Expert Critics Of The HHS Report On Youth Gender Medicine Are Projecting—And Helping To Implode Their Own Credibility (Part 2 of 2)

Overdue and long but hopefully thorough

I’d planned to publish my responses to the latest Ask Me Anything this week, but it’s now looking like I’ll do so early next week instead. So if you have a question or just want to vote on the questions that have already been submitted, click here.

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Here’s Part 1.

This is very, very overdue. It’s arguably stale. The reason I’m publishing it anyway is that I do want there to be a record of who wrote what and when during the debate over American youth gender medicine.

At the end of Part 1, I wrote, “In Part 2, which will be up soon [uh, sorry], I’m going to critique the responses to the HHS report by Kellan Baker, a leading researcher and activist in this area, and by Science magazine, one of the most important science publications in the world.” I also mention The Trevor Project at the end.

Jumping right into it:

Kellan Baker

Kellan Baker is a frequently quoted expert on youth gender medicine whose bio reads as follows:

Dr. Kellan E. Baker is the Executive Director of the Institute for Health Research and Policy at Whitman-Walker, which fosters healthier communities and advances good health for all through person-centered research and evidence-based policy. The Institute is affiliated with Whitman-Walker Health, a Federally Qualified Health Center with more than 50 years of service to communities in Washington, D.C. and beyond. Dr. Baker is a nationally known health services researcher, educator, and health policy professional who serves on numerous advisory boards and councils and is an appointed consumer representative to the National Association of Insurance Commissioners.

Dr. Baker holds appointments as affiliate faculty in the Departments of Health Policy and Management at the George Washington University and the Johns Hopkins School of Public Health, where he received the Golden Apple Award for excellence in teaching public health studies. He received his PhD in health policy and management from Johns Hopkins, where he was a Health Policy Research Scholar and Centennial Scholar; an MPH and MA from George Washington University; and a BA with high honors from Swarthmore College.

If anyone should be trustworthy, it’s someone with credentials like this.

The day the HHS report came out, I got an email from Shane Tan of the powerhouse PR firm BerlinRosen. Here it is in its entirety, all emphasis in the original:

Hi Jesse,

In the latest Trump administration attack on science and transgender rights, the Department of Health and Human Services has issued a new report attempting to promote thoroughly discredited and dangerous “conversion therapy” programs for transgender youth. For any coverage, I encourage you to reference the statement below from transgender health care expert Dr. Kellan Baker, a health care expert specializing in the research behind health care for transgender youth.

Dr. Kellan Baker, Executive Director of the Institute for Health Research and Policy at Whitman-Walker, said:

“This report is pure politics masquerading as science. Rather than following the recommendations of every major US expert medical association, including the American Medical Association and the American Academy of Pediatrics, it pushes the dangerous and discredited practice of conversion therapy to try to force transgender people to change a fundamental, deeply rooted part of who they are. The ultimate goal of this report is to impose a political agenda in place of science and to insert the federal government where it does not belong—between healthcare providers and the families and patients they care for.”

Let me know if you have any questions for Dr. Baker!

Best,
Shane

This was great news, because I did have questions for Dr. Baker.

I’d been hoping to speak with him for a while, because there were aspects of his work I was hoping to better understand. Back in 2021, he lead-authored a systematic review of the evidence on “Hormone Therapy, Mental Health, and Quality of Life Among Transgender People,” as the title of the paper puts it, which was commissioned by the World Professional Association for Transgender Health.

This systematic review, which searched for articles covering all age groups rather than those dealing with youth in particular, found the same thing basically every similar effort has found: The strength of evidence for the studies evaluating these treatments is “Low,” which simply means we can’t confidently conclude much of anything from them. The one exception was “Death by suicide,” where Baker and his team found insufficient research to give any rating to the strength of evidence.

