The HHS Review is an umbrella review that summarizes the results of 17 previous systematic evidence reviews, including those conducted for the Cass Review. In alignment with the most rigorous of those reviews, the HHS Review concluded that the “evidence for benefit of pediatric medical transition is very uncertain, while the evidence for harm is less uncertain.”

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The 600+ page report has five main sections: Background, Evidence Review, Clinical Realities, Ethical Considerations, and Psychotherapy. (A roundtable discussion with the Review’s authors provides an in-depth overview of the Review’s key findings, and explains the current state of pediatric gender medicine.) 

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BACKGROUND

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The HHS Review was commissioned in response to a presidential executive order to complete “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.” This order was made against a backdrop of exploding numbers of youth seeking extreme medical interventions for gender-related distress, and a growing worldwide confusion about the best way to help them, despite prior systematic reviews none of which found solid evidence to support interventions like puberty blockers, opposite-sex hormones, and surgeries.

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According to the authors, the HHS Review “is not a clinical practice guideline, and it does not issue legislative or policy recommendations. Rather, it seeks to provide the most accurate and current information available regarding the evidence base for the treatment of gender dysphoria in this population, the state of the relevant medical field in the United States, and the ethical considerations associated with the treatments offered.”

 

Despite being commissioned by an administration that can credibly be accused of being “anti-science” on several issues (childhood vaccines and climate change, for example), the HHS Review is a sober, sensible, bipartisan effort, informed by rigorous scientific reviews and studies. The authors hold a wide range of political beliefs, but all were chosen for their commitment to scientific principles. As stated in an article published in StatNews following the review’s release:

 

“Most of us are liberals and longtime Democratic Party supporters. All of us share a commitment to evidence-based medicine and have been willing to stick our necks out, often at personal or professional cost, to speak the truth. We did not expect HHS to entrust this sensitive task to us; it could have chosen a team that was ideologically aligned with the current administration. We are grateful that the administration set aside coalition politics and chose us instead.”

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THE CURRENT EVIDENCE BASE FOR PEDIATRIC GENDER MEDICINE

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Unsurprisingly, like studies conducted by other countries (England, Finland, and Sweden, for example), the HHS Review found that the studies on the efficacy of pediatric gender medicine are of low or very low quality according to standard evidence-based medicine criteria (e.g., rigorous research design, use of control groups, long-term follow-up). Positive long-term outcomes are highly uncertain.

 

The review looked at the evidence for social transition (name and pronoun changes, binding, tucking), puberty blockers, opposite-sex hormones, and surgeries. Key limitations of the evidence include: ​

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• small or uncontrolled studies

• a lack of randomized trials

• short duration of follow-up

• inconsistent reporting of harms, and

• a reliance on subjective or self-reported outcomes.

 

The review found that psychotherapy focusing on mental health, identity development, family support, etc. is supported by good evidence while other interventions are not.

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​ETHICAL CONSIDERATIONS 

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Unlike the Cass Review, the HHS Review included a chapter on Ethical Considerations. This chapter (starting on page 218) considers the mismatch between evidence quality and the current practice of pediatric gender medicine (where such practices are still allowed). As outlined in this chapter, for medical professionals to honor their oath to “do no harm,” they must acknowledge that these interventions are often risky, irreversible, and that the very vulnerable population they are treating is too young to understand the long-term impact of puberty blockers, opposite-sex hormones, and “gender” related cosmetic surgeries, rendering moot the idea of “informed consent.”

 

Sterility, sexual dysfunction, and negative impacts on physical development (such as decreased bone density and unknown—but likely—impact on brain development) are all potential outcomes of current pediatric gender practices. When combined with the lack of quality evidence to support the efficacy of these interventions, it is clear the “affirmative model” is unethical.

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A PSYCHOTHERAPEUTIC APPROACH

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Psychotherapy is a non-physically-invasive intervention for gender-distressed minors and is therefore far safer than medical interventions. The HHS Review supports psychological approaches that address distress, anxiety, depression, family dynamics, and identity development without presupposing medical transition as the goal.

 

The HHS Review asserts that such approaches may allow clinicians to better understand underlying psychosocial contributors to distress while avoiding irreversible physical damage.Psychotherapy can provide a framework that encourages open-ended exploration of identity, emotions, and social influences like peers and social media. It frames this approach as distinct from the widely discredited “conversion therapy,” and emphasizes voluntary participation and patient autonomy.

 

The HHS Review also points out that exploratory psychotherapy aligns with standard practices used to treat other forms of adolescent distress and identity confusion, and that gender distress should be treated similarly.

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KEY FINDINGS FROM THE HHS REVIEW

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• Existing research suggests that most cases of gender dysphoria will abate without intervention.

• Evidence supporting medical interventions for minors is of low or very low quality.“Informed consent” to any permanent, harmful consequences is not realistically possible in this cohort.

• Pediatric gender medicine does not reduce suicide.

• The evidence of harm from pediatric medical interventions is more uncertain than evidence of benefit.

• The harms posed by pediatric gender medicine (including greater susceptibility to hormone-sensitive cancers, cardiac disease, reduced bone density, sexual dysfunction, infection, and infertility) are “objectively detrimental to health. Such medical harms, or plausible risks thereof, should not be imposed on children or adolescents in the absence of a reasonable expectation of proportionate medical benefit.”

• Long-term outcomes of pediatric gender medicine are largely unknown.

• Rising rates of gender-related referrals have outpaced the growth of strong, high-certainty evidence on treatment outcomes, leading to a worrying mismatch between practice and evidence quality.

• Psychological support is a lower-risk intervention.

• High-quality, long-term research is urgently needed.

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RELATED RESOURCES

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• “We wrote the HHS review on treatment for minors with gender dysphoria. We hope our critics actually read our report,” Stat News, December 2025

• “Supplement to Treatment for Pediatric Gender Dysphoria Review of Evidence and Best Practices: Peer Reviews and Replies,” HHS, November 2025

• “Expert Critics Of The HHS Report On Youth Gender Medicine Are Projecting—And Helping Implode Their Own Credibility (Part 1 of 2),” Jesse Signal, Signal Minded, June 2025

• “HHS’s Peer-Reviewed Gender Dysphoria Report Answers Critics,” Joseph Figliolia, City Journal, December 2025

• “Eager to Affirm, Yet Unwilling to Defend Their Claims,” Colin Wright, Reality’s Last Stand, November 2025

• Roundtable discussion with the Review’s authors, December 2025: