Authors of HHS Report Blasting Youth Gender Care Revealed

The Washington Post

13:19 JST, November 22, 2025

The Trump administration released a report in May warning the science behind gender transition care for youths was shaky and potentially dangerous, but withheld the identities of the authors in a move that was criticized for obscuring potential biases.

On Wednesday, the Department of Health and Human Services released a final version of the report that disclosed the nine authors – all of whom had previously criticized medical transition treatments for children and teenagers. Health officials invoked the broad evaluation of gender care research and its endorsement from peer reviewers, some of whom have also criticized the treatments, to justify a broader crackdown on pediatric transgender care.

“Today, we released a report exposing the truth: pediatric sex-rejecting procedures are not evidence-based. They are dangerous,” HHS Assistant Secretary for Health Brian Christine, who has called for transgender youths to undergo “corrective care,” said in a video posted to X on Wednesday.

LGBTQ+ health care providers and activists argued the disclosures instead show the administration did not undergo a dispassionate review of evidence and had a predetermined conclusion as it prepares to slash federal funding to providers who offer transition treatments to young people.

The dispute over the report underscores the challenge of scrutinizing gender transition care amid an international reckoning over how to best treat the rising number of gender-nonconforming children and whether medical interventions have been too broadly administered without robust evidence to justify their use.

The intense polarization surrounding transgender health care means many people deeply involved in the issue have strong opinions and more-neutral parties may be reluctant to weigh in. Transition care providers and leading medical associations fiercely defend the availability of such care and say the fixation on long-term unknowns overlooks the consequences of a child’s distress as their body develops in a way that does not align with their gender identity.

While the motivations of the Trump administration’s review have been scrutinized given that it was commissioned as part of an executive order to ban the care, other efforts to scrutinize the science have raised concerns about the treatments.

A similar review in the United Kingdom led to the country banning puberty blockers until more research could be done; several other countries have followed suit, while medical organizations in others have affirmed support for the care.

The authors of the U.S. report include two psychiatrists, two bioethicists, a philosopher, an endocrinologist, a specialist in evidence-based medicine and two researchers who specialize in gender medicine. Five have been paid for consultations or speeches related to pediatric gender care. Four have testified to states considering bans.

HHS also released seven peer reviews from experts and the American Psychiatric Association and detailed responses in a 239-page supplement to the report, which was an “umbrella” review of 17 other systemic looks at pediatric gender medicine. It urges therapy before medical interventions. Most transgender children do receive counseling and do not receive medication or procedures to support transition, according to surveys and data released by individual providers.

Scott Leibowitz, a psychiatrist and board member of the World Professional Association for Transgender Health, an organization that sets protocols for transition treatment that were heavily criticized in the report, declined to comment on the report’s conclusions. But he described it as unreliable overall because the authors and peer reviewers lack clinical experience caring for transgender youths.

“I don’t know who they are,” he said. “That makes me question how accurate and relevant their experience is on this report.”

Authors of the report rejected arguments that their critiques of transition care and lack of clinical experience rendered them too biased to offer an independent evaluation.

“At this point it’s impossible to assemble a team with suitable expertise who have no opinions about pediatric gender medicine,” Alex Byrne, a professor of philosophy at the Massachusetts Institute of Technology who wrote a book defending the concept of sex as a binary, said in an email. “Usually people who aren’t invested in applying a treatment are better placed to assess its efficacy: practicing homeopaths should be kept out of a review of homeopathy.”

Critics of the report also questioned the motivations of authors based on their past comments about the transition treatments, including at least two who compared them to lobotomies.

“Today’s gender interventions for children are disturbingly similar. In trying to relieve mental suffering, they cause permanent harm,” Farr Curlin, a Duke University School of Medicine professor, wrote in the Wall Street Journal.

Curlin said critics of the report’s authors should judge it on its findings.

“If they see errors in the interpretation of the science or in the arguments, they should explain those,” Curlin said.

