Evidence · Children and gender
What did the 2025 HHS review find on medical treatment of gender dysphoria in minors?
A plain-language guide to the federal review of puberty blockers, cross-sex hormones and surgery for children and teenagers, with the debate around it.
The short answer
The U.S. Department of Health and Human Services (HHS) reviewed the research on medical treatment for gender dysphoria in minors. It found the evidence of benefit very uncertain and listed serious known risks. It pointed to psychotherapy as a noninvasive approach. Its findings line up with a major review in England. Leading U.S. medical groups disagree with the review.
What the review is
The review is titled Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices. HHS prepared it under an executive order signed on January 28, 2025. HHS released a first version on May 1, 2025, and the final version on November 19, 2025, together with outside peer reviews and the authors' replies.
What it found
The evidence of benefit is very uncertain
The authors pooled existing systematic reviews. They rated the certainty of evidence as very low for psychological outcomes, quality of life, regret and long-term health. In plain terms, the benefits reported in studies may differ a lot from the true effects.
The known risks are serious
The review lists infertility, sexual dysfunction, lower bone density, effects on thinking and memory, heart and metabolic problems, psychiatric problems, surgical complications and regret. It notes that studies track harms poorly, so the research likely undercounts them.
Psychotherapy is a noninvasive option
Systematic reviews found no evidence of harm from psychotherapy for gender dysphoria, although research on it is limited. The evidence is stronger for treating conditions that often occur alongside gender dysphoria, such as anxiety and depression.
How it compares with England's review
England's National Health Service asked Dr. Hilary Cass, a pediatrician, to review its gender service for young people. The final Cass Review came out in April 2024. Systematic reviews by the University of York rated the quality of the studies it relied on:
After the Cass Review, the UK government restricted the prescribing and supply of puberty blockers for minors. The HHS review notes that a growing number of countries have restricted these treatments or limited them to research studies.
Who disagrees, and why
The American Academy of Pediatrics, the Endocrine Society and the American Medical Association still back gender-affirming medical care for minors. A Manhattan Institute analysis finds that these groups get the science wrong. In 2026 the AMA agreed that surgery for minors should generally wait until adulthood. The American Society of Plastic Surgeons now recommends waiting until at least age 19.
Critics also attacked England's Cass Review. Many of those attacks rely on a single report from Yale Law School, whose errors and conflicts of interest are documented in detail.
HHS published the final report together with a supplement of peer reviews and the authors' replies.
Who wrote it
HHS names nine authors in the final report: Evgenia Abbruzzese, Alex Byrne, Farr Curlin, Moti Gorin, Kristopher Kaliebe, Michael K. Laidlaw, Kathleen McDeavitt, Leor Sapir and Yuan Zhang. Five of them disclosed payments related to work in this field. Disclosure: Dr. Kaliebe also co-authored Restore Childhood's toolkit for parents.
The law
On June 18, 2025, the U.S. Supreme Court upheld a Tennessee law that restricts these treatments for minors. The decision means states may set such limits, so the rules now differ from state to state.
What you can do now
- Read the HHS executive summary yourself. It is short and written for a general reader.
- If a clinician recommends medical treatment for your child, ask what evidence supports it and what the risks are, in writing.
- Ask whether your child has been screened for anxiety, depression, autism or trauma, and how those will be treated.
- Get a second opinion before any medical step.
- Learn your state's current law. Our free toolkit for parents includes a state-by-state guide.
Related
This page explains public research. It is not medical advice for any person. We update it as new research comes out. If you see an error, please contact us.