When the Department of Health and Human Services quietly dropped its long-anticipated “Review of Evidence and Best Practices” for treating gender dysphoria in minors, it came cloaked in the language of neutrality. At over 250 pages, the report purports to be a comprehensive, evidence-based review of how best to help trans youth. But beneath its sterile tone lies something deeply ideological: a political document masquerading as science.
The topline recommendations are familiar to anyone following recent international debates. The report:
Declares the evidence supporting gender-affirming care for youth to be “very low quality.”
Calls for psychotherapy, not medical care, to be the default treatment.
Heavily criticizes the World Professional Association for Transgender Health (WPATH).
Urges the U.S. to follow the UK, Sweden, and Finland in restricting access to transition-related care for minors.
But dig beneath the surface, and what you find isn’t a sober scientific review. What you find is a document that abandons the very principles it claims to uphold—selectively citing sources, erasing the voices of trans people, and applying ethical standards with breathtaking inconsistency.
The good news—if there is any—is that the report follows a familiar pattern from the Trump administration: it focuses almost entirely on pediatric transition while largely ignoring gender-affirming care for adults. That’s no accident. Trans adults are harder to target politically, and most Americans support the right of adults to access care. By fixating on youth, the administration creates a moral panic, then uses it to lay the groundwork for broader attacks. But this report, like many before it, overreaches. And that overreach creates opportunities to push back.
Let’s start with the evidence. The report repeats over and over that the data behind gender-affirming care is “low quality”—a fair critique of a still-developing field. But it fails to apply that same skepticism to the studies it favors. Anecdotal reports from detransitioners are treated as hard evidence. The Cass Review is cited extensively, without noting that even Dr. Cass has publicly cautioned against using her findings to justify blanket bans. Meanwhile, large peer-reviewed studies that support the benefits of affirming care are dismissed or ignored. This isn’t scientific rigor. It’s cherry-picking in a lab coat.
And then there’s the erasure. Despite being a report about transgender youth, not one quote from a trans young person appears in the entire document. No interviews. No first-person accounts. Just policymakers, critics, and whistleblowers. The people most affected by these decisions are written out of the story entirely. That’s not objectivity—it’s control.
The ethical argument is no better. The report leans heavily on the principle of “first, do no harm,” arguing that doctors should withhold gender-affirming care because the long-term risks aren’t fully understood. But it refuses to engage with the harm of denying care. It ignores that trans youth who are supported in their identities experience lower rates of depression and anxiety. It ignores the risk of forcing kids to go through the wrong puberty. It refuses to acknowledge that doing nothing is also a choice—with its own consequences. And it frames autonomy not as a right, but as a liability—something too dangerous to entrust to trans teens.
What’s more, the report treats ethical principles as one-directional. It asks whether a doctor can live with prescribing puberty blockers, but never whether a trans kid can live without them. It worries about regret—but not about what it means to be denied care that could have made your life better. It warns against medicine becoming consumerism, but offers no concern for what happens when medicine becomes paternalism.
Even the language is telling. The authors claim to be “scientifically neutral,” yet consistently use terms like “sexed bodies” and “embodiment goals” while putting “authentic gender selves” in scare quotes. They reject phrases like “transgender” and “gender-affirming care” as ideologically biased—but they’re not offering neutrality in return. They’re just replacing one framework with another, less honest one.
And then there’s the international framing. The report cites Europe’s turn toward caution as proof of a global consensus. But that consensus is mostly fiction. Medical bodies in Canada, Australia, and major international associations like WPATH and the Endocrine Society still support gender-affirming care. The report fails to mention this—perhaps because it doesn’t fit the narrative. It cherry-picks policies like it cherry-picks data.
The result is a document that doesn't protect kids. It endangers them. It doesn't promote ethical medicine. It undermines it. And it doesn't reflect a neutral, evidence-based view. It reflects a political movement that has spent the past five years trying to make trans existence seem like a problem to be solved, rather than a life to be supported.
And we don’t even know who’s behind it. The authors of the HHS report are anonymous. Their names, qualifications, and potential conflicts of interest are hidden from public view. That makes it impossible to evaluate their expertise—or to know whether they have any at all. In a document that demands transparency and rigor from everyone else, that kind of secrecy is more than ironic. It’s disqualifying.
The truth is this: trans kids deserve care. Not scare tactics. Not false objectivity. Not a government report designed to sound like science while doing the work of ideology.
We see through it. We know what it’s doing. And we’re not going to let it define the future of trans healthcare without a fight.
I knew this was coming. And I knew it would contain lots of blatant falsehoods. Which wouldn't be so bad if critical thinking weren't a lost art.
Thorough and insightful reporting from Ari Drennen.
When we live in our own truth, we can tell our own stories. Doing so takes power back from liars hiding in the shadows.