HHS Report on Gender Dysphoria in Youth Faces Scrutiny Over Authors’ Bias and Conflicts of Interest
The Department of Health and Human Services (HHS) on Wednesday re-released its controversial report on gender dysphoria in children, this time disclosing the identities of the previously anonymous authors and publishing a selection of peer review comments. The revised report, initially faulted for a lack of openness, reveals that many of those involved have openly criticized gender-affirming care and hold affiliations with organizations categorized as anti-LGBTQ+ by groups like the Southern Poverty Law center.
The updated report reaffirms the original conclusion – that the evidence supporting the benefits of gender-affirming care is insufficient – and suggests prioritizing alternatives to interventions like puberty blockers, hormones, and surgery. HHS Secretary Robert F. Kennedy Jr. stated that the American Medical Association and the American Academy of Pediatrics had “peddled the lie that chemical and surgical sex-rejecting procedures could be good for children.”
In response, the American Medical Association and the American academy of Pediatrics issued a joint statement rejecting Kennedy’s characterization as “negligent or ideologically driven,” asserting that such claims “misrepresent the consensus of medical science, undermine the professionalism of physicians, and risk harming vulnerable young people and their families.” The initial report, released in May, was completed under a 90-day deadline established by a January executive order from President Trump, which referred to gender-affirming care as “chemical and surgical mutilation.”
Concerns are mounting that the report will serve as justification for proposed rules from the Centers for Medicare and Medicaid Services (CMS) aimed at withholding federal funding from programs offering gender-affirming care to minors, as well as from hospitals and clinics providing such services.
Lack of Clinical Expertise Among Authors
Critics point to a significant lack of direct clinical experience in transgender healthcare among the report’s authors and reviewers. “They did not engage with anyone with actual clinical expertise in the care of trans youth,” said Kellan Baker,a senior advisor for health policy at the Movement Advancement Project. Baker noted that a critical paper he co-authored was cited in the peer review section, but neither he nor his co-authors were invited to contribute to the report or participate in the peer review process.
“It is a very small loop of people who have already been on record,as they would call themselves ‘skeptics’-I think it’s fair to call them opponents of care for trans young people,” Baker added.
HHS communications director Andrew Nixon stated that the agency sought a diverse range of perspectives, including from organizations supportive of gender-affirming care, and that the publication of peer review comments was in line with the Facts Quality Act and a commitment to “radical transparency.”
Methodological Concerns and Biased Reviews
While some reviewers generally agreed with the report’s conclusions, others raised concerns about its methodology. Jilles Smids, a postdoctoral researcher, acknowledged the report’s “well-argued analysis” but emphasized that it was “clearly not a neutral report” and “decidedly argues against early medical intervention for minors.”
Richard Santen, a past president of the Endocrine Society, stated he had spent the past year attempting to form an objective opinion. His review centered on whether gender-affirming care should be considered “experimental” – as the report asserts – or “accepted practice,” as many clinicians argue. santen revealed he utilized Gemini AI to establish criteria for evaluating this question, ultimately concluding that while the report’s “experimental” designation had merit, it was also open to reasonable disagreement.
an examination by STAT revealed a pattern of financial and ideological connections among the report’s contributors and reviewers. Six of the nine authors have received payments for work opposing gender-affirming care, including consulting, speaking engagements, and expert testimony. Many are affiliated with religious or anti-LGBTQ+ groups, including the Society for Evidence Based Gender Medicine (SEBM), which the southern Poverty Law Center has labeled a pseudoscience and LGBTQ+ hate group.
Key Contributors and Their Affiliations
Physician Michael K. Laidlaw,a frequent witness in legal cases concerning bans on gender-affirming care,is the sole endocrinologist among the contributors. A federal judge previously questioned his expertise in treating transgender patients, deeming his views “decidedly out of the mainstream.” The state of Tennessee recently cited his testimony in defense of its ban on gender-affirming care for youth.
Contributors Leor Sapir and Alex Byrne have also long been vocal critics of gender-affirming treatment for minors. Sapir, a fellow at the Manhattan Institute, has received payments for legal consultations and speaking engagements related to pediatric gender medicine. Byrne, a ideology professor at MIT and author of “Trouble With Gender,” actively challenges gender identity theories and has spoken at events organized by Genspect, another organization listed as an LGBTQ+ hate group by the Southern Poverty Law Center.
Farr Curlin, a professor of medicine at Duke, has also received payments for expert testimony opposing gender-affirming care, arguing that it “treats his healthy body as a diseased one.” Kristopher Kaliebe, a psychiatrist, has disputed the validity of transgender healthcare guidelines and received payment for expert testimony. Kathleen McDeavitt, a psychiatrist at Baylor Collage of Medicine, has published papers criticizing pediatric gender-affirming care as “not evidence-based.”
Non-physician authors include Evgenia Abbruzzese, a co-founder of SEBM, and Moti Gorin, a bioethics professor and board member of the LBG Courage Coalition, an organization opposing gender-affirming care. Yuan Zhang, founder of Evidence Bridge, also received commissions from SEBM.
Peer Review Process Questioned
The report includes seven peer reviews, with the majority supporting its conclusions. However, critics argue the selection process was biased. “They very clearly picked their own reviewers to tell them what they wanted to hear,” Baker asserted.
Several reviewers have previously published work critical of gender-affirming care. Johan Bester, for exmaple, has argued that minors “lack the autonomy” to consent to such care. Karleen Gribble,an adjunct professor,focused her review on potential impacts on breastfeeding ability after top surgery.
The American Psychiatric Association (APA) noted in its review that the report’s methodology lacked “sufficient transparency and clarity.” A review by methodologists Trudy Bekkering and Patrik Vankrunkelsven found no major flaws in the report’s design but highlighted the “very low” or “low certainty” of evidence supporting gender-affirming care options.
However, gordon Guyatt, the epidemiologist who developed the GRADE approach to evidence assessment, cautioned against using low-quality evidence to ban gender-affirming care. “Low quality evidence doesn’t mean it doesn’t work. It means we don’t know. And so,we try,” he stated.”There is, I would say, quite good evidence from the accounts of the individuals who’ve undergone the therapy, that they were really benefited by the therapy.”
The report authors responded to the APA’s review by asserting their adherence to Guyatt’s methodology. The controversy surrounding this report underscores the deeply polarized debate surrounding gender-affirming care and its implications for young people.
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