“Psychotherapy is a noninvasive alternative to endocrine and surgical interventions for the treatment of pediatric gender dysphoria,“ it reads. ”Systematic reviews of evidence have found no evidence of adverse effects of psychotherapy in this context.”
National Debate
Leor Sapir, an HHS report author and senior fellow at the Manhattan Institute, agreed that the report represents an important milestone in how childhood gender dysphoria should be treated.“At the highest level, this is the closest the United States has ever got, and probably will ever get, to a scientific debate about this topic,” Sapir told The Epoch Times.
National Institutes of Health Director Dr. Jay Bhattacharya said in the Nov. 19 statement that the report’s evidence documents the “risks the profession has imposed on vulnerable children.”
“This report marks a turning point for American medicine,” he said.
Peer reviews from professors, doctors, and researchers were positive overall. The only review from a professional psychiatric group came from the American Psychiatric Association (APA). Two unsolicited negative articles were included, and HHS responded to them as well.
The APA, as the sole professional association to provide a formal peer review, said the report’s underlying methodology lacked “sufficient transparency and clarity for its findings to be taken at face value.”
The organization also criticized the HHS report, saying it failed to identify potential harm from withholding medical interventions, citing higher rates of depression, anxiety, and suicidal thoughts. Likewise, it condemned the report for not immediately disclosing report authors and any potential conflicts of interest.
In its reply to the APA, HHS responded that it was an established practice in scientific reviews to withhold authors’ names until after peer review so that the focus would be on the research.
Sapir called the validation of methodology extremely important because major flaws would damage the report’s credibility.
“That’s the beating heart of this review,” he said.
HHS noted that evidence underpinning the alleged benefits of medical interventions is “very uncertain.”
The agency also invited the American Academy of Pediatrics and the Endocrine Society to participate in the review. They criticized the report but did not offer a peer review.
The Cass report, a 2024 report to the UK’s National Health Service, resulted in a shift away from the gender affirmation model for children to a more conservative approach. The National Health Service significantly curtailed the prescribing of puberty blockers because there was insufficient evidence that puberty blockers benefited patients.
Leaders in pediatric gender medicine have criticized the HHS report in two journal commentaries.
The commentaries state, among other complaints, that the report does not name its authors, has factual errors, and misrepresents scientific evidence.
HHS noted that none of the government report’s contributors was employed by the agency and that its conclusions were reproducible and in line with scholarly norms.
The agency also stated that the Cass report has been accepted by both major political parties in the UK but noted that criticism was expected.
“It is not surprising that gender clinicians and the professional associations that represent them would disparage a review that upended their favored treatment model in the [UK],” HHS stated.
Positive Peer Reviews
However, most peer reviewers found that the government analysis met professional standards and had no major flaws.“This is an important and timely work. It is well written, methodologically rigorous, and makes a significant contribution to the discussion on this topic,” Johan C. Bester, professor of family and community medicine and health care ethics at Saint Louis University School of Medicine, wrote in his peer review.
“What the Cass review did in the UK, the [HHS] review does in the United States.”
Bester went on to write that the current practice of offering medical intervention to help youths with gender dysphoria “ought not continue.” He stated that much research is still needed on the causes of gender dysphoria, its natural course, and treatments.
Others, such as Dr. Richard Santen, professor emeritus of endocrinology at the University of Virginia School of Medicine, said the overall assessment of the studies in the report “was scientifically sound.”
Karleen Gribble, professor at the School of Nursing and Midwifery at Western Sydney University, applauded the report’s commitment to using scientifically accurate, neutral terminology. She said that rejecting terminology such as “sex assigned at birth” was “well-argued.”
HHS said the goal of the report was to provide accurate and current information on the treatment of children distressed over their biological sex.
“We must follow the gold standard of science, not activist agendas.”