Despite these disappointing findings, Baker and his colleagues end their paper by editorializing strongly in favor of gender medicine:

Despite the limitations of the available evidence, however, our review indicates that gender-affirming hormone therapy is likely associated with improvements in QOL, depression, and anxiety. No studies showed that hormone therapy harms mental health or quality of life among transgender people. These benefits make hormone therapy an essential component of care that promotes the health and well-being of transgender people.

I noted the oddness of this language in UnHerd a couple years ago, and later found a potential explanation in documents that were published as part of a lawsuit challenging a state ban on youth gender medicine. As I reported in The Economist (unpaywalled version here), these documents showed, rather conclusively, that WPATH had interfered in the execution and publication of the supposedly “independent” systematic reviews it had commissioned.

One particularly interesting document concerned Baker’s SR specifically:

This document appears to prove that WPATH had direct editorial influence over the paper — the team “Involv[ed] the work group leader of the Chapter, or alternatively a designated representative of that specific [Standards of Care] 8 Chapter in the design, drafting of the article, and final approval of the article.” If WPATH had “final approval” over this or other research, which a boatload of other evidence for the lawsuit also suggests (see my article), that torpedoes the claim that this was independent research.

And yet Baker et al.’s paper included this paragraph, emphasis mine:

WPATH provided the research question and reviewed the protocol, evidence tables, and report. WPATH had no role in study design, data collection, analysis, interpretation, or drafting. The corresponding author had full access to all the data and had final responsibility for the decision to submit for publication. The authors are responsible for all content, and statements in this report do not necessarily reflect the official views of or imply endorsement by WPATH.

At face value, this looks like a dishonest claim: The bolded statement can’t be true if WPATH also had as much influence over the paper as the above checklist suggests.

That being said, there are definitely other potential explanations. That’s why I reached out to Baker (and others) when I wrote The Economist article, and that’s why, when Shane Tan of BerlinRosen reached out asking if I wanted to speak with Kellan Baker, I quickly responded: Yes, let’s set up an interview. I didn’t hear back, so I nudged a few days later. Alas. . . nothing.

The authors of the HHS paper specifically mentioned Baker et al. in a couple of important contexts. First, they noted that this paper has been cited a lot as evidence for the efficacy of gender medicine, so they subjected it to a risk-of-bias analysis and concluded that that risk was high (for what that’s worth — remember that the paper itself didn’t find anything to really recommend these treatments anyway, setting aside that strange editorializing at the end).

The HHS team was also aware of the backstory involving WPATH’s apparent interference with the Baker et al. paper, and recounts it accordingly (PDF):

Internal WPATH documents reveal that Baker et al. complied with all the mandatory steps of WPATH’s updated approval policy—from approving the conclusions before the manuscript was drafted to ensuring extensive WPATH engagement in the process and obtaining the final approvals. The Baker et al. SR was published with the mandatory disclaimer that “WPATH had no role in study design, data collection, analysis, interpretation, or drafting” of the SR, despite the checklist clearly recording that WPATH had engaged in the design, drafting, and final approval of the article.

There’s a major, unavoidable conflict here: Baker is criticizing a report that cast a negative light on both his own work and his own scientific integrity, but without disclosing these facts.

In addition, his factual claims appear to be suspect, particularly the idea that the HHS paper “pushes the dangerous and discredited practice of conversion therapy to try to force transgender people to change a fundamental, deeply rooted part of who they are.” I just don’t think that’s a fair interpretation of the report. Rather, the authors argue that while “exploratory therapy” to better understand a young person’s gender identity has been misconstrued as conversion therapy by activists, it was actually a routine part of the Dutch protocol that is, at core, the basis for the “affirming” approach now prevalent in U.S. states where these treatments are legal — or which was prevalent, at least, before threats from the Trump administration began causing some youth gender clinics to shut down. Nobody who is well-informed and fair-minded on this subject actually thinks that talking through a young person’s gender concerns in a compassionate, open-minded way prior to putting them on medical treatment is the same thing as conversion therapy, no matter how often this claim is repeated.

