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The HHS published on Thursday a journal of the long -awaited literature which pushes suppliers to rely on behavioral therapy during the treatment of dysphoria between the sexes in those under 19 and largely disavowers the options of care affirming the sexes, in particular hormonal therapies, prescauvin and surgeries.
Although the report continues to make political recommendations and is not clinical advice, it marks a gap in relation to the standards issued by the World Professional Association for Transgender Health, a non -profit organization dedicated to research based on evidence on transgender health care.
The American Medical Association, the American Psychological Association and the American Academy of Pediatrics approved independent recommendations of WPath, which advocates a social, psychological, behavioral and medical approach to the treatment of gender dysphoria. However, President Donald Trump repeatedly condemned the organization as politically motivated.
In January, the president published an executive decree calling for the federal government to arrest financially supporting providers who offer stupid sexist care to minors and asked HHS to conduct their own research on best practices to treat gender dysphoria at age under 19.
The resulting Report, which extends over 409 pages, said that WPath had falsely perpetuated a story that there was a consensus on how to treat adolescents struggling with their gender identity and had “suppressed the dissent and stifled a debate” among the professionals.
The HHS has relied heavily on the results of a 2024 controversial British report, called The Cass Review, to offer a counter-story. The journal Cass maintains that there is a lack of long -term evidence supporting puberty blockers and hormonal therapies for adolescents and should only be used experimentally. The report was strongly examined to rely on low -quality research, the skeptics saying that the author, Hilary Cass, “probably” Exclusion of relevant studies. Cass has referred to the exclusion of certain studies for methodological reasons, while at other times, the scientist offered no justification to exclude research.
The HHS review also included testimonials from five Reports, Who worked in clinics and would have seen affirmative treatments between the sexes causing damage to patients.
The agency said that the examination, in total, revealed that affirmative sex care had “significant risks” for patients while offering “very low proofs of profits”.
Instead, HHS advocates increased use of behavioral or “exploratory” therapy, which the agency never defines completely. The report seeks to distance its recommendation from the term “conversion therapy” – that 20 states, Puerto Rico and Washington, DC have laws limiting or prohibit a certain title, according to the human rights campaign.
“There is a shortage of research on psychotherapeutic approaches to manage sexes between sexes in children and adolescents. “Psychotherapy is a non -invasive alternative to endocrine and surgical interventions for the treatment of pediatric gender dysphoria.”
However, a name can only be a name.
“The report of psychotherapy by the report as an alternative to medical affirmation – in particular in a way that delays or discourages access to care providers affirmed by the sexes – echoes the same practices of ideology and pathologizing the therapy practices of previous conversion,” said Arjee Restar, Social and Legal Epiologist of Yale University which previously written genres.
Accusations of exceeding
The director of the National Institutes of Health, Jay Bhattacharya, applauded the report in a statement on Thursday.
“Our duty is to protect the children of our country – not exposing them to unproven and irreversible medical interventions,” said Bhattacharya. “We have to follow the Order of Sciences, not activist agendas.”
However, some doctors, medical researchers and analysts quickly said that HHS did exactly that – trying to assert its own program on scientific consensus.
“If you are essentially looking at another ruin democracy, one of the first things starting is that the government is starting to make medical decisions for its population via a policy.”
Meredithe McNamara
Deputy Professor of Pediatrics at the Yale School of Medicine
“This report is a pure policy pretending to be science,” said Kellan Baker, executive director of the Institute for Health Research and Policy by Whitman-Walker, by email. “The ultimate goal of this report is to impose a political program in place of science and to insert the federal government where it does not belong – between health care providers and families and patients they are dealing with.”
The experts interviewed for this play have relied on the use of anecdotes to shed light on the political recommendations, as well as the refusal of the detail that wrote the journal. The agency said that in the press release, it refused the names of the authors to “maintain the integrity of this process”.
