The U.S. Department of Health and Human Services released a report about youth gender care last week that cautions against the use of medical interventions in gender-affirming care, such as puberty blockers, for minors. It instead recommends something called “exploratory therapy,” a controversial form of psychotherapy which has been compared by many to a kind of conversion therapy by a kinder name.
One especially concerning fact about this report is that HHS did not disclose the names of those involved in putting it together, nor information about who was consulted for the report, raising questions over what potential biases should be accounted for. The HHS report joins the United Kingdom’s Cass Review — which has been similarly denounced by prominent researchers and practitioners dealing in transgender care — as a major national report on youth gender medicine for which no expert contributors have been named.
Major medical associations in the U.S. have denounced the report, including the American Association of Pediatrics.
Transfeminine jurist and bioethicist Florence Ashley, who has authored numerous academic papers on trans-related health care, (including a 2022 report titled “Interrogating Gender-Exploratory Therapy” published in Perspectives on Psychological Science) shared on BlueSky that a meta analysis of the appendix of the HHS report, which you can access through EXIF data by opening the appendix in NotePad, shows the name Alex Byrne, an MIT philosophy professor who posts anti-trans messages nearly every day on social media. It’s unclear whether, or to what extent, Byrne played a role in the report, and my questions to him about this went unanswered.
It’s notable that the HHS report mentions the Cass Review, which was led by British pediatrician and former chair of the British Academy of Childhood Disability Hilary Cass, who according to New York Times reporting has “never treated children with gender dysphoria,” 198 times in its 400 pages. This apparent reliance on the Cass Review as a kind of blueprint for its findings could also explain how such a lengthy report was produced in the three or so months since Trump ordered its creation in a Jan. 28 executive order. Typically, a medical report of this scale takes years to complete. The aforementioned Cass Review took four years to complete, for example.
Major medical associations in the U.S. have denounced the report, including the American Association of Pediatrics, which said in a statement: “For such an analysis to carry credibility, it must consider the totality of available data and the full spectrum of clinical outcomes rather than relying on select perspectives and a narrow set of data. This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care. As we have seen with immunizations, bypassing medical expertise and scientific evidence has real consequences for the health of America’s children. AAP was not consulted in the development of this report, yet our policy and intentions behind our recommendations were cited throughout in inaccurate and misleading ways. The report prioritizes opinions over dispassionate reviews of evidence.”
On its face, the “exploratory therapy” the report encourages as a primary form of treatment for children with gender dysphoria might not appear so bad. It’s also important to note that therapy is already a major requirement for gender transitions of people of all ages, and especially for children, although it generally looks quite different. Proponents of exploratory therapy describe it as simply exploring a teenager’s life in search of potential “causes” of any gender dysphoria. The problem is there is no legitimate science with another explanation for gender dysphoria other than it is a naturally occurring trait among a tiny proportion of the population.
The HHS document claims that exploratory therapy is meant to help trans youth “come to terms” with their birth sexed body as an end goal. There’s no data presented on the efficacy of this approach beyond guesswork by proponents of this therapy. There are no studies presented to show how the exploratory therapy approach might impact suicidality in trans teens. We know from past history that victims of conversion therapy, where their true self is denied and overruled by doctors with an anti-LGBTQ agenda, are at very elevated risk for suicidality.
The report’s own findings show how natural gender dysphoria is in those who present with it. In one section, its authors state that about 90% of gender dysphoric youth who go on puberty blockers end up “graduating” to cross sex hormones when they are older (a finding backed up in multiple studies) and can make a more mature and permanent decision.
When I see that 90% number, I see a process that is working at correctly identifying which youth with gender dysphoria are actually just naturally trans.
Yet, the report states that puberty blockers may act as a “gas pedal” for further medical interventions. “The perception of PBs has shifted — from being seen as a reversible ‘pause button’ to more like a ‘gas pedal’ that accelerates medical transition,” reads a key passage from the report. “Social transition in childhood may have similar effects, with some low-quality studies suggesting the majority of children who socially transition before puberty progress to medical interventions. These patients ‘are likely [to] seek blockers or hormones.’”
Social transition is the process wherein a trans youth may try a different haircut, name and pronouns. But these statements can only be true if you desire fewer trans youth to transition. The report authors’ solution to this so-called problem is gender exploratory therapy.
On its face, exploratory therapy is, according to its proponents, meant to help a young person experiencing gender dysphoria “come to terms” and accept their birth sexed body. Practitioners of exploratory therapy believe that gender dysphoria has a wide range of causes, from childhood sexual trauma, to the discredited idea that being trans is socially contagious, to just typical pubertal discomfort with body changes.
Many of these proposed “causes” were also used to justify conversion therapy in gay and lesbian teens 30 years ago.
Many of these proposed “causes” were also used to justify conversion therapy in gay and lesbian teens 30 years ago. It’s hard to not conclude that practitioners of exploratory therapy simply do not believe that trans minors should be allowed to transition, since there’s no endpoint to exploratory approaches that can result in a patient accessing gender-affirming care.
It’s an approach designed to run out the clock on a teenager’s natural puberty, potentially trapping them in a sexed body they never wanted until they may be able to transition as adults.
Compare this with the gender-affirming approach, which lets a teen take the lead on how they are feeling about transitioning. Does it seem too scary right now? OK, let’s wait. Do we want to try puberty blockers to see how it feels for a while? Let’s try. Do we want to stop all this gender treatment altogether because it feels like too much? That’s fine, too.
There’s a major misconception about the gender-affirming approach. Critics have misinformed the public into thinking that the affirming approach automatically affirms that every child who shows up in a gender clinic is trans and launches them into a full and immediate medical treatment. This simply doesn’t happen. The process for accessing this care is long and arduous. Teens must express their gender dysphoria persistently, consistently and insistently over a long period of time, often for years, to even get a gender dysphoria diagnosis.
The bare contempt this report’s anonymous authors hold for transgender people is astounding to take in, even for someone like myself who has spent the last decade covering trans issues.
We already have a solid system for carefully identifying youth with gender dysphoria and guiding them through a fairly simple, but lengthy and emotional medical transition process. I suggest we leave the analysis to the true experts, whose years of research and abundance of medical studies have provided the public with the comprehensive, medically sound treatment plans we already have in place — rather than unnamed authors who provide little evidence for what very much appears to be bad-faith findings.
