The HHS report was commissioned under Executive Order 14187 (signed January 28, 2025) and published last month, in November 2025. It aimed to review and synthesize the scientific evidence and ethical issues around treating gender dysphoria in children and adolescents (not adults), focusing on health outcomes and best practices. This document represents the United States catching up to the UK’s Cass Review completed in April of 2024. It is a 410 page document and well worth reading if you are a clinician, researcher, parent, teacher, advocate, lawmaker, or are involved in working with young people experiencing sexual identity-related distress.
The stated goals were:
- To evaluate how well current science supports various treatments for pediatric and adolescent gender dysphoria.
- To identify risks and benefits of medical and non-medical approaches.
- To discuss ethical implications of interventions.
HHS describes the work as a review of evidence and best practices, not a clinical guideline or direct policy prescription.
Key Findings: Evidence Quality and Risks
Low Certainty of Benefits
One of the main messages of the report is that the quality of evidence supporting the long-term benefits of medical interventions — such as puberty blockers, cross-sex hormones, and surgeries — for youth with gender dysphoria is very low or uncertain. Systematic reviews analyzed in the document reveal deep uncertainty about whether these treatments improve psychological outcomes, quality of life, or long-term functioning.
Significant Potential Harms
The report highlights that these medical interventions are associated with potentially serious and irreversible risks, including:
- Infertility or sterility.
- Sexual dysfunction.
- Impaired bone density accrual.
- Cardiovascular and metabolic concerns.
- Psychiatric disorders and surgical complications.
- Regret in some individuals.
Because long-term data are limited, the frequency and severity of these harms are not fully quantified, but the concern is that current research does not adequately detect or track them.
Natural Course and Diagnosis
The report underscores important clinical and scientific uncertainties:
- Gender dysphoria in youth is diagnosed based on subjective symptoms, without objective physical or laboratory markers.
- Research suggests that the condition often remits without medical intervention, especially in children.
- There is no reliable way to predict which young people will persist in dysphoria and which will desist, raising questions about early irreversible medical interventions.
Ethical and Clinical Context
Beyond medical evidence, the report delves into ethical analysis. It frames pediatric gender-affirming medical care as:
- An area where clinical uncertainty remains high.
- One where ethical principles like non-maleficence (“do no harm”), informed consent, and autonomy must be carefully balanced.
The report stresses that therapeutic approaches and decision-making should be grounded in evidence and ethical reflection, especially given the long-term implications of irreversible treatments.
Broader Scientific and Public Reactions
While the report itself is a detailed review, its interpretations and implications remain highly controversial in medical and public health circles:
- Supporters argue it realistically reflects limitations in the evidence base and emphasizes caution with irreversible interventions.
- Critics contend the report selectively interprets evidence, underrepresents supportive research, and may fuel policy actions that restrict access to care. Major medical organizations (e.g., American Academy of Pediatrics, American Medical Association) have challenged similar conclusions in other contexts, asserting that gender-affirming care can be evidence-based and beneficial when tailored to individuals.
Where It Fits in the Ongoing Debate
This HHS report does not prescribe specific treatment guidelines, but it has already influenced health policy discourse and regulatory proposals (as evidenced by related federal statements and initiatives). Its emphasis on evidence uncertainty, potential harms, and ethical scrutiny has encouraged:
- Calls for more research and robust long-term data.
- Renewed debate among clinicians, families, advocates, and policymakers about how to support youth experiencing gender dysphoria.
- Discussion of non-medical approaches — like psychotherapy and supportive care — as alternatives to hormonal and surgical interventions.
Conclusion: A Report at the Intersection of Science and Society
The HHS Treatment for Pediatric Gender Dysphoria report is a comprehensive, complex document that reviews existing research and ethical thought relating to youth gender dysphoria. It highlights the current gaps and uncertainties in high-quality evidence about medical interventions and emphasizes potential risks. While it avoids making concrete clinical guidelines, it situates itself as a resource for clinicians, families, and policymakers navigating a deeply contested and evolving field.
Ultimately, the report’s release has both reflected and contributed to a broader national conversation about how society, medicine, and policy should respond to the needs of gender-diverse young people — a conversation that continues to evolve.