Leor Sapir, a senior fellow at the conservative Manhattan Institute who led the review and has extensively advocated against hormone therapy and surgeries for children, said the report should be evaluated on the basis of its content and accuracy. Charged by HHS with picking the authors earlier this year, he said he looked for people committed to following the evidence and dismissed the notion that their previous comments biased them.

The authors “expressed skepticism about pediatric gender transition because they care about evidence, and every systematic review to date has shown the evidence is poor,” Sapir said.

Major medical associations have disputed the notion that the evidence is too poor to justify transition care for children and broadly endorse a range of interventions. The American Psychiatric Association concluded it couldn’t assess the report’s rigor because it was not clear how the studies it reviewed were selected or judged.

Two other medical associations declined to participate in the peer review.

A spokeswoman for the Endocrine Society said the authors were not clear about the process. The group issued a statement Wednesday saying the final report overemphasizes giving children counseling first.

The American Academy of Pediatrics, which criticized HHS for not consulting the organization while drafting its initial report, declined to comment on why it skipped peer review.

The White House is currently reviewing two proposals from the Centers for Medicare and Medicaid Services to strip Medicaid funds from hospitals that provide “sex-trait modification.”

HHS officials touted the peer reviews of the gender care report as offering scientific credibility to its conclusions, noting they offered mostly positive comments about the report’s approach and conclusions, with a few caveats.

Richard Santen, former head of the Endocrine Society and one of the reviewers, said he believes the society’s 2017 guidelines on transition care were “flawed” and that experts were discounting evidence taken seriously in European nations that have tightened rules around care.

Santen, who is an endocrinologist at University of Virginia Health, said he wishes the report had gone further and declared transition care for children “experimental” but overall felt its methodology “was excellent.”

The peer review document includes critical pieces written independently by two groups of gender researchers criticizing the report’s initial draft.

Kellan Baker, who was part of one of the groups, called the inclusion of those two reviewers a “fig leaf” because they weren’t invited to participate in the process.

He criticized the authors for having made a “cottage industry” out of criticizing gender care. Baker also said its credibility was undermined because it was commissioned by an order seeking to ban the very care the report was meant to evaluate.

“In science, we would call that a fatal flaw in scientific independence, because you already have your outcome,” said Baker, senior adviser for health policy at the Movement Advancement Project, an LGBTQ+ think tank.

Jilles Smids, a postdoctoral researcher at Erasmus MC in the Netherlands who has criticized the country’s protocols for treating transgender youths, wrote in his peer review that it’s “clearly not a neutral report” as it argues against early medical intervention for minors, while still calling the report a “well-argued analysis.”

HHS said that it invited a “diverse group of individuals and organizations” to participate in peer review and that the “highly critical academic articles” were treated as “unsolicited,” agency spokesman Andrew Nixon said in a statement. The peer review comments were consistent with a federal law regarding objective data and the administration’s commitment to “radical transparency and gold standard science,” Nixon said.

Lane Strathearn, a professor of pediatrics at the University of Iowa who said he was contacted via email “out of the blue” to review the HHS report, said he had concerns about the report suggesting research on the topic was unethical. He also expressed concerns about the polarized nature of Trump’s executive order in January – which demanded the review within 90 days – and the language surrounding the commissioning of the report.

“I see it as just an impossible political situation in the U.S., where things are so polarized that people can’t sit down and have a reasonable conversation,” said Strathearn, a native Australian who used to vote Republican before Trump’s entry into politics but has since voted for Democrats.

Another peer reviewer, Western Sydney University professor Karleen Gribble, said she has been frustrated by what she views as a lack of exploration into the potential harms of breast removal surgery, which is one of her areas of focus.

She describes herself as “very much a lefty” and said she doesn’t follow American politics but wanted to participate in peer review because she thinks there should be more discussion about the risks and benefits of transition.

“Getting people who disagree with my viewpoint to actually engage in the discussion is just about impossible,” she said.