The Department of Health and Human Services (HHS) issued a report Thursday that outlines concerns about the use of life-altering drugs and surgeries on minors who struggle with gender dysphoria.

The HHS report notes that this model, sometimes called “gender-affirming care,” includes irreversible medical interventions on children who do not have any physical health conditions. The treatments are designed to feminize boys and masculinize girls, and the surgeries make the child’s body appear more similar to that of the opposite sex.

“Systematic reviews of the evidence have revealed deep uncertainty about the purported benefits of these interventions,” the foreword of the executive summary of the 400-page report notes.

President Donald Trump signed an executive order during his second week in office that directed HHS, led by Secretary Robert F. Kennedy Jr., to produce a report on this subject. The order also directed all hospitals that receive federal funding to halt the practice of giving children drugs or performing surgeries on them to treat gender dysphoria.

According to the report, “these interventions carry risk of significant harms,” which can include infertility, sexual dysfunction, underdeveloped bone mass, cardiovascular disease, metabolic disorders, psychiatric disorders, and adverse cognitive impacts, among other complications.

The report notes that the purported benefit of these interventions is “to improve mental health outcomes” for children who identify themselves as transgender and desire certain physical changes. However, according to the report, systematic reviews of patients “have not found credible evidence that they lead to meaningful improvement in mental health.”

“When medical interventions pose unnecessary, disproportionate risks of harm, health care providers should refuse to offer them even when they are preferred, requested, or demanded by patients,” the report’s authors write.

The report finds “no evidence that pediatric medical transition reduces the incidence of suicide, which remains, fortunately, very low.” For this reason, the authors criticize organizations that frame these interventions as “medically necessary” or “lifesaving,” arguing that such characterizations are not supported by the evidence. 

Although the authors note that “the principle of autonomy” is important in medicine, they add that there is not a “right to receive interventions that are not beneficial” and that autonomy “does not negate clinicians’ professional and ethical obligation to protect and promote their patients’ health.” 

The report also discusses “regret,” particularly coming from so-called “detransitioners” who seek to reverse body-altering medical interventions they have received. It states that the “regret” rate is unknown and that more evidence is needed, but adds: “That some patients report profound regret after undergoing invasive, life-changing medical interventions is clearly of importance.”

There is little evidence concerning the benefits of psychotherapeutic interventions in the treatment of children with gender dysphoria, according to the report. However, there is evidence supporting psychotherapeutic interventions for children with other mental health problems, and there is no evidence psychotherapeutic interventions for gender dysphoria causes harm.

Mary Rice Hasson, the director of the Person and Identity Project at the Ethics and Public Policy Center, told CNA that the report is “extremely well done” and provides an “in-depth and unbiased analysis” of the current medical literature related to treating children who have gender dysphoria.

Hasson said this guidance can serve as a resource for parents, physicians, and policymakers who are “seeking to help ‘gender-dysphoric’ minors.”

“Both evidence and ethics point to the better solution for treating identity-distressed kids: psychotherapy and time,” she said. “Let kids be kids, and let them grow up undamaged by drastic, disabling interventions.”

Jill Simons, a pediatrician and executive director of the American College of Pediatricians, told CNA that the Trump administration “should be applauded” for its work so far on this subject but added that “more has to be done” and called on pediatricians to “stand up to the organizations … that are still promoting … these harmful [procedures].”

Simons also noted that the report found no evidence that these medical interventions reduce the risk of suicide and warned that some doctors make that claim “to scare parents.” 

“Parents need to know that that is just simply not true,” she said.

The Human Rights Campaign (HRC), a pro-LGBT group, criticized the HHS report.

“Trans people are who we are,” HRC Chief of Staff Jay Brown said in a statement. “We’re born this way. And we deserve to live our best lives and have a fair shot and equal opportunity at living a good life.”

Trump’s executive order to halt gender-altering drugs and surgeries for children has been subject to numerous lawsuits.