Once more, let’s go back to the issue of trust: Has Kellan Baker, who is treated as a quote-worthy expert and who has the credentials to back up that assessment, acted in a trustworthy manner? If you were a parent trying to figure out how to help your gender-distressed child, and you found all this out, would you say, “Yes, this is whose counsel I should seek”?

Science Magazine

You can’t discuss the collapse of trust in expertise without mentioning journalism’s role in accelerating that collapse.

My critiques of the American Academy of Pediatrics (AAP) and Kellan Baker bring me to an article in Science by general assignment reporter Phie Jacobs headlined “Researchers slam HHS report on gender-affirming care for youth.” The subhed reports that “Critics say the report, which declines to disclose its authors, contradicts decades of scientific research.” (Archive here if you hit a paywall.)

It probably won’t surprise you to find out that among those critics are the American Academy of Pediatrics and Kellan Baker.

Part of the problem here is that, at this late stage in the debate over youth gender medicine in the States, it is exceptionally complicated. And Jacobs just isn’t familiar with certain basic facets of it, as evidenced by their (Jacobs uses they/their pronouns) credulous approach to Baker:

“The finger was already on the scale when this report was commissioned,” says Kellan Baker, a health services researcher who serves as executive director of the Whitman-Walker Institute for Health Research and Policy. In recent years, more than half of all states, including Florida and Tennessee, have implemented policies restricting or banning gender-affirming care for minors. Soon after taking office in January, Trump gave HHS a 90-day deadline to publish the review in an executive order titled “Protecting Children from Chemical and Surgical Mutilation,” which claimed without evidence that medical professionals in the United States “are maiming and sterilizing a growing number of impressionable children” and threatened to revoke federal funding from hospital clinics that provide gender-affirming care to minors.

A mere 90 days is not enough time to conduct a thorough review, Baker argues. By contrast, the most recent standards for the treatment of gender dysphoria in youth issued by the World Professional Association for Transgender Health (WPATH)—an organization that determines the clinical protocols used by the majority of professionals who work with trans people—took more than a decade to compile with numerous systematic reviews, and “reflect the consensus of hundreds of experts in transgender health from around the world,” Baker says. (In its report, HHS dismisses WPATH as an ideologically motivated organization.)

I agree completely that 90 days is not enough time to publish this sort of report. But it says what it says. And it’s pretty wild, in this context, to tout the Standards of Care’s supposed reliance on systematic reviews. After all, we know from the aforementioned court documents that 1) WPATH commissioned a small pile of them that subsequently disappeared, almost certainly because the results did not make gender medicine look good, and which remain unpublished to this day; and 2) Baker himself appears to have misled the public about his team’s own coordination with WPATH on the hormones paper. This is exceptionally important context to provide to readers to help better equip them to decide who to trust, and it’s absent from the story.

I emailed Tim Appenzeller, news editor at Science, with questions about this article, and he forwarded my email to Jacobs, who responded. Here’s¹ my email and Jacobs’ response², both in full, via footnotes.

One issue I raised was the “numerous systematic reviews” mention, and the lack of any context about the research WPATH had suppressed or interfered with. Here was Jacobs’ response:

The sentence stating WPATH SOC8 “took more than a decade to compile with numerous systematic reviews” refers to the fact that the authors of the SOC8 considered dozens of pre-existing systematic reviews while developing their recommendations (one looking at the global burden of HIV in trans women, one on psychiatric disorders in people with gender dysphoria, and one on the impact of gender-affirming hormone therapy on blood pressure, to name just a few cited in the document’s footnotes), as well as the reviews specifically commissioned by WPATH (Baker et al. 2021 and Wilson et al. 2020) that were published separately. [note that that last link points to an acknowledgements section but is supposed to point here]

As you can see, Jacobs simply ignored the points from my email, instead re-citing Baker et al. And in the context of this dispute, other systematic reviews on other aspects of gender medicine aren’t really relevant.

Another problem with Jacobs’ article is they simply don’t engage with the actual content of the HHS report, or with prior criticism of the extant studies.

