The Trump administration has introduced a comprehensive 409-page report on transgender health care, which promotes the use of behavioural therapy over extensive gender-affirming medical care for minors diagnosed with gender dysphoria. This report challenges established guidelines from the World Professional Association for Transgender Health (WPATH) and aims to reinforce the administration’s shift in policy regarding care for transgender youth, a controversial political issue.
Major medical associations and professionals who provide care for transgender youths have expressed strong disapproval of the report, labelling it as inaccurate. This document stems from an executive order issued by Trump shortly after his second term commenced, which indicated a federal stance against gender transition treatments for individuals under 19.
According to Jay Bhattacharya, Director of the National Institutes of Health, the report prioritises the protection of children over the endorsement of “unproven and irreversible medical interventions,” arguing for adherence to scientific standards over activist agendas. It questions the ethics surrounding medical interventions for young people, implying that adolescents may be too immature to consent to treatments that could lead to future infertility.
The report has raised concerns about over-reliance on therapy, suggesting that practitioners often overlook psychotherapy methods that challenge pre-existing beliefs, erroneously equating them with ‘conversion therapy’, which has been largely discredited and banned in many states. Critics note that conversion therapies have proven harmful, coinciding with higher rates of suicidal thoughts among youth.
With the assertion that their report is not intended as clinical guidance or policy advice, the Health and Human Services (HHS) nonetheless claims to aim it at policymakers and healthcare professionals, deeming the current approaches of gender care specialists as failures in safeguarding young patients.
Experts worry the report could create anxiety for families and healthcare providers. They caution that it appears politically motivated, with Dr Scott Leibowitz, a psychiatrist involved in developing WPATH standards, arguing it reinforces harmful biases in treatment methodology.
The administration has not disclosed the contributors of the report, with many prominent medical groups claiming they were not involved. It contradicts existing guidelines by the American Medical Association, which discourages state-level bans on gender-affirming care for minors, asserting that non-binary and transgender identities are valid components of human expression.
While the report claims a significant number of adolescents undergo gender-related surgeries or treatments, actual statistics indicate these interventions are infrequent, with fewer than 1 in 1000 adolescents receiving gender-affirming medications. A balanced approach to care generally includes supportive therapy alongside medical interventions.
Further complicating matters, various states have enacted bans on gender-affirming care, with legal challenges ongoing regarding these policies. This report represents a significant departure from prior guidelines and research, promoting a narrative that attempts to undermine the validity of transgender identities and medical practices associated with their care.