HHS re-releases gender dysphoria report with names, peer review

The Department of Health and Human Services on Wednesday re-released its controversial report on gender dysphoria in children, and this time it named the previously anonymous authors and published a handful of peer review comments after the initial study had been faulted for a lack of transparency.

The new version reveals that many of the authors and reviewers have been outspoken critics of gender-affirming care, are affiliated with anti-LGBTQ+ groups, and have little-to-no experience providing clinical care for young trans people. Some have been paid to speak, consult, or testify as expert witnesses against treating children with gender-affirming care such as puberty blockers, hormones, or surgery. However, HHS also solicited reviews from major medical groups, including the American Psychiatric Association.

The updated report reaches the same conclusion as its predecessor, that the evidence for the benefits of gender-affirming care is insufficient, and interventions like hormones and surgery should be deprioritized. “The American Medical Association and the American Academy of Pediatrics peddled the lie that chemical and surgical sex-rejecting procedures could be good for children,” HHS Secretary Robert F. Kennedy Jr. said in a statement. 

Those organizations, which have guidelines supporting gender-affirming care, issued a joint statement in response to Kennedy’s remarks. “We reject characterizations of our approach to gender-affirming care as negligent or ideologically driven,” they said. “These claims, rooted in politics and partisanship, misrepresent the consensus of medical science, undermine the professionalism of physicians, and risk harming vulnerable young people and their families.”

The May report was prepared swiftly under a 90-day deadline set in President Trump’s January executive order that sought to limit gender-affirming care for young people, referring to it as “chemical and surgical mutilation.” It was widely criticized for its anonymous authorship and obscured conflicts of interest. 

Proponents of gender-affirming care suspect that the updated report will be used as justification for impending proposed rules from the Centers for Medicare and Medicaid that aim to withhold federal funds from going toward such care for minors, as well as any hospital or clinic that provides it.  

“They did not engage with anyone with actual clinical expertise in the care of trans youth,” said Kellan Baker, a senior adviser for health policy at the Movement Advancement Project. A paper critical of the original report, co-authored by Baker, was cited in the peer review section of the latest HHS report. But neither Baker nor the other authors were asked to contribute to the report or to do an official peer review, he said.

“It is a very small loop of people who have already been on record, as they would call themselves ‘skeptics,’ — I think it’s fair to call them opponents of care for trans young people,” Baker said of the authors.

HHS published peer review comments in a manner consistent with both the Information Quality Act (which applies to federal agencies) and “the Trump administration’s commitment to radical transparency and gold standard science,” communications director Andrew Nixon said by email. 

While many of the reviewers broadly agreed with the conclusions of the HHS report, some pointed out methodological flaws. Jilles Smids, a postdoctoral researcher at Erasmus MC in the Netherlands said the report as a whole provides “well-argued analysis,” but pointed out in his review that “it is clearly not a neutral report” and that it “decidedly argues against early medical intervention for minors.” 

Another reviewer, Richard Santen, a past president of the Endocrine Society, has been “keenly interested in this topic,” he wrote in an email to STAT,  adding that he has “spent the last year trying to reach an objective opinion.” Santen’s review focused mainly on the question of whether gender-affirming care is “experimental” as the report asserts, or “accepted practice,” as practitioners say. Santen said he used Gemini AI to come up with criteria that could help answer that question. While the report concludes that gender-affirming care is experimental in nature, and a “strong case” can be made for that argument, Santen also believes that “this conclusion can reasonably be disagreed upon.” 

STAT examined the prior work of the report’s authors and reviewers, as well as the relationships between them. 

The contributors

The authors have a diverse array of expertise, but a minority of them hold a medical degree. Out of nine contributors, six have been paid for consulting work, speaking engagements, or for testifying as an expert against gender-affirming care. Many are affiliated with anti-LGBTQ+ or religious groups. One organization, the Society for Evidence Based Gender Medicine, has been described by the Southern Poverty Law Center as a pseudoscience group and an LGBTQ+ hate group.

Many of the authors are well-known for their work criticizing gender-affirming care. Among them, physician Michael K. Laidlaw has testified in multiple states in favor of banning gender-affirming care. In a 2022 case on a state law attempting to ban Medicaid payments for gender-affirming care, a federal judge questioned Florida’s decision to use Laidlaw as a witness due to his lack of experience treating trans patients, saying he was “decidedly out of the mainstream.” The state of Tennessee cited him in its defense of a ban on gender-affirming care for youth that was upheld by the Supreme Court earlier this year.

Laidlaw is the sole endocrinologist among the contributors, though his practice in Locklin, Calif., does not appear to focus on transgender health. He has published several papers critical of gender-affirming interventions, medical and surgical, among both youths and adults. Laidlaw is affiliated with Changed, a movement of people who formerly identified as LGBTQ+ and have embraced the Christian faith as a path towards cis and straight lives. 

Contributors Leor Sapir and Alex Byrne have also long been critics of gender-affirming treatment for minors. Sapir, a political scientist and fellow of the conservative think tank Manhattan Institute, “has received payments for legal consultations and honoraria for speaking engagements related to pediatric gender medicine,” the report discloses.

