Within President Trump’s Executive Order 14187, “Protecting Children from Chemical and Surgical Mutilation”, was a directive. The Department of Health and Human Services had 90 days to conduct “a review of the existing literature on best practices for promoting the health of children who assert gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion”.

That report, which first came out on 1 May, 2025, was originally published anonymously, and without peer review due to time constraints. Many proponents of gender-affirming care ignored the report’s important takeaways about science and medical ethics, and criticized it for the anonymity and lack of peer review.

Today, the report has been re-released with peer reviews, responses, minor changes to the text, and the names of the authors revealed.

Those authors include self-identified liberals such as bioethicist Moti Goren and healthcare researcher Evgenia Abbruzzese, along with the center-right political scientist Leor Sapir, and the more conservative endocrinologist Michael Laidlaw. In other words, this is not a MAGA team, but rather a diverse group of experts, including an MIT philosopher and a research methodologist.

Seven of the reviews were solicited from doctors, nurses, bioethicists and others. They evaluated the report’s methodology and generally found it to be sound, and its conclusions to be reasonable. In fact, at least one of them had already tried to raise awareness about the lack of science supporting gender-affirming care, even before the HHS Review.

University of Iowa professor of pediatrics, psychiatry, neuroscience and pharmacology Lane Strathearn was an editorial board member for the Journal of Pediatrics. In August 2024, an editor at the journal had approved him to write an editorial about the discrepancy between what was often claimed about the field — that it was evidence-based and life-saving — and the reality of its “limited evidence base.” The piece, “What We Know and What We Don’t: Evaluating the Evidence for Gender-Affirming Care in Pediatrics” raised “many of the same concerns” as the HHS report”, Strathearn wrote. But because peer reviewers vehemently objected to it, the Journal of Pediatrics never published it.

That is, some people critiqued the original HHS report for not having been peer reviewed. But that peer review process had weeded out the information and point of view in this report. The peer review process has essentially shut the door on dissent and questioning within the medical field.

As important as the peer reviews are, it’s what’s not there that might matter the most. The HHS Report authors sought peer reviews from both the Endocrine Society and American Academy of Pediatrics (AAP), medical advocacy groups that have both supported the gender-affirming model.

The AAP had denounced all 409 pages of the initial report, mere hours after publication, asserting that it “misrepresents the current medical consensus”. It insisted that the report “prioritizes opinions over dispassionate reviews of evidence”.

According to Sapir, the AAP had agreed to offer a review — as opposed to the attack it had led with before. But not long before publication, it backed out, insisting that it should have been included all along. The Endocrine Society refused to review it altogether.

In reality, the report reflected the truth — that, in contrast to what the AAP asserted, there was no medical consensus. The HHS report contained an “umbrella review”, which gathers the relevant systematic evidence reviews and evaluates their claims. This is the highest point on the pyramid of “evidence-based medicine”. And what it found was “low-certainty” evidence: whatever the conclusions of various studies claiming puberty blockers and cross-sex hormones for youth had alleviated mental distress, the real outcomes might be quite different. The studies were too poorly conducted for anyone to really know.

The report also made the case that youth gender medicine does not meet the basic moral principles of ethical healthcare. With no clear benefit, and some known bodily harms from blockers, hormones, and surgeries, the field promised neither non-malfeasance — the obligation to avoid harm — nor beneficence. The report authors think that because of this, there is no ethical way to even conduct further research on young people.

Rather than offer a defense of continuing to socially and medically transition young people, and a basis for continuing research, the AAP and other medical groups simply stuck to insisting that they must operate “free from political interference” and thus condemned the report. These medical groups don’t seem to realize their own hypocrisy, or how they project politics onto science, just as they accuse others of doing.

The AAP and other proponents of gender-affirming care should actually read the report and engage with its ideas and suggestions, rather than projecting onto it the sins they’re guilty of themselves. They are the ones who’ve misrepresented the medical consensus, and prioritized opinions over dispassionate reviews of evidence. With the names revealed, and the peer reviews in place, they no longer have reason to ignore this report.

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Lisa Selin Davis is the author of Tomboy. She writes at Broadview on Substack.

LisaSelinDavis

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