The Department of Health and Human Services recently released what it called a "comprehensive review" of medical or surgical gender reassignment procedures for minors who identify as transgender, calling for broader use of psychotherapy for young people with gender dysphoria rather than what proponents call gender-affirming care.
Catholic health care providers and commentators praised the report, while its critics questioned whether psychotherapy resolves gender dysphoria and argued that HHS did not disclose the report's authors.
The more than 400-page document that HHS released May 1 was the result of a January executive order issued by President Donald Trump that said his administration would seek to prohibit certain types of medical or surgical gender reassignment procedures for those under 19. That order also required HHS to publish "a review of the existing literature on best practices for promoting the health of children who assert gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion."
"Our duty is to protect our nation's children -- not expose them to unproven and irreversible medical interventions," Dr. Jay Bhattacharya, director of HHS' National Institutes of Health, said in a statement. "We must follow the gold standard of science, not activist agendas."
Supporters of banning gender transition surgeries or hormonal treatments for minors who identify as transgender say such restrictions will prevent them from making irreversible decisions as children that they may later come to regret as adults. Critics of such bans argue that preventing those interventions could cause other harm to minors, such as mental health issues or increase the risk of physical self-harm.
Theresa Farnan, a fellow at the Ethics and Public Policy Center in Washington, told OSV News the report "exceeded my expectations."
The report, Farnan argued, sifts "through all available evidence analyzing the quality of evidence that is alleged to support pediatric medical transition" to show that "this evidence is weak and of low quality."
The report found that what proponents sometimes call a "gender-affirming" model of care "includes irreversible endocrine and surgical interventions on minors with no physical pathology." It said these interventions risk "significant harms including infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret."
Jay Brown, chief of staff of the Human Rights Campaign, an LGBTQ+ policy advocacy group, argued in a statement the report "misrepresents the science that has led all mainstream American medical and mental health professionals to declare healthcare for transgender youth to be best practice and instead follows a script predetermined not by experts but by Sec. Kennedy and anti-equality politicians."
"It lays the groundwork to push parents and doctors aside and allow politicians to subject our kids to the debunked practice of conversion therapy," Brown said.
A joint statement from the American Academy of Family Physicians, the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association and American Psychiatric Association argued that their respective organizations "have consistently opposed any legislation, regulation, or executive action that interferes in the confidential relationship between a patient and their physician or undermines the provision of evidence-based standards of patient care and physician training and education."
"We support our members and will continue to advocate for access to the full spectrum of evidence-based health care and medical education," the statement said.
Dr. Alfonso Oliva, a plastic and reconstructive surgeon and an executive board member of the Catholic Medical Association, told OSV News that the HHS report was similar to England's notable Cass report that found "gaps in the evidence base" for puberty blockers, which arrest the onset of puberty by inhibiting sex hormones, and led to that nation scaling back its approach to the issue.
"There are no systematic reviews that show a benefit to medical transitioning of children and adolescents," Oliva said. "However, the risks include permanent sterility, decreased cognitive development, worsening psychological health, depleted bone density, increase in obesity, diabetes, and insulin resistance."
Louis Brown Jr., executive director of the Christ Medicus Foundation, a Catholic health care ministry that works to protect religious freedom for medical professionals and patients, told OSV News that a Catholic medical approach to treating a minor patient experiencing gender dysphoria would be to care for the patient on "the spiritual level, on the physical level, their mental health and their emotional health, but starting from the place that every child is a gift of God is good, has dignity and is owed love and truth."
Critics of the report also argued that HHS did not disclose the report's authors. For example, the Cass report was named for its author, Dr. Hilary Cass, a former president of the Royal College of Pediatrics and Child Health, whom the NHS appointed in 2020 to conduct an independent review of its gender identity services.
But the HHS report's supporters who spoke with OSV News argued that the department's decision to withhold the authors' names was not a source of concern for them.
"I do find it telling that instead of responding to the contents of the report on its own merits, critics keep harping on the fact that the authors are anonymous or trying to identify who the authors might be," Farnan argued.
Oliva acknowledged that it is "not typical" to withhold the authors' names on such a report. But he noted HHS' claim that nine experts across the political spectrum, who are very well known and respected in their fields, were involved.
"They expect that the review will undergo peer-reviewed scrutiny and HHS claims they wished to maintain the integrity of this process," he said. "We'll see if that is true and whether the names will be published."
At least 25 Republican-led states have adopted laws restricting or banning gender reassignment surgery or related hormonal treatments for minors, although not all of those bans are currently in effect amid legal challenges, according to data from the Movement Advancement Project, an LGBTQ+ policy group.
A still-pending ruling by the U.S. Supreme Court in United States v. Skrmetti, a challenge to one such law in Tennessee, could potentially have a significant impact on the future of those laws.
In guidance on health care policy and practices released in March 2023, the U.S. Conference of Catholic Bishops' Committee on Doctrine stated the church's opposition to interventions that "involve the use of surgical or chemical techniques that aim to exchange the sex characteristics of a patient's body for those of the opposite sex or for simulations thereof."
"Any technological intervention that does not accord with the fundamental order of the human person as a unity of body and soul, including the sexual difference inscribed in the body, ultimately does not help but, rather, harms the human person," the document states.
A January 2025 JAMA Pediatrics study found fewer than 1,000 U.S. adolescents with commercial insurance and a gender-related diagnosis received puberty blockers from 2018 through 2022, and none of them were under the age of 12. The study did not include minors covered by Medicaid.
