A sweeping review of transgender treatments on minors found “deep uncertainty about the purported benefits” of many of those interventions — and urged doctors to put more of an emphasis on behavioral therapy when addressing gender dysphoria.
Researchers also concluded that many of the protocols for treating children with gender dysphoria became widely used before outcome studies determined whether or not they were safe practices, a massive 409-page Health and Human Services study revealed.
“The umbrella review found that the overall quality of evidence concerning the effects of any intervention on psychological outcomes, quality of life, regret, or long-term health, is very low,” HHS’ Gender Dysphoria Report determined in its assessment of common studies on transgender treatments.
“This indicates that the beneficial effects reported in the literature are likely to differ substantially from the true effects of the interventions.”
President Trump signed an executive order in January ordering HHS to conduct a review of best practices for treating gender dysphoria within 90 days, which was released Thursday.
Transgender interventions in children that were scrutinized in the blockbuster HHS report include the use of puberty blockers, hormone therapy and surgeries.
While the report stressed it is not a “clinical practice guideline,” the paper examined 17 systematic reviews of transgender treatments in minors and concluded that there was limited evidence to suggest those interventions had any “meaningful improvement in mental health.”
In some instances, this was because studies did not properly measure track patient outcomes or studied individuals whose mental health was already at a “high-functioning at baseline.”
“Multiple SRs [systematic reviews] have concluded that the evidence supporting the benefits of pediatric transition interventions—from PBs [puberty blockers] to CSH [cross-sex hormone therapy] and surgery—is of ‘very low certainty,’” the HHS report said.
“All medical interventions carry the potential for harm.”
A lot of the research into transgenderism in question was conducted overseas. One of the most famous ones was the Dutch Protocol, which was originally published in 2006 and outlined “highly medicalized” methods to treat young people with gender dysphoria, including puberty blockers.
For years, the Dutch Protocol was generally regarded as the gold standard guideline for treating young people struggling with gender dysphoria. The guidance has since been weakened over time, with some of its eligibility restrictions pared down.
Following the 2006 publication of the Dutch Protocol, there had been a sharp rise in transgender treatments in minors.
An estimated 3.3% of US adolescents consider themselves transgender, per the HHS report. Meanwhile, about 0.1% of 17-year-olds received hormonal treatment between 2018 and 2022.
But HHS researchers found that the Dutch Protocol was based on “methodological flaws” that were “largely overlooked” by the broader medical community since its publication.
“One of the study’s limitations was its retrospective selection of 70 subjects from a larger ‘intent-to-treat’ group of 111 using non-randomized methods,” the HHS report said.
“This selection process inadvertently biased the sample toward cases with the most favorable prognoses, thereby limiting the generalizability of the study’s findings.”
The HHS study cautioned that there is an “extreme toxicity and polarization surrounding this field of medicine.”
Researchers in the HHS report frequently pointed to the United Kingdom’s Cass Review, a sweeping four-year study by the National Health Service that similarly poked metholodical holes in more conventional research into transgenderism.
They also acknowledged that there’s a “growing international concern about pediatric medical transition” and that foreign countries are increasingly restricting transgender treatments on minors.
“There is currently no international consensus about best practices for the care of children and adolescents with gender dysphoria,” the HHS report stressed.
Still, the medical ethicists, doctors and methodologies that put the HHS review together highlighted the potential benefits of psychotherapeutic approaches to tackling gender dysphoria in minors.
HHS researchers admitted that “direct evidence for psychotherapy” in children with gender dysphoria is limited, but argued there is “available evidence to support the role of psychotherapy in
treating children and adolescents with other mental health problems, like depression.
The HHS study has been met with mixed reactions from the medical community.
Susan Kressly, the president of the American Academy of Pediatrics, slammed the report, arguing that it relied too heavily upon a “narrow set of data” and “select perspectives.
“This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care,” she said in a statement.
Dr. Stanley Goldfarb, chairman of Do No Harm, an organization that opposes so-called gender transition surgeries, hailed the HHS review for exposing “a number of serious risks in the medical transition of young people.”
“The report cites a ‘lack of robust evidence’ for these medical procedures,” Goldfarb said in a statement. “It is clearer now, more than ever, that we must end this misguided practice and replace it with evidence-based treatment for gender confused kids.”
Trump’s directive for the HHS study was nestled in a broader January executive order to cut off government funding to support or promote operations for child sex changes.
National Institutes of Health (NIH) Director Dr. Jay Bhattacharya, whose agency helped conduct the HHS study, underscored the need to not let political agendas interfere with science.
“Our duty is to protect our nation’s children—not expose them to unproven and irreversible medical interventions,” Bhattacharya said. “We must follow the gold standard of science, not activist agendas.”
Now that it has been released, the HHS study, titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” is set to get peer-reviewed.
A modified version of the report is expected once the peer review process is complete.
