From ... in History Research — Jun 28, 2025

Federal Report Challenges Safety of Gender-Affirming Care for Minors

Over the past decade, gender dysphoria diagnoses in children and adolescents have surged. In the United States alone, the number of youths aged 6 to 17 receiving this diagnosis rose sharply from about 15,000 in 2017 to over 42,000 by 2021.

Once considered rare and carefully navigated, these treatments are now being fast- tracked in clinics that increasingly operate on a “child-led” model of care, where a minor's stated identity and treatment wishes are prioritized over in-depth psychological evaluation or long-term developmental assessment. While advocates argue that gender-affirming care is both lifesaving and necessary, a sweeping new review from the U.S. Department of Health and Human Services (HHS) directly challenges that claim. The 409-page federal report exposes significant flaws in how gender medicine has been introduced and promoted, especially for minors.

Gender dysphoria refers to the distress someone feels when their internal sense of gender doesn't match their biological sex. In children and teens, this distress might appear as discomfort with their body, a strong wish to be the opposite sex, or rejection of gendered roles, clothes, and behaviors tied to their birth sex. • In young children, this often manifests through behavior — A child might consistently insist they are a different gender, reject certain clothes, or seek out playmates and toys associated with the opposite sex. These behaviors appear early, but they do not automatically signal a lifelong identity shift. Instead, they often reflect a developmental phase or emotional response to family, social, or cultural dynamics. • Gender dysphoria intersects with multiple psychological factors — Some adolescents diagnosed with gender dysphoria also experience anxiety, depression, trauma, or neurodevelopmental traits, including autism spectrum features. In such cases, the discomfort with gender may function as a coping mechanism to externalize or organize inner emotional distress. When this happens, treating the gender conflict directly without addressing these underlying conditions misses the root of the problem.

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• Diagnosis depends on more than identity statements — For a clinical diagnosis of gender dysphoria, there must be evidence of sustained distress, not just identity experimentation or gender nonconforming behavior. Clinicians are expected to assess the duration, severity, and functional impact of the dysphoria. That includes evaluating whether the distress stems from gender identity itself or other social or psychological stressors. Misdiagnoses occur when clinicians fail to distinguish between transient identity exploration and deeper, persistent incongruence. • The Dutch Protocol shaped early medical treatment guidelines — Developed in the 1990s, the Dutch approach was cautious and designed for the minority of children whose dysphoria intensified during puberty. Under this model, puberty blockers could be prescribed around age 12, cross-sex hormones at 16, and surgeries at 18, but only after rigorous psychological evaluation, emotional stability, and family support were confirmed. • A new pattern emerged with teens who showed no early signs — In the past decade, clinics began seeing a wave of adolescents, mostly girls, suddenly identifying as transgender despite no childhood history of gender issues. Many of these teens had peers who were also transitioning or were immersed in online communities that discussed gender change as a way to manage emotional distress. This new pattern has been referred to as “rapid-onset gender dysphoria” (ROGD), a term that remains controversial but reflects clinical observations across multiple countries. Gender dysphoria is real, and for some, deeply painful. But recognizing its complexity means taking the time to understand what's driving it rather than assuming that every case needs the same fast solution.

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The 2025 umbrella review conducted by the HHS evaluated the strength of existing evidence behind medical treatments offered to gender-distressed minors. What it found instead was a scientific landscape riddled with weak studies, missing data, and unsupported claims. The review concluded that the current foundation of pediatric gender medicine is built on quicksand, not science. • Medical interventions for gender-distressed youth lack solid scientific backing — Puberty blockers, cross-sex hormones, and surgeries have been administered to children despite what the report describes as “very low” quality evidence for outcomes like mental health improvement, life satisfaction, or reduced regret. Many of the studies used to support these interventions were small, lacked control groups, and failed to track long-term health impacts. There was also no strong evidence that these treatments reduce suicide risk, despite frequent claims to the contrary. In fact, the report emphasized that suicide rates among gender-distressed youth are statistically low, and that medical interventions carry their own lifelong risks. • Puberty blockers alter lifelong development — The report criticizes the claim that puberty blockers are simply reversible. In reality, they interfere with bone mineralization during critical growth windows, raising the risk of stunted skeletal development and early-onset osteoporosis. When followed by cross-sex hormones, as occurs in over 90% of cases, risks escalate to include infertility, metabolic disruption, cardiovascular issues, and permanent loss of sexual function. • Informed consent and ethical oversight are being ignored — Some clinics offer medical interventions after a single two-hour session, without thorough psychological evaluations. The review criticizes the “child-led” model for assuming that a young person's expressed desire to transition is proof of informed maturity.

