Trump's health agency urges therapy for transgender youth, not broader
gender-affirming health care
[May 02, 2025]
By GEOFF MULVIHILL, CARLA K. JOHNSON and AMANDA SEITZ
President Donald Trump’s administration released a lengthy review of
transgender health care on Thursday that advocates for a greater
reliance on behavioral therapy rather than broad gender-affirming
medical care for youths with gender dysphoria.
The 409-page Health and Human Services report questions standards for
the treatment of transgender youth issued by the World Professional
Association for Transgender Health and is likely to be used to bolster
the government’s abrupt shift in how to care for a subset of the
population that has become a political lightning rod.
Major medical groups and those who treat transgender young people
sharply criticized the new report as inaccurate.
This “best practices” report is in response to an executive order Trump
issued days into his second term that says the federal government must
not support gender transitions for anyone under age 19.
“Our duty is to protect our nation’s children — not expose them to
unproven and irreversible medical interventions,” National Institutes of
Health Director Dr. Jay Bhattacharya said in a statement. “We must
follow the gold standard of science, not activist agendas.”
The report questions the ethics of medical interventions for transgender
young people, suggesting that adolescents are too young to give consent
to life-changing treatments that could result in future infertility. It
also cites and echoes a report in England that reinforced a decision by
its public health services to stop prescribing puberty blockers outside
of research settings.
The report's focus on therapy alone troubles advocates
The report accuses transgender care specialists of disregarding
psychotherapy that might challenge preconceptions, partly because of a
“mischaracterization of such approaches as ‘conversion therapy,’” a
discredited practice that seeks to change patients’ sexual orientation
or gender identification. About half the states have banned conversion
therapy for minors.
The American Academy of Child & Adolescent Psychiatry has said evidence
shows conversion therapies inflict harm on young people, including
elevated rates of suicidal thoughts.
HHS said its report does not address treatment for adults, is not
clinical guidance and does not make any policy recommendations. However,
it also says the review “is intended for policymakers, clinicians,
therapists, medical organizations, and importantly, patients and their
families,” and it declares that medical professionals involved in
transgender care have failed their young patients.
The report could create fear for families seeking care and for medical
providers, said Shannon Minter, the legal director at the National
Center for Lesbian Rights. “It’s very chilling to see the federal
government injecting politics and ideology into medical science,” Minter
said.
“It’s Orwellian. It is designed to confuse and disorient,” Minter added.
Child and adolescent psychiatrist Dr. Scott Leibowitz, a co-author of
the influential WPATH standards for youth, said the new report
“legitimizes the harmful idea that providers should approach young
people with the notion that alignment between sex and gender is
preferred, instead of approaching the treatment frame in a neutral
manner.”
Major medical groups did not contribute; the administration won't say
who did
While Health Secretary Robert F. Kennedy Jr. has repeatedly pledged to
practice “radical transparency,” his department did not release any
information about who authored the document. The administration says the
new report will go through a peer-review process and will only say who
contributed to the report after “in order to help maintain the integrity
of this process.”
The report contradicts American Medical Association guidance, which
urges states not to ban gender-affirming care for minors, saying that
“empirical evidence has demonstrated that trans and non-binary gender
identities are normal variations of human identity and expression.”
It also was prepared without input from the American Academy of
Pediatrics, according to its president, Dr. Susan Kressly.
[to top of second column]
|
President Donald Trump holds up an executive order after signing it
at an indoor Presidential Inauguration parade event in Washington,
Jan. 20, 2025. (AP Photo/Matt Rourke, File)
 “This report misrepresents the
current medical consensus and fails to reflect the realities of
pediatric care,” Kressly said. She said the AAP was not consulted
“yet our policy and intentions behind our recommendations were cited
throughout in inaccurate and misleading ways.”
Dr. Jack Drescher, a New York psychiatrist and psychoanalyst who
works on sexual orientation and gender identity issues, said the
report is one-sided and “magnifies the risks of treatments while
minimizing benefits.”
Talk therapy is already a prominent part of treatments
The Trump administration’s report says “many” U.S. adolescents who
are transgender or are questioning their gender identity have
received surgeries or medications. In fact, such treatments remain
rare as a portion of the population. Fewer than 1 in 1,000
adolescents in the U.S. received gender-affirming medication —
puberty blockers or hormones — according to a five-year study of
those on commercial insurance released this year. About 1,200
patients underwent gender-affirming surgeries in one recent year,
according to another study.
Gender-affirming care for transgender youth under standards widely
used in the U.S. includes developing a plan with medical experts and
family members that includes supportive talk therapy and can — but
does not always — involve puberty blockers or hormone treatment.
Many U.S. adolescents with gender dysphoria may decide not to
proceed with medications or surgeries.
Jamie Bruesehoff, a New Jersey mom, said her 18-year-old daughter,
who was assigned male at birth, identified with girls as soon as she
could talk. She began using a female name and pronouns at 8 and
received puberty blockers at 11 before eventually beginning estrogen
therapy.
“She is thriving by every definition of the word,” said Bruesehoff,
who wrote a book on parenting gender-diverse children. “All of that
is because she had access to this support from her family and
community and access to evidence-based gender-affirming health care
when it was appropriate.”
Politics looms over doctor’s offices
A judge has blocked key parts of Trump’s order, which includes
denying research and educational grants for medical schools,
hospitals and other institutions that provide gender-affirming care
to people 18 or younger. Several hospitals around the country ceased
providing care. The White House said Monday that since Trump took
office, HHS has eliminated 215 grants totaling $477 million for
research or education on gender-affirming treatment.
Most Republican-controlled states have also adopted bans or
restrictions on gender-affirming care. A U.S. Supreme Court ruling
is pending after justices heard arguments in December in a case
about whether states can enforce such laws.
The Jan. 28 executive order is among several administration policies
aimed at denying the existence of transgender people. Trump also has
ordered the government to identify people as either male or female
rather than accept a concept of gender in which people fall along a
spectrum, remove transgender service members from the military, and
bar transgender women and girls from sports competitions that align
with their gender. This month, HHS issued guidance to protect
whistleblowers who report doctors or hospitals providing
gender-affirming care. Judges are blocking enforcement of several of
the policies.
This latest HHS report, which Trump called for while campaigning
last year, represents a reversal in federal policy. The U.S.
Substance Abuse and Mental Health Services Administration, which is
part of HHS, found that no research had determined that behavioral
health interventions could change someone’s gender identity or
sexual orientation. The 2023 update to the 2015 finding is no longer
on the agency’s website.
All contents © copyright 2025 Associated Press. All rights reserved |
