What’s in HHS Review of Youth Gender Medicine? A Lot of Harmful Politics.
Leading Off: A government report that reads like a long anti-trans opinion piece. Trump just keeps losing in Maine. The top story lines as the week begins.
by Evan Urquhart
President Trump signed an executive order on Jan. 28, declaring “medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child's sex” and proposing to put an end to this practice. Included in the order was a request for a literature review from the Department of Health and Human Services concerning gender-affirming treatments, to be delivered within 90 days of the order. Late last week, HHS released an anonymously authored document of over 280 pages, along with another hundred-odd pages of sources and appendices.
The report was swiftly dismissed as politicized and potentially harmful by experts including the American Academy of Pediatrics, who released a statement comparing it to recent attempts to rewrite the science around vaccination.
But what’s actually in this lengthy, hastily assembled document?
The introductory chapter claims youth gender medicine departs from usual medical practice, and then briefly concedes that every area of supposed exceptionalism occurs in many other areas of medicine.
It states that 3.3 percent of American youths identify as trans while only 0.1 percent receive hormone therapy and 0.01 percent receive surgery, but avoids the obvious conclusion that medical transition is rare among young people with a transgender identity. To the contrary, it suggests medicalization is nearly synonymous with transgender identity, stating on page 38, “the term ‘transgender child’ suggests that medical intervention is the default or primary course of action.”
The report includes a chapter complaining about the language of those who support the trans community, and a chapter offering a non-comprehensive history of gender-affirming treatments that ignores past attempts to treat trans people through psychotherapy. The latter tees up a later chapter promoting psychotherapy only as the best treatment option.
The overall tone of the report, however, is not polemical. It’s dry and academic, even when it ventures far outside the mainstream, such as when it misgenders and deadnames Christine Jorgensen, suggesting in a footnote on page 43 that this pioneering American trans woman was really a gay man. It’s unclear why Jorgensen’s story is related in such detail, or why a history of youth gender medicine spends so much time on the adult Jorgensen.
Nor does it mention the failed efforts by psychologists of the past to coerce youth with gender differences into growing up as cisgender men and women, an effort that pre-dated the more recent gender-affirming approach among professionals. One notable person to have made such attempts, Kenneth Zucker, is cited repeatedly, though his work with youth and its outcomes is never described. Zucker’s Canadian clinic was shut down after an external review highlighted harsh practices aimed at changing young patients’ gender identities.
Taken as a whole, the document is more legible as an extended opinion column than a scientific review of evidence, and in places where evidence is discussed it cribs extensively from the U.K.’s Cass Review. It makes a now-familiar case, plucked from the opinion pages, that something has gone wrong with gender medicine, and psychotherapy alone should be the default, perhaps only, treatment for trans young people. Experts disagree
Doctors slam the HHS “review:” Trump’s politicized report “misrepresents existing research and disregards the expertise of professionals who have been working with transgender and gender-diverse youth for decades,” said the two health agencies that guide professional standards of care, the World Professional Association for Transgender Health and the US Professional Association for Transgender Health.
“Healthcare decisions should remain in the hands of patients, their families, and qualified clinicians—not politicians,” the group said.
Trump stands down v Maine, but it’s not over: The administration on Friday dropped its retaliatory, anti-trans effort to withhold federal funds for child nutrition. Maine officials had resisted Trump’s pressure to unilaterally abandon state and federal law, filing a lawsuit.
“It’s unfortunate that my office had to resort to federal court just to get USDA to comply with the law and its own regulations,” said Aaron Frey, the Maine attorney general.
Still, Trump’s retreat does not affect another ongoing lawsuit filed by his administration against the Maine Department of Education over its trans-inclusive athletic policies. And the Maine state legislature will hold hearings this week on Republican-sponsored bills that would try to bar young trans people from school sports.
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Evan Urquhart is the founder of Assigned Media.