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Clinicians must distinguish between a request for treatment and actual readiness. When a child lacks the ability to comprehend the risks, long-term outcomes, and alternatives, medical professionals are ethically obligated to say no. The HHS calls it a failure of care when providers greenlight serious interventions despite “unnecessary, disproportionate risks of harm.” • Premature medicalization blocks understanding of natural resolution — Before puberty blockers became widely available, most young children with gender distress ended up accepting their bodies as they matured. But because these drugs are now offered so early, researchers no longer track how gender dysphoria unfolds naturally. Some studies suggest that the condition may not be as permanent as it's often made out to be. In one German study, more than 70% of teenage girls diagnosed with gender dysphoria had dropped the diagnosis within a few years. The report warns that fast-tracking irreversible interventions blocks opportunities for natural resolution and thoughtful care. • Institutional support for gender-affirming care is shallow and ideologically driven — Contrary to popular claims of consensus, the HHS review uncovers a fragile support base concentrated among small, ideologically aligned groups within larger medical organizations. Clinicians and researchers who raised concerns were often silenced, punished, or legally threatened for questioning prevailing practices. Despite evidence suggesting that gender distress in adolescents often resolves or shifts over time, many clinics still treat it as permanent and urgent. The HHS report warns against offering irreversible interventions based on limited evidence and brief evaluations. It urges providers to return to thoughtful, child-specific treatment plans that prioritize long-term well-being.

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Puberty blockers, also known as gonadotropin-releasing hormone (GnRH) agonists, are drugs used to halt the physical changes associated with puberty, such as breast growth or voice deepening. However, blocking the hormonal signals that drive these changes creates lasting consequences. In fact, in the last 20 years, over 70,000 adverse reports have been tied to puberty blockers. • Disruption of bone density development — One of the most well-documented effects of puberty blockers is a significant decline in bone mineral density. Puberty is the phase when the body builds the majority of its adult bone mass. Delaying this process results in weaker bones and an increased risk of osteoporosis later in life. Studies have shown that even after stopping the drugs or starting cross-sex hormones, some individuals never fully recover normal bone density. • Impaired growth and height potential — By halting the hormonal triggers for growth plate maturation, puberty blockers affect height outcomes. In some cases, individuals reach a shorter adult stature than they would have without intervention. Growth may resume after treatment stops, but this depends on the timing and duration of use. • Sexual function and maturity — Blocking puberty interrupts the development of sexual organs, reproductive function, and sexual desire. Adolescents who remain on blockers and then transition to cross-sex hormones may permanently miss out on the window for sexual development. This results in lifelong anorgasmia (a type of sexual dysfunction where a person has difficulty achieving orgasm), low libido, or incomplete genital formation. • Impact on fertility — While puberty blockers alone do not sterilize, they delay or disrupt the development of gametes (sperm or egg cells). If used as a bridge to cross-sex hormones, fertility is often permanently impaired. For adolescents who never experience full pubertal development, options for biological reproduction are extremely limited.

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• Neurological and cognitive effects — Puberty is also a key period of brain remodeling. Hormonal changes affect cognitive development, emotional regulation, and social maturity. Animal studies suggest that suppressing puberty may interfere with these processes, though human data are still emerging. Some researchers have raised concerns that long-term blockade could alter emotional responsiveness or executive functioning. To learn more about the adverse effects of these drugs, read “ 70,000 Adverse Events from Puberty-Blocking Drugs Ignored by FDA .”

The use of cross-sex hormones (CSH) — testosterone for females and estrogen for males — is a central part of gender-affirming care, yet the risks associated with these drugs are often downplayed. While CSH induces secondary sex characteristics of the opposite sex, it also introduces substantial physiological disruptions, many of which remain poorly understood due to a lack of long-term research. • Hormone levels are pushed far beyond healthy ranges — For females, testosterone is typically administered at levels between 320 and 1,000 ng/dL, which is up to 100 times higher than physiological norms. For males, estradiol levels are increased to two to 43 times the normal range. These “supraphysiologic” doses are not aligned with any natural endocrine state and are known to induce conditions like hyperandrogenism (high levels of androgen hormones) in females and hyperestrogenemia (high levels of estrogen) in males. • Major cardiovascular and metabolic concerns — CSH is linked to increased risk of cardiovascular events. Males on estrogen face heightened odds of venous thromboembolism and stroke, while females on testosterone show increases in hematocrit and lipid abnormalities, both of which elevate risk for coronary events. Polycythemia, which refers to having abnormally high levels of red blood cells that lead to increased blood viscosity, is another documented concern.

