The US Department of Health and Human Services (HHS), in a final report on care for transgender youth, claims certain medical and surgical treatments do more harm than good, contradicting the recommendations of leading medical societies.

The report, published November 19 on the HHS website, calls puberty-blocking hormones and genital surgeries “unproven.” HHS Secretary Robert F. Kennedy Jr., in a statement, said such treatments, commonly referred to as gender-affirming care, constitute “malpractice” by the physicians who provide them. 

“The American Medical Association (AMA) and the American Academy of Pediatrics (AAP) peddled the lie that chemical and surgical sex-rejecting procedures could be good for children,” Kennedy stated. “They betrayed their oath to first do no harm, and their so-called ‘gender-affirming care’ has inflicted lasting physical and psychological damage on vulnerable young people. That is not medicine — it’s malpractice.”

In using the term “sex-rejecting procedures” to describe transitional care, HHS appears to have adopted the language of the Ethics & Public Policy Center, a conservative think tank in Washington, D.C. 

More than 20 major US medical groups, including the AMA, AAP, and American Psychiatric Association (APA), support gender-affirming care for minors, according to the American Association of Medical Colleges. Research shows gender-affirming surgeries for minors such as breast removal are relatively uncommon in the United States. 

In a November 19 statement, David Aizuss, MD, chair of the AMA Board of Trustees, and AAP President Susan J. Kressly, MD, accused HHS of “selective or politically motivated interpretations of data.” 

“We reject characterizations of our approach to gender-affirming care as negligent or ideologically driven, and take particular issue with the false assertion that our members have committed ‘malpractice’ or betrayed their oath in any way,” Aizuss and Kressly stated. “These claims, rooted in politics and partisanship, misrepresent the consensus of medical science, undermine the professionalism of physicians, and risk harming vulnerable young people and their families.”

Titled, “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” the report was written by a group of nine authors, of whom four are physicians. It states, “there is currently no international consensus about best practices for the care of children and adolescents with gender dysphoria,” and 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.”

Instead, the report recommends psychotherapy as “a noninvasive alternative to endocrine and surgical interventions for the treatment of pediatric gender dysphoria” with “no evidence of adverse effects of psychotherapy in this context.”

Brian Christine, MD, HHS assistant secretary for health, in a statement on the HHS website, called the report “an urgent wake-up call to doctors and parents about the clear dangers of trying to turn girls into boys and vice versa.” Christine, a urologist from Alabama, has in the past called for children to undergo “corrective” treatment rather than transitioning. 

Released during Transgender Awareness Week, the document claims medical groups in the United States that endorse the value of gender-affirming care have relied on the recommendations of “a small number of specialized committees” whose opinions were shaped by the World Professional Association for Transgender Health (WPATH). The HHS report accuses WPATH of pushing more aggressive approaches in children with gender dysphoria at the expense of psychotherapy. 

WPATH did not immediately return a request for comment. However, in a statement in May about a draft of the document, the group said the report did not “meet established scientific standards.” 

“The HHS report claims that psychotherapy is the only viable treatment for youth with gender dysphoria — a position we firmly reject,” according to the group.

Although HHS states the document underwent peer review, two major medical societies invited to assess the manuscript — the Endocrine Society and AAP — declined to do so. A third group, the APA, agreed to review the text, but its report, which HHS released, was unfavorable.

According to the APA’s review, “while the HHS report purports to be a thorough, evidence-based assessment of gender-affirming care for transgender youth, its underlying methodology lacks sufficient transparency and clarity for its findings to be taken at face value.” 

The APA today said it “stands by our peer review” of the document.

In another controversial move this week, HHS modified the language about vaccines and autism on the website of the Centers for Disease Control and Prevention. The site now states, “the claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism” — a view the nation’s major medical groups have strongly rejected. 

In response to the change, the AAP’s Kressly stated, “Since 1998, independent researchers across seven countries have conducted more than 40 high-quality studies involving over 5.6 million people. The conclusion is clear and unambiguous: There’s no link between vaccines and autism. Anyone repeating this harmful myth is misinformed or intentionally trying to mislead parents.”