“It’s simply nonsense,” said Merethe McNamara, deputy professor of pediatrics at the Yale School of Medicine And the co -founder of the Integrity project, which seeks to promote a solid science in the health policy of children and adolescents. “This is not that scientific integrity works. If people are not willing to put their names in it, then it should not be taken seriously. ”
McNamara continued by saying that the alleged problem of the agency with a lack of long -term studies on the affirmative care between the sexes was out of step with the way in which the medical field is regularly based on observational studies to advance care practices.
“I think that each intervention that is only recently available – which is a fair way to describe medical care affirming sexes in the past 10 years – begins with observational studies for a few years,” she said. “The positive results are in a way deleted and rejected from these journals of artificial and biased evidence [cited in the report]. “”
Susan Kressly, president of the American Academy of Pediatrics, echoed this feeling in a shared statement on Thursday, saying that she was “deeply alarmed” by the report.
“For such an analysis to be credible, it must take into account all of the available data and the full spectrum of clinical results rather than counting on certain perspectives and a close set of data,” said Kressly. “This report distorts current medical consensus and does not reflect the realities of pediatric care.”
However, Stanley Goldfarb, president of Do No Buds, a group that aims to protect health care against “disastrous consequences of identity policy”, has fully approved the report, saying that it “rightly exposes a certain number of serious risks in the medical transition of young people”.
“It is clearer more than ever than we have to put an end to this erroneous practice and replace it with treatment based on evidence for gender confused children,” said Goldfarb.
The report is part of a series of climbing measures taken by the administration to limit the access of young transgender to Americans to health care and medical research on associated treatments.
Earlier this week, Trump said that he had in charge of the Ministry of Justice to investigate parties that allowed sexual care for minors, including providers who have carried out services and businesses who “misleaded the long -term side effects” of treatment under food, Drug and Cosmetic Act.
The administration has also created a website where the parties concerned can act as denunciators on gender assertions and have proposed to establish a private right of action, with a long limitation period, to allow children or their families who have received care treatments affirming the sex to continue for damages.
Wider benefits could follow
The emphasis put by Trump on the transgender population is disproportionate. Although the administration has repeatedly indicated that “many” children have received a diagnosis of gender dysphoria, in reality, only about 1% have such a diagnosis, and only a fraction which receives treatment, according to a research letter published in Jama in January.
However, the president is not the only one to seek to reduce access to care for transgender for young people. Across the country, 26 states have issued bay on affirmative care, according to a human rights campaign tracker. A certain number of these prohibitions are disputed in court, including that of Tennessee, which awaits a decision of the Supreme Court of the United States this summer.
If the court refuses to make a radical decision – similar to the way it has taken a fragmentary approach to abortion prohibitions at state level – the literature review may appear in the battles of the courtroom on access to health care.
Currently, the complainants seeking to preserve access to health care for young people have largely called upon WPath Guidance. However, many conservative judges have demonstrated a tongue to accept the recommendations.
Chief judge Jeffrey Sutton, for example, who wrote the majority opinion of the Court of Appeal, confirming the ban on Tennessee before the Court of Appeal for the 6th circuit, said the medical protocols were “constantly evolving”. He said it was difficult to determine a luminous line of what was “medically necessary care”, although doctors heard WPath’s advice and come from the advantages of hormonal treatments.
Now, Thursday’s literature review devotes 30 pages to discredit WPath. If the attorneys generally lead him, the directives could offer judges other ammunition to reject the recommendations of the medical community on affirmative care.
“If this report is presented, the complainants seeking to protect access to care affirmed by the sexes will have the opportunity to criticize his claims, his credibility and his approach, including the high dependence on the report to the British Cass journal,” said Suzanne Goldberg, professor of law at Columbia Law School and director of sexuality and the law on sex, questioning of the evidence presented.
However, providers who seek to offer sexual care for young people are increasingly in a hostile climate. Already, several suppliers have suspended the services in the light of Trump’s repression, including Children’s Healthcare of Atlanta, Penn State Health, UPMC and Lurie Children’s Hospital of Chicago.
McNamara said that the government’s scope to guide medical practices was unprecedented.
“If you mainly look at another ruin democracy, one of the first things starting is that the government is starting to make medical decisions for its population via a policy,” she said. “It seems really shocking and unusual, and we cannot forget that.”
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