We wrote the HHS review on treatment for minors with gender dysphoria. We hope our critics actually read our report

STAT News – Monday, December 8, 2025
By Evgenia Abbruzzese, Alex Byrne, Farr Curlin, Moti Gorin, Kristopher Kaliebe, Michael K. Laidlaw, Kathleen McDeavitt, Leor Sapir, and Yuan Zhang

The Department of Health and Human Services recently published its final version of “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.” The review confirmed what several European health authorities recognized as early as 2019: the assumed benefits of pediatric medical transition are profoundly uncertain, while the risks are significant.

As the authors of the HHS review, we understand that some may be skeptical of our conclusions. After all, the report was commissioned by an administration whose policies are unpopular with many in the medical community.

But we are a politically diverse group. Most of us are liberals and long-time Democratic Party supporters. All of us share a commitment to evidence-based medicine and have been willing to stick our necks out, often at personal or professional cost, to speak the truth. We did not expect HHS to entrust this sensitive task to us; it could have chosen a team that was ideologically aligned with the current administration. We are grateful that the administration set aside coalition politics and chose us instead.

Our process for producing this review was independent of the current administration. Our findings are transparently laid out; our methods are reproducible. After publication of the initial review in May, HHS sought critical feedback from the American Academy of Pediatrics, the Endocrine Society, and the American Psychiatric Association, among others, in a peer review process. The APA, to its credit, agreed to participate. Because the other two organizations refused, we decided to respond to two published critiques of the initial review by some two dozen of the top gender clinicians in the United States. If anyone could find significant errors in the review, surely it would be them.

And yet, the APA’s peer review and the two critiques failed to identify any significant errors. Meanwhile, other peer reviewers commended the report overall, identifying only minor issues and in some cases arguing that our assessment of the field wasn’t critical enough. A past president of the Endocrine Society agreed with the report’s evidence review and incorporation of evidence from physiology, pharmacology, and human sexual development. Experts in methodology at Belgium’s Centre for Evidence-Based Medicine commended the report’s methodology as “robust” and “transparent.” Declaring the report’s “findings and conclusions” to be “correct,” a distinguished professor of bioethics (and critic of claims that vaccines cause autism) concluded: “Given the lack of demonstrable benefit and concern about potential harms, the use of puberty blockers, cross-sex hormones, and gender transition surgery in minors with gender dysphoria cannot be ethically justified.”

The HHS review comes out against a backdrop of growing international skepticism about pediatric medical transition. Scholarly criticism, including research authored by one of us, Abbruzzese, has shown that even the seminal studies that launched the field are unreliable due to significant methodological limitations. Researchers in this field greatly exaggerate or misrepresent their findings, and studies are regularly spun or go unpublished if their results do not support the medical model. Systematic appraisal of medical guidelines used in U.S. health care settings found them to be untrustworthy.

In Sweden and Finland, evidence reviews (like the one we conducted) and practice reversals were initiated under liberal governments. The ban on puberty blockers outside of clinical trials in the U.K. was endorsed by Conservative and Labour governments alike. In America, by contrast, the debate over pediatric gender medicine has split mainly along party lines, though Democratic-leaning voters, unlike their representatives, are mostly critical of the practice.

The review also presents evidence of a medical scandal at home. Leading gender clinicians have misled their colleagues and the public not only about the evidence, but about what pediatric gender clinics actually do. In 2023, the author of the American Academy of Pediatrics’ policy statement on youth gender medicine said the quiet part out loud: “the child’s sense of reality and feeling of who they are is the navigational beacon to sort of orient treatment around.” Boston Children’s Hospital is a good example. In 2021, the director of its gender clinic admitted in a private video that the clinic was giving out puberty blockers “like candy.” Court proceedings later revealed that assessment times at the clinic had collapsed from 20 hours or more in 2013 to two hours by 2018. We discuss other examples of how safeguards have been systematically dismantled in the HHS review. Of note, neither the APA nor the gender clinicians who criticized the review disputed any of these findings.

