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The final version of a Trump-commissioned review scrutinizing the scientific foundation for offering “gender-affirming care” to minors was released Wednesday, following approval through scientific peer review. The report suggests there is scant medical evidence endorsing hormone therapy and other treatments for transgender-identifying minors.
This comprehensive review underwent evaluation by ten different experts and research organizations. According to the lead author, none of these reviewers found significant flaws in the report’s conclusion that U.S. physicians should reconsider administering common treatments for gender dysphoria to minors until more is known about long-term effects.
Dr. Leor Sapir, a senior fellow at the Manhattan Institute and one of the researchers involved, stated, “Reviewers were provided the opportunity to identify any mistakes or errors, yet they were unable to do so.”
Sapir further noted, “There were minor comments here and there, but nothing substantial that challenged the core findings regarding evidence and ethical considerations. Essentially, they concurred with the conclusions.”
He highlighted that this consensus included the former president of the Endocrine Society, an organization that has been a prominent advocate of these interventions.
The report was first released in May after President Trump issued Executive Order 14187 after taking office.
The order claimed that US doctors were “maiming” teens with gender-affirming treatment that “must end,” and ordered the Department of Health and Human Services (HHS) to compile an assessment of the standards of care of minors who identify as transgender.
The subsequent report found that many of the studies that proponents of gender-affirming care use to back their treatments were of “very low quality,” and that little is really known about the long-term psychological and quality-of-life effects of treatment, along with how often patients regret about undertaking them.
Because of that, the report recommended that the US limit the use of puberty blockers and other treatments for minors — noting that the UK has banned such treatments for kids altogether.
Instead, the report said, doctors should focus on psychotherapy until more is known about the effects of gender-affirming care treatments for children.
The report was widely denounced by trans advocates when it was released in May — with many complaining that the authors’ names had been withheld and that it was biased by the Trump administration’s open hostility toward the trans community.
But Sapir noted that the report’s nine authors and their research process were “completely independent of HHS” — and that most are Democrats.
Including Sapir, they were Dr. Alex Byrne, a philosophy and linguistics professor at MIT; Evgenia Abbruzzese, a health care researcher at the Society for Evidence-Based Gender Medicine; Dr. Farr Curlin, a professor at the Duke University School of Medicine; and Dr. Moti Gorin, who teaches philosophy at Colorado State University.
The others were Dr. Kristopher Kaliebe, a psychiatrist who teaches at the University of Southern Florida Morsani College of Medicine; Dr. Michael Laidlaw, a private practicing endocrinologist; Dr. Kathleen McDeavitt, a psychiatrist teaching at the Baylor College of Medicine; and Dr. Yuan Zhang, a researcher at the health care policy group Evidence Bridge.
“We are very politically and ideologically a diverse group,” he said. “Most of the authors are liberals, Democrats. They wouldn’t vote for Trump if he forced them to. This is a bi-partisan initiative.”
He added that keeping names anonymous was also standard practice in peer review processes, so that responses are not colored by preconceived notions of authors.
And when the report was submitted to three organizations that had been critical so they could join the peer review process, only one responded.
That group was the American Psychiatric Association, which Sapir said took no issue with the report’s ultimate findings about the lack of evidence driving gender-affirming care.
Seven other experts from across the medical field participated in the peer review, too, and also found no fundamental problems.
They included Dr. Richard Santen, a University of Virginia professor emeritus of endocrinology and metabolism who used to be president of the Endocrine Society — which Sapir said has been one of the leading proponents of gender-affirming practices. Santen called the HHS review “scientifically sound.”
Others readers were Dr. Johan Bester, an associate dean at St. Louis University School of Medicine who called the reports main findings “correct”; Karleen Gribble, a professor at the School of Nursing and Midwifery; and Dr. Lane Strathearn a professor of pediatrics, neuroscience and other fields at the University of Iowa who called the report “a valuable and much needed contribution to this important field of practice.”
And none of their critiques matched the outcry from some the report faced when it was first released in May.
“They can condemn the report all they want, but they were not able to identify a single mistake. Not one,” Sapir said.
Exactly what the Trump administration will do with the report remains to be seen, but Sapir said he hopes that the medical community will take a step back from the culture war debate over gender-affirming care and look at the science.
“Let’s reassess. At minimum, let’s allow for open debate. Let’s listen to dissenting perspectives. Let’s do rigorous analysis,” he said.