Byrne, the only previously disclosed author, is a philosophy professor at MIT and the author of “Trouble With Gender,” an examination challenging gender identity theories, in which he rejects the “gender revolution” and “joins the forefront of the counter-revolution, restoring sex to its rightful place, at the centre of what it means to be human,” per the book’s marketing copy. He has been a featured speaker at a conference organized by Genspect, which is also listed as a LGBTQ+ hate group by the Southern Poverty Law Center.

Farr Curlin, a professor of medicine at Duke who specializes in geriatrics and palliative care, has received payments for expert testimony and honoraria for speaking engagements related to pediatric gender medicine, notes the report. “Medicalized gender transition turns this norm on its head, ‘affirming’ the child’s disordered perception and treating his healthy body as a diseased one,” Curlin wrote earlier this year commenting on the Supreme Court’s decision to uphold Tennessee’s ban of gender-affirming care for minors. 

Kristopher Kaliebe is a psychiatrist and professor at the University of South Florida. His expertise on transgender health has been disputed in court, and in 2024 he signed an open letter calling for the American Psychiatric Association to withdraw its guidelines for gender-affirming care. The report discloses that Kaliebe received payment for expert testimony related to pediatric gender medicine as well as an honorarium to attend the Society for Evidence Based Gender Medicine’s 2023 conference.

Kathleen McDeavitt, a psychiatrist and associate professor at Baylor College of Medicine, has authored several papers criticizing pediatric gender-affirming care as “not evidence-based.” 

Non-physician authors of the report include Evgenia Abbruzzese, a co-founder and senior advisor to SEBM, and the report discloses she received “payments for legal consultations related to pediatric gender medicine.” Though she is credited as a “healthcare researcher,” Abruzzese holds only a bachelor’s degree from Willamette University in Oregon.

Moti Gorin, who teaches bioethics at Colorado State University, serves as a board member for the LBG Courage Coalition, a gay and lesbian advocacy group that opposes gender affirming care and what it calls the “medicalization of gender.” He, too, was a speaker at the 2023 SEGM conference, though he didn’t disclose it as a conflict of interest in the report. 

Yuan Zhang, the founder of nonprofit Evidence Bridge, holds a Ph.D. in health care methodologies. Though this is not disclosed in the report, he received commissions from SEBM to analyze pediatric gender medicine, and was a speaker at one of the organization’s conferences.

The peer reviewers

The updated report includes seven peer reviews from a professional organization, individual researchers, clinicians, bioethicists, and methodologists, the majority of which took a favorable view of the report and its conclusions. It also links to two published papers that are more critical of the May report, including Baker’s. Not all reviews are dated, but those that are appear to have been written in the months after the first version’s publication.

“They very clearly picked their own reviewers to tell them what they wanted to hear,” Baker said. 

Nixon of HHS said that the agency invited a diverse group to participate in the peer review process, including groups like the American Psychiatric Association, “that are supportive of sex-rejecting procedures.” The American Academy of Pediatrics and the Endocrine Society declined to participate in the report, according to a press release from HHS. 

Out of seven named peer reviewers, at least two have previously published papers that are critical of gender-affirming care practices. Johan Bester, a professor and associate dean at the Saint Louis University School of Medicine, wrote in 2024 that minors “lack the autonomy” to consent to gender-affirming care. The argument was made in reply to a paper by HHS report author Gorin. While that publication shows an interest in this topic, Bester writes in his review that his focus within pediatric ethics is measles vaccination.

Smids, the postdoc at Erasmus MC in the Netherlands, has co-authored multiple papers with Gorin and appeared at at least one event in 2024 hosted by the Society of Evidence Based Gender Medicine.

Karleen Gribble, an adjunct professor of nursing and midwifery at Western Sydney University in Australia, has argued in letters to trans health associations that guidelines for care should include warnings about potential risks around breastfeeding ability after top surgery.

Gribble was asked in June to participate in the peer review process — she assumes because of her work around breastfeeding, which includes a case study on somebody who received chest masculinizing surgery who later became pregnant and was unable to breastfeed. She wrote her commentary through that narrow lens, urging the authors to address breastfeeding. 

While Gribble was surprised that there were so few peer reviewers, she thinks people worried about the authors’ or reviewers’ affiliations are asking the wrong questions. “Don’t assume that because people are putting forward that they have concerns about this health care, that they are therefore hostile or uncaring,” she said in an interview. 

The APA noted in its review that the report’s “underlying methodology lacks sufficient transparency and clarity for its findings to be taken at face value.” 

A review by methodologists Trudy Bekkering and Patrik Vankrunkelsven of the Belgian Centre for Evidence-Based Medicine finds no major problems with the review’s design or conclusions. The two repeatedly highlight the fact that evidence for gender-affirming care options is “very low” or “low certainty,” as per the GRADE approach to evidence assessment. The report itself relies on the concept of low certainty evidence as a core reason to be wary of gender-affirming care. 

But the epidemiologist who coined the term “evidence-based medicine” and created the GRADE approach, Gordon Guyatt, says that banning gender-affirming care based on low quality evidence is an “egregious misuse” of such findings.  

“Low quality evidence doesn’t mean it doesn’t work. It means we don’t know. And so, we try,” Guyatt told STAT in September. “There is, I would say, quite good evidence from the accounts of the individuals who’ve undergone the therapy, that they were really benefited by the therapy.”

In a response to the APA’s review, the report authors note that their work adheres to Guyatt’s methodology for assessment.