One of the main criticisms of our report has been that none of us prescribe hormonal interventions to or perform gender surgeries on minors. But is it wise to trust experts who are committed to a certain treatment model to impartially evaluate the evidence base for their practice? The tragedy of opioid overprescription is proof enough that physicians strongly committed to their favored treatment model are capable of great error. The suggestion that a review of pediatric gender medicine “should be authored by experts who have dedicated their careers” to the practice should be taken with a large grain of salt.

Evidence appraisal requires specialized expertise. For good reason, Sweden, Finland, and the U.K. entrusted such evidence evaluation to methodology experts. The HHS review’s evidence appraisal was also performed by a professional in evidence evaluation — and confirmed as accurate by researchers at Cochrane Belgium, who served as peer-reviewers.

As doctors and researchers, we have spent the better part of a decade deeply immersed in this topic. We have published scholarly analyses of gender medicine research and clinical practice, and we have grappled with the most difficult questions of the field. One of us is a child psychiatrist who regularly sees these patients in clinical practice.

Last year, court documents revealed what happens when doctors in a specialist subfield have free rein to grade their own homework. The World Professional Association for Transgender Health (WPATH) suppressed evidence reviews whose conclusions it disliked and eliminated age minimums in response to political pressure when drafting its latest medical guidelines. That guideline was promptly adopted across American health care settings. Systematic reviews of guideline quality finding it unfit for use, and detailed coverage of the WPATH scandal in outlets such as The New York Times and the Economist, didn’t help: the WPATH guideline continues to form the foundation for medical education in this area.

Some critics might respond that very low quality evidence doesn’t mean a treatment doesn’t work and that it should be provided nonetheless, especially when some patients say they are benefitted by it. We address this line of reasoning explicitly in the HHS review and find it unpersuasive, even when applied to experimental settings. Evidence-based medicine was developed to counter the overreliance on expert opinion and clinical anecdote. Decades of research have failed to demonstrate convincing evidence of benefit from puberty blockers, cross-sex hormones, and surgeries in minors.

Meanwhile, some of their harms are known (infertility, decreased bone density accrual, inability to breastfeed, arrested genitalia development) and some can plausibly be expected (sexual dysfunction, delayed neurocognitive development). As these significant harms outweigh speculative benefits, the continued insistence by some medical groups that hormones and surgeries should be routine practice —meaning, offered outside of strictly controlled clinical trials — is inconsistent with principles of evidence-based medicine and medical ethics.

Some of our critics have alleged that we are “anti-LGBTQ+.” This is a baseless smear that rests entirely on the fact that we have questioned the evidence base for using endocrine and surgical interventions to treat gender dysphoria in minors. The fallaciousness of the allegation is obvious: our skepticism of the evidence is dismissed because we are “anti-LGBTQ+,” and we are called “anti-LGBTQ+” because of our skepticism of the evidence.

Medical professionals in the United States should look past the partisan framing and engage with the substance of this debate about how to help vulnerable adolescents. Unlike the gender clinicians who, along with the medical organizations that represent their interests, urge the public to “trust the experts,” we are not asking people to take our word for it. We encourage everyone to read the supplement to the HHS review, which contains all the peer reviews and our responses to them, and judge for themselves.

Evgenia (Zhenya) Abbruzzese is a co-founder of the Society for Evidence-Based Gender Medicine. Alex Byrne is a professor of philosophy at MIT. Farr Curlin is an internist and professor at Duke University School of Medicine. Moti Gorin is a bioethicist and philosopher at Colorado State University. Kristopher Kaliebe is a psychiatrist and professor at the University of South Florida Morsani College of Medicine. Michael K. Laidlaw is an endocrinologist at Michael K. Laidlaw, M.D., Inc. Kathleen McDeavitt is a psychiatrist and associate professor at Baylor College of Medicine. Leor Sapir is a senior fellow at the Manhattan Institute for Policy Research. Yuan Zhang is a Canadian researcher and the founder of Evidence Bridge. Abbruzzese, Curlin, Kaliebe, Laidlaw, and Sapir have received payments and honoraria for work related to pediatric gender medicine, such as expert testimony, legal consultations, speaking engagements, or conference attendance.

The views expressed here are solely those of the authors and do not represent their institutions.

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