cis people receive gender-affirming care, so do trans people.”
In the UK, a separate high-profile review last year urged “extreme caution” when prescribing hormone treatments.
The four-year probe of child and youth gender identity services, led by retired pediatrician Hilary Cass, made dozens of recommendations ranging from more research to reform of the referrals system.
The American Academy of Pediatrics has maintained its support for providing transgender adolescents with medically necessary care and opposes legislation that restricts such access or interferes with the doctor-patient relationship.
While the political rhetoric around gender care has grown louder, data shows that in reality the use of such care is not widespread.
Fewer than 0.1 per cent of gender-diverse minors with private insurance received puberty blockers or hormone therapy between 2018 and 2022, according to a recent study published in JAMA Pediatrics.
