Youth gender medicine report commissioned by HHS still finds harm after peer review, names authors

Social scientist Lisa Littman put a target on her back seven years ago by documenting "rapid-onset gender dysphoria" in youth, prompting her to leave Brown University after the Ivy League school tried to discredit her research by implying her study was retracted rather than slightly revised. 

Another publisher retracted a subsequent ROGD paper under threat of an academic boycott and a demand to fire the journal's editor, gender dysphoria research pioneer Kenneth Zucker, claiming it lacked "informed consent" for its use of opt-in survey data.

Now advocates for giving healthy children puberty blockers, cross-sex hormones and surgeries to remove breasts and genitals have a fresh target: the newly identified authors of a "pediatric gender dysphoria" systematic review commissioned by the Trump administration, which concludes global evidence does not support such interventions.

The final report Wednesday made "fairly minor edits" to the original published this spring, gender medicine journalist Ben Ryan said in the New York Sun, documented in the 3-page errata now attached to the report. 

One notable correction: The authors forgot to qualify that a "statistically significant" finding of small improvement on "transgender congruence" from treatment was only "in males."

There's also a new 241-page supplement with peer reviews of the report recruited by the Department of Health and Human Services, most prominently by the American Psychiatric Association, and authors' replies to each.

HHS emphasized that the American Academy of Pediatrics and Endocrine Society – strong supporters of so-called gender-affirming care for minors – turned down its invitations. 

It praised the APA, another GAC supporter, for participating as the only institutional peer reviewer among nine. APA's four-page review said the "underlying methodology lacks sufficient transparency and clarity for its findings to be taken at face value" and "key elements … are either underexplained or absent."

The American Medical Association and AAP "peddled the lie that chemical and surgical sex-rejecting procedures could be good for children,” HHS Secretary Robert F. Kennedy Jr. said Wednesday, using the same confrontational tone as when his agency released the original.

"They betrayed their oath to first do no harm" and "inflicted lasting physical and psychological damage on vulnerable young people," which is "malpractice," he also said. 

The authors' findings discredit "pediatric sex-rejecting procedures" and affirm the Make America Healthy Again Commission’s findings, that "unnecessary procedures and long-term health risks such as infertility are the byproduct of the overmedicalization of children," HHS said.

"Sex-rejecting procedures" appear to have been first suggested as a replacement for "gender-affirming," and as an alternative to HHS's proposed "sex-trait modification," just a week after the original report's release, coined by the Ethics and Public Policy Center. It's also used on the assistant secretary for health's "priorities" page.

New Zealand follows U.K. caution on puberty blockers, Alberta goes nuclear

The Washington Post editorial board commended the final report, albeit under the cagey headline "What we still don’t know about pediatric medical transition."

With the authors' identities now public, it is clear they are "not ideological cranks" but rather "thoughtful researchers," the editorial said. "It is fair to say that their work has withstood scrutiny, with minor updates," and the core finding "echoes the results of systematic reviews in other countries."

While the editorial quibbles with the report's conclusions that "it is not ethical" to even provide GAC for minors in a research trial "until and unless the state of the evidence suggests a favorable risk/benefit profile for the studied intervention," it credits the report with "jump-start[ing] a much-needed conversation. Scientists should continue it."

The final report coincides with a big change in the Southern Hemisphere, with New Zealand's government following the lead of the United Kingdom by halting the prescription of "gonadotropin-releasing hormone analogues" – puberty blockers – for new patients seeking  treatment for "gender dysphoria or incongruence."

It will review them again when the U.K.'s clinical trial on such use is finished, Health Minister Simeon Brown said, noting that Finland, Norway and Sweden have adopted similar "safeguards" to align decisions "with the best available evidence."

Gender-critical Genspect NZ called it "an overdue correction," given the country "has one of the highest prescribing rates of puberty blockers in the world, making us an outlier."

The Alberta, Canada government invoked a "notwithstanding" clause to shield three transgender-related bills from legal challenges, including one that bans GAC for minors, the CBC reported. Premier Danielle Smith called it "one of the most consequential actions our government will take during our time in office.”

The Alberta Medical Association dragged the government for the move, a response to a recent court ruling, without noting such restrictions are aligned with much of Europe and now the U.S. President Brian Wirzba claimed it ditched "evidence-based standards of care that have been safely and responsibly administered for years to support children and families."

Consensus of 'small number of specialized committees,' not medicine at large

The big change between spring and fall HHS reports is the public reveal of the nine authors, whom HHS initially hid to "help maintain the integrity of this process" amid peer review. (HHS privately identified them to science journalist Jesse Singal, who called them "informed skeptics who have been deep in the weeds" on youth gender medicine.)

Several are associated with the Society for Evidence-Based Gender Medicine, "the bête noire of trans activists" and supposed hate group as determined by the Southern Poverty Law Center, according to Ryan's lengthy Substack article on the nine authors, whose "personal politics" he described as "tilted toward the left" at the median. 

They include SEGM cofounder Evgenia Abbruzzese, who put a target on her back in 2023 by scrutinizing what she considers the weak evidence base for GAC in minors in the Journal of Sex and Marital Therapy. Manhattan Institute senior fellow Leor Sapir, who researches medicalized transition protocols, is another.

Several have university affiliations: bioethicists Farr Curlin of Duke University and philosopher Moti Gorin of Colorado State University and psychiatrists Kristopher Kaliebe of the University of South Florida and Kathleen McDeavitt of Baylor University. Endocrinologist Michael Laidlaw and evidence-based medicine specialist Yuan Zhang also contributed.

One author, MIT philosopher of gender Alex Byrne, outed himself after the original came out, arguing the anonymity was needed in light of the "hostile reaction" to a work mostly written by "liberals." His wife is sex researcher Carole Hooven, who left Harvard following a cancellation campaign based on her public remark that "sex is binary and biological."

Their "umbrella review" of systematic reviews, "including several that have informed health authorities in Europe," found that the "overall quality of evidence concerning the effects of any intervention on psychological outcomes, quality of life, regret, or long-term health, is very low," the executive summary says.

While the evidence of harm is also "sparse," the authors emphasized this "may reflect the relatively short period of time since the widespread adoption of the medical/surgical treatment model; the failure of existing studies to systematically track and report harms; and publication bias."

It cited the politicized drafting process for the World Professional Association for Transgender Health's Standards of Care 8, in which Biden administration HHS Assistant Secretary Rachel Levine pressured drafters to remove age minimums for treatment.

While "U.S. medical associations played a key role in creating a perception that there is professional consensus in support of pediatric medical transition," this is limited to "a small number of specialized committees, influenced by WPATH," the summary says, citing evidence that associations "have suppressed dissent and stifled debate" among members.