The U.S. Department of Health and Human Services (HHS) on Wednesday released an update to its May review of the evidence and best practices for children and teens with gender dysphoria, which addresses criticisms brought by major medical organizations like the American Psychiatric Association (APA).
The report, titled "Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices," released through the Office of the Assistant Secretary for Health, was originally published May 1 and commissioned under President Donald Trump's January executive order directing the HHS to "publish a review of the existing literature on best practices for promoting the health of children who assert gender dysphoria."
HHS's review synthesized existing systematic reviews on youth gender treatments and raised "serious concerns" about medical interventions such as puberty blockers, cross-sex hormones and surgeries, listing potential risks that include "infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret."
The updated version identifies nine contributors — physicians, researchers and ethicists — and adds a supplement compiling nine post-publication peer reviews alongside the authors’ responses. It also includes minor corrections for clarity and formatting, as well as conflict-of-interest disclosures.
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Manhattan Institute senior fellow Leor Sapir and MIT philosopher Alex Byrne, two of the review's authors, told Fox News Digital that after "a months-long process of peer review" of the central findings of the May report, its core findings — that there is "very weak" evidence to support pediatric medical transition and that the evidence for harms is "stronger" — remains unchanged.
They argued that most existing research on youth gender medicine suffers from methodological flaws and bias.
"With a few notable exceptions, such as the Finnish research, studies in this field are of poor quality and tend to exaggerate the evidence of benefit and underreport harms," they said. "These studies usually come from the gender clinics themselves."
The authors said that even if stronger evidence existed, ethical and diagnostic challenges would remain.
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"There are no randomized controlled trials in pediatric gender medicine," they said.
"Even if there was high quality evidence for a favorable risk/benefit profile, the problem of diagnosis would remain," they continued. "Clinicians are unable to distinguish minors who may have a lifelong struggle with their sex from those for whom the distress is temporary or manageable through less invasive means."
The World Professional Association for Transgender Health (WPATH) — an organization that provides clinical practice guidelines for treating people with gender dysphoria — the American Academy of Pediatrics (AAP) and the APA criticized the May report shortly after its release, claiming it misrepresented the medical consensus and lacked author identification.
In its update, HHS said it invited the AAP, APA and Endocrine Society to participate in a peer review of the report. Only the APA agreed.
The APA’s review said HHS’s methodology wasn’t transparent enough to take its conclusions "at face value," citing missing author identification and insufficient detail about study selection and analysis.
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The HHS responded that its process was documented in the report’s appendix and reviewed by two external experts, Dr. Trudy Bekkering and Prof. Patrik Vankrunkelsven of the Belgian Centre for Evidence-Based Medicine, who found the methods "robust."
The agency also said the APA overlooked or mischaracterized several studies in its critique.
Sapir and Byrne said they welcomed scientific criticism but called the AAP and Endocrine Society’s refusal to participate "a missed opportunity."
"The AAP and Endocrine Society are strong supporters of pediatric medical transition and have led the medical community and the public to believe that these interventions are well supported," the authors said. "American children and their parents deserve the best possible care, and it’s unfortunate that prominent medical associations have consistently refused to address scientific criticism of their positions."
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"We welcome criticism, especially from clinicians who support pediatric medical transition," they continued. "Because the AAP and Endocrine Society did not agree to take part, we decided to reply to two already-published critiques of the report, written by leading figures in the field of gender medicine. We explain why these critiques are full of fallacies and mistakes: people can read our replies and make up their own minds."
They also rejected claims that their review was politically motivated.
"Accusations of political motivation are a deflection," they said. "We are a politically diverse group, including Democrats. The process for writing this report was independent, from start to finish, and our only loyalty was to the principles of evidence-based medicine. The review is there for all to see and scrutinize, and it speaks for itself."
In a press release, National Institutes of Health Director Jay Bhattacharya hailed the report as a "turning point for American medicine."
"The evidence in it meticulously documents the risks the profession has imposed on vulnerable children. At the NIH, we are committed to ensuring that science, not ideology, guides America’s medical research," he added.
The AAP did not return Fox News Digital's request for comment.
A spokesperson for the Endocrine Society told Fox News Digital the organization did not participate in the HHS review because it was unclear about the peer review process but shared that it "supports access to evidence-based healthcare" for transgender youth.
The society said the HHS report emphasizes mental healthcare for this population, which is an "essential part" of the Endocrine Society's Clinical Practice Guidelines, but cautioned that decisions must be made holistically and individually, because "puberty-delaying medicine or hormone therapy could be a crucial part of their treatment plan and necessary to preserve their health."
It noted that such interventions are rare and that "fewer than 1 in 1,000 U.S. adolescents with commercial insurance received either treatment during the five-year period from 2018 to 2022," according to a January 2025 study from Harvard. The spokesperson noted that the 2017 Endocrine Society guideline recommends against puberty blockers or hormones in prepubertal children.
"The widely accepted view of the professional medical community is that medical treatment is appropriate for transgender and gender-diverse teenagers who experience persistent feelings of gender dysphoria. Medical studies show that access to this care improves the well-being of transgender and nonbinary people," a spokesperson added.
Fox News' Melissa Rudy contributed to this report.
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