By Jen Christensen, CNN
The US Department of Health and Human Services said Wednesday that Secretary Robert F. Kennedy Jr. sent a letter urging health care providers and medical boards to update treatment protocols for youth with gender dysphoria based on a controversial HHS review of scientific literature that was released earlier this month.
The HHS report, released May 1, says it is “not a clinical practice guideline,” but Kennedy’s letter warns providers against relying on science-based professional guidelines and urges them to use the government document to inform their practice instead. The letter also said that HHS is committed to protecting whistleblowers and may soon create new policies and oversight actions to “hold providers that harm children accountable.”
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The Centers for Medicare and Medicaid Services – a subagency of HHS – also announced Wednesday that it was launching an oversight initiative into hospitals that performed “experimental sex trait modification procedures” on children. Administrator Dr. Mehmet Oz said CMS “will not turn a blind eye to procedures that lack a solid foundation of evidence and may result in lifelong harm.” Oz added that he was concerned about the “profits related to these harmful procedures.”
Research shows that gender-affirming surgery is rarely performed on transgender or gender-diverse children or teens in the US, and professional medical organizations do not recommend surgery for children as part of gender-affirming care.
Kennedy’s letter, which HHS shared Wednesday on social media, warns providers to avoid relying on guidelines from the World Professional Association for Transgender Health on care for transgender and gender-diverse people. “These and other guidelines based on the so-called ‘gender-affirming’ model of care should not be relied upon to harm children any further,” the letter says.
Kennedy urges providers to read HHS’s review of the scientific literature on care for trans individuals and “update your treatment protocols and training to ensure that our nation’s children are protected from harm.”
In the US, care for gender dysphoria – an official diagnosis of a condition in which an individual feels significant distress because of a mismatch between the sex they were assigned at birth and their sense of their gender – is tailored to an individual’s needs and is typically offered through a multidisciplinary team of doctors. Not everyone who identifies as transgender or gender-diverse has this diagnosis.
Gender-affirming care is guided by several professional association guidelines, based on decades of research that shows that it is safe and that it can have a positive impact on a person’s life and mental health. Major medical associations – including the American Medical Association, the American Psychiatric Association, the Endocrine Society, the American Psychological Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry – have affirmed the practice of gender-affirming care and agree that it’s clinically appropriate and can provide lifesaving treatment for children and adults.
The 400-page review that Kennedy’s letter referenced was initiated by an executive order from President Donald Trump that called gender-affirming care “chemical and surgical mutilation” and stated that the federal government would not “fund, sponsor, promote, assist or support” any kind of gender-affirming care for people under the age of 19.
When the report was released, HHS refused to identify who wrote it. HHS said parts of it were peer-reviewed, but it would not disclose which parts or identify who reviewed it.
The report spelled out that “it is not a clinical practice guideline, and it does not issue legislative or policy recommendations.” Rather, it included sections on evidence, ethical considerations, psychotherapy and “clinical realities” focused on treatment of gender dysphoria in young people. The review did not examine the treatment of adults.
The report said that the science used to inform the practice of gender-affirming care was weak and that the practice was harmful. It also sharply criticized US medical associations for what it said was suppression of dissent among members on the issue.
The Endocrine Society, a professional group whose guidelines are also mentioned in Kennedy’s new letter, said in an email Wednesday that its guideline development process “adheres to the highest standards of trustworthiness and transparence.”
“The widely accepted view of the professional medical community is that medical treatment is appropriate for transgender and gender-diverse teenagers who experience persistent feelings of gender dysphoria. Medical studies show that access to this care improves the well-being of transgender and nonbinary people,” the group said.
The American Academy of Pediatrics said when the HHS report was issued that it was “deeply alarmed” and that the report relied on “select perspectives and a narrow set of data,” the group’s president, Dr. Susan Kressly, said at the time.
“This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care,” Kressly said in a statement.
Gender-affirming care in the US typically starts with a conversation between the individual and a clinician. If the patient is a child, the conversation will involve the family or caregiver when possible. Once the clinician understands what the individual needs, they will design a plan with a team of providers. The practice can include mental health care, support groups and even legal help.
When a person is past the start of puberty, their care may include hormones, but not everyone chooses to use them. When a person is an adult, a patient may also seek out surgery to better align their body with their gender.
A 2024 study of medical insurance claims in the US from 2019, the latest year available, found that there were no gender-affirming surgeries performed on transgender youth 12 and younger. For older teens and adults, the rates of gender-affirming surgery with a trans or gender diverse-related diagnosis were 2.1 per 100,000 and 5.3 per 100,000, respectively, the study said.
Transgender people have been a major focus of the second Trump administration. Soon after his inauguration, Trump signed executive orders that denied the existence of transgender people and instructed government agencies to acknowledge a strict gender binary and withdraw any support for people who identified otherwise.
The administration has cut hundreds of millions of dollars in funding used to study trans issues and removed information about transgender people from government websites. Trump has ordered trans troops out of the military, and on Tuesday, he threatened to withhold federal funding from California over a transgender athlete’s participation in an upcoming sporting event. Earlier this year, the administration moved to strip funding from Maine, to include funding that fed children and disabled adults, because the state allows trans students to compete in athletics.
Gender-affirming care for youth has also been a growing target for state governments. As of March, 27 states have enacted restrictions on such care, meaning about 40% of trans youth live in a state with limited gender-affirming health care options, according to KFF, a health policy organization.
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