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• Structural changes to reproductive organs — Estrogen exposure in males leads to testicular tissue remodeling, damage to the blood-testis barrier, and impaired spermatogenesis. In females, testosterone has been found to cause fibrotic changes in breast tissue and atrophy of reproductive organs. There is concern about elevated cancer risks in both sexes, although more research is needed to confirm this. • Brain and cognitive impacts remain unclear — Early evidence points to a reduction in brain volume among males on estrogen. While still preliminary, these changes warrant close study, especially since cognitive function is a key component of quality of life. • Sexual dysfunction and early mortality — High-dose hormone use may lead to loss of libido, erectile dysfunction, anorgasmia, and persistent pelvic pain. Some research even links CSH with increased mortality risk, though causation has not been definitively established. Despite conventional claims that CSH therapy is safe, the evidence tells a more complex story. These drugs alter foundational biological systems and cause irreversible harm, particularly when used before the body has fully matured. Ethical practice demands full disclosure of these risks, not just to patients, but to families, clinicians, and policymakers who influence care standards.

The rapid normalization of gender-affirming medical interventions, particularly in children, has raised concerns not only about physical and psychological harm but also about the ideological direction behind these practices. Investigative reporters like Jennifer Bilek argue that the transgender movement is part of a broader transhumanist agenda aimed at detaching humanity from its biological roots. • Transhumanism views the body as a problem to solve — Encouraging children to see their sexed bodies as wrong or modifiable lays the psychological foundation for rejecting physical embodiment altogether. Sterilization through puberty blockers and hormones reframes reproduction as a service, setting the stage for artificial wombs and biotech-managed birth. • Gender fluidity is a gateway to bodily erasure — The idea that identity is based on internal feeling, not biological form, mirrors the transhumanist claim that consciousness exists independently of the body. Once society accepts that sex is changeable, it becomes easier to normalize the belief that the body itself is optional, and that human beings can or should merge with machines. • Transitioning becomes a test case for full human modification — The transgender movement isn't the end point — it's the beginning. It teaches children to distrust their biology and to see irreversible medical interventions as liberating. This primes future generations to accept synthetic identity, lifelong dependency on pharmaceutical control, and ultimately, the merging of man with machine.

Parents are no longer just raising children — they're defending them. In a world where schools, media, and even medical institutions promote radical ideas about sex and identity, protecting your child now means more than keeping them safe physically. • Affirm your child's biology early and consistently — It's important for parents to affirm the biology of their children from the start. By teaching them the value and permanence of their biological sex, you effectively "inoculate" them against ideas being brought in later. • Educate yourself on gender ideology and how it spreads — "Lost in Trans Nation," written by Dr. Miriam Grossman, a child and adolescent psychiatrist and board- certified medical doctor, provides parents with the required knowledge and tools to protect their children from the transgender ideology contagion. While I believe the transgender movement poses a severe threat to mental, emotional, and physical health, it can be counteracted by level-headed discourse and the sharing of truthful information. • Demand honesty and transparency — You deserve straight answers about safety — not vague promises. Ask hard questions about puberty blockers, hormones, and surgical interventions. If something doesn't sound right, speak up. The well-being of your child depends on your willingness to challenge the narrative. You can find more detailed strategies on how to protect children from ideological capture and irreversible harm in “ How to Protect Your Child From Transgender Lies .”

Q: What is gender dysphoria in children and teens? A: Gender dysphoria in minors refers to the emotional distress that occurs when a child or adolescent feels a mismatch between their biological sex and their internal sense of gender. This can lead to discomfort with their body, rejection of sex-related roles, and significant psychological distress. Q: Is gender-affirming care for youth supported by strong scientific evidence? A: No. According to the 2025 HHS report, most studies supporting gender-affirming interventions are small, poorly controlled, and rated as “very low” quality. Many lack long-term follow-up, comparison groups, or clearly defined outcomes, making it difficult to assess whether the treatments are truly effective or safe. Q: Do puberty blockers have side effects? A: Yes. Puberty blockers can disrupt bone density development, impair height potential, delay sexual maturation, and impact brain development. These drugs are not simply reversible, and some effects may be permanent. Q: Are cross-sex hormones safe for teenagers? A: Cross-sex hormone therapy is associated with significant risks, including cardiovascular disease, reproductive organ damage, sexual dysfunction, and possibly increased mortality. These hormones push the body into unnatural hormonal ranges and cause irreversible changes. Q: How can I protect my child from gender ideology? A: Start by affirming your child's biological reality early. Educate yourself with resources, ask direct questions about any treatment being recommended, and demand transparency from educators, clinicians, and public institutions.

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Federal Report Challenges Safety of Gender-Affirming Care for Minors

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