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  The text of the full report can be found here.

Introduction

The treatment of gender dysphoria in children and adolescents has become a highly debated topic. A recent report from the Department of Health and Human Services (May 1, 2025) provides a comprehensive review of the evidence behind these treatments. This first post in our series explores the overall findings of the systematic review, highlighting the quality and limitations of the evidence for medical interventions like puberty blockers, cross-sex hormones, and surgeries.

Key Findings from the Systematic Review

The report’s “umbrella review” (Chapter 5, pages 77-96) evaluated existing systematic reviews to assess the benefits and harms of treatments for pediatric gender dysphoria. The findings are striking: the evidence supporting these interventions is of very low quality. This means that claims about their benefits—such as improved mental health or quality of life—are uncertain and may differ significantly from the true effects. Studies often lack rigorous methodology, with issues like small sample sizes, short follow-up periods, and potential publication bias (page 103) clouding the results.

For example, the review found that studies claiming benefits from puberty blockers or hormones, such as de Vries et al. (2011, 2014) and Tordoff et al. (2022), are short-term and observational, lacking the robustness of randomized controlled trials (pages 98-101). These studies often fail to account for confounding factors like concurrent mental health treatment, making it hard to attribute outcomes solely to medical interventions. Additionally, the review notes a lack of systematic tracking of harms, which may underreport risks like infertility or bone density issues (page 13).

What This Means

The low-quality evidence raises serious questions about the widespread use of medical interventions for children with gender dysphoria. Without clear data on long-term outcomes, families and clinicians face uncertainty when making decisions. This gap in evidence has led countries like the UK to restrict puberty blockers, prioritizing psychosocial approaches instead (page 13).

Three Arguments Against Transitioning Children

1. Insufficient Evidence of Benefit: The systematic review found that the evidence for psychological benefits from puberty blockers, hormones, or surgeries is very low quality, with studies often biased or inconclusive (page 13). This uncertainty makes it risky to pursue invasive treatments with unproven efficacy.

2. Significant Risks of Harm: Medical interventions carry serious risks, including infertility, sexual dysfunction, impaired bone density, and potential cognitive impacts (page 14). These risks are particularly concerning for children, whose bodies and minds are still developing.

3. Natural Resolution of Gender Dysphoria: Research suggests that gender dysphoria often resolves without intervention in many cases, especially when untreated (page 21). Medical transition may disrupt this natural process, leading to irreversible changes for children who might otherwise reconcile with their bodies.

References

• Department of Health and Human Services. (2025). Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, page 13.

• Ibid., page 14.

• Ibid., page 21.