HHS Moves to Restrict Gender-Affirming Care Based on Dubious Report Shredded in Peer Review
A review of the report HHS relied on calls it “a dangerous incursion of politics into science and medicine.”
On Thursday, Health and Human Services Secretary Robert Kennedy Jr. announced new policies to restrict transgender and nonbinary youths’ access to gender-affirming care.
Accompanied by his top lieutenants, including National Institutes of Health Director Jay Bhattacharya, Food and Drug Administration Commissioner Marty Makary, and Centers for Medicare & Medicaid Services (CMS) Director Dr. Mehmet Oz, Kennedy declared, “Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk.”
The promised changes include leveraging CMS participation rules to stop hospitals from performing gender-related medical procedures on minors and using the FDA to target companies that market breast binders to children. HHS will also move to reverse a Biden-Era rule that classified gender dysphoria as a disability subject to federal civil rights protections.
According to a press release, the HHS policy changes to prevent what it called “sex-rejecting procedures on minors” were based on a peer-reviewed report claiming such care did not meet “professionally recognized standards.” But Important Context looked into the peer reviews, which are available on the HHS website, and several offer stark criticism and warnings that the document is not a credible basis upon which to set policy.
One of the most authoritative reviews came from the American Psychiatric Association, which wrote that “the Report’s claims fall short of the standard of methodological rigor that should be considered a prerequisite for policy guidance in clinical care.” The APA highlighted a number of serious methodological problems with the report. It noted, for example, that the document failed to “clearly articulate how the studies were selected, what criteria governed their inclusion or exclusion, or how their quality was assessed.”
Most seriously, the APA warned that the report failed to account for confirmation bias. It noted that “There is no indication that key stakeholders—namely, transgender individuals, their families, and clinicians—were consulted or that their perspectives were considered.”
“A comprehensive review of best practices would include input from recipients (both those for whom treatment was beneficial, and those for whom it was not), families, and providers of the treatments under evaluation,” the review read.
The APA further noted that the report failed to “apply any kind of rational scrutiny to potential harms that have been associated with withholding intervention, including higher rates of depression, anxiety, suicidality, and social withdrawal” and relied heavily on the so-called Cass Review “which itself has been criticized by experts for its methodological flaws and biases.”
A second review, published in the Society of Adolescent Health and Medicine’s Journal of Adolescent Health, was similarly critical. It warned of its “extensive violations of scientific norms, misrepresentations of science, and wanton disregard of the expert standard of care for [transgender] youth” and called it “a dangerous incursion of politics into science and medicine.”
The review noted that because the report had been commissioned by an executive order that described “expert clinical guidelines as ‘junk science’ and uses incredibly incendiary language…the possibility that the findings…were predetermined…must be considered.”
It further noted that “Over 20% of the references in the HHS report are of lay press articles, blogs, or social media posts,” adding “Such citations fall far short of the minimum standard of evidentiary credibility typically expected of a scientific review because they skew toward personal opinion rather than observations supported by peer-reviewed scientific literature.”
A third review by a team of researchers led by Nic Rider, Ph.D., an associate professor and a licensed psychologist at the University of Minnesota, concluded that the HHS report was “replete with factual errors, distort[ed] current scientific evidence, and defi[ed] expert medical consensus,” warning that it “joins a growing list of White House-endorsed actions that platform harmful practices against [transgender and nonbinary] children and adolescents and their families, as well as the healthcare professionals who support them, with little regard for their civil rights and for the expertise that protects and promotes their well-being.”
The review added that the report reflected the White House’s “politically motivated and biased agenda” and similarly noted that “more than a fifth of its references are from popular media articles, blogs, or social media…compromising the transparency, accountability, and rigor central to scientific best practices.”
The HHS report does have favorable reviews as well. Several of the writers behind those positive appraisals, however, have no publications related to gender-affirming care listed on PubMed, the database of the National Library of Medicine. One individual had even assisted in the crafting of the HHS report.
As STAT News reported last month, some of the report’s original authors had involvement with anti-LGBTQIA+ groups. More than half disclosed receiving payments or honoraria for consultations, speaking engagements, or testimony about “pediatric gender medicine,” including Leon Sapir, a senior fellow at the far-right Manhattan Institute, and Evgenia Abbruzzese, co-founder of the Society for Evidence-Based Gender Medicine. The latter was labeled a pseudoscience group by the Southern Poverty Law Center.