For example:

Sean Cahill, who serves as director of health policy research at the Fenway Institute, also disputes the report’s claim that treatments such as puberty blockers and hormones have shown no evidence of benefits. It either downplays or dismisses studies that have found that access to these treatments leads to improved mental health, Cahill says. The report also claims these treatments are associated with significant harms even though it found “sparse” to no evidence of such harm

Jacobs links to Diana Tordoff’s study from 2022. This study is notorious among critics of youth gender medicine because of the way Tordoff and her team tortured the data until they could kinda-sorta claim the treatments worked — all despite the fact that the most straightforward presentation of the data, buried in an e-supplement, plainly showed no evidence of improvement (to the extent anything can be drawn from a study in which the non-treated group had dwindled, via attrition, to almost zero by the last wave of data collection). For a Science writer to credulously amplify this debunked study yet again, in 2025, without even gesturing toward its very serious problems, is not good science journalism. (Jacobs did not respond to this part of my email.)

There’s an even bigger problem here, though, which is that it makes very little sense to accuse the HHS report of “downplay[ing] or dismiss[ing]” individual studies, given the report’s methodology. The HHS team based their evaluation of the literature on an “umbrella review” of previously published systematic reviews. Of the three systematic reviews the HHS team deemed to be high-quality and therefore leaned on most heavily, only one of them (the Cass Review’s, which was actually multiple SRs) was published after Tordoff et al. Sure enough, that review rated Tordoff et al. as providing “Very low” certainty evidence for the benefits of youth gender medicine on depression, meaning “The evidence is very uncertain about the effect of gender affirming hormone therapy on depression at long term follow-up.” That’s the lowest possible rating, and it is warranted given the problems with this study.

(Poking around in the Cass systematic reviews sometimes involves navigating a dense forest of documents and supplemental appendices. If you follow the “rated Tordoff et al.” link, you’ll see that the study I’m highlighting here is tagged with Footnote 3, which in turn references Tordoff et al.

Finally, Section 6.2 of the HHS report is titled “Short-term observational studies,” and in it the authors dig into four influential ones. One of them is Tordoff et al. — pages 99–101 cover the paper’s weaknesses with a great deal of specificity. (For what it’s worth, I’m cited there, I think because I wrote what I believe is the first in-depth critique of that study to gain some purchase online.)

Here was another part of Jacobs’ response:

The sentence [from their Science article] stating that the HHS report “either downplays or dismisses studies that have found that access to these treatments leads to improved mental health” is based on my conversation with Sean Cahill, who noted the overall body of evidence linking access to gender-affirming care with lower rates of depression and suicidality and improvements in body dissatisfaction (including studies like Green et al. 2021 [sic], Kuper et al. 2020, Costa et al. 2015, Allen et al. 2019, Turban et al. 2022, van der Miesen et al. 2020, Grannis et al. 2021, Chelliah et al. 2024, López de Lara et al. 2020, Olsavsky et al. 2023, and McGregor et al. 2024 to name a few). It might have been more precise to say that Torkoff [sic] et al. 2022 in particular found that gender-affirming treatments appeared to mitigate comparative risk (i.e. that subjects who received care showed lower rates of depression and suicidality compared to similar subjects who didn’t), but I believe that distinction is splitting hairs.

Again, Jacobs is simply demonstrating that they are not familiar with this subject or with well-worn disputes within this world. For one thing, given the attrition, the weird statistical method, and other problems with the Tordoff study, you really can’t claim that it showed a comparative benefit.

More fundamentally, if someone does a systematic review claiming that the evidence for a given intervention is weak, you cannot then pull out a list of individual studies that seem to show otherwise and say, “See? Look at these studies.” The whole point of a systematic review is to overcome the potential biases and weaknesses of individual studies! It’s 2025, decades into multiple replication crises, and a reporter at one of the top science publications in the world is saying, “Look at this list of studies!” when multiple systematic reviews are available. That’s not good. Even before all the systematic reviews were completed, it was plain that a number of these studies did not quite say what their proponents claimed.

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I know we’re now deep in the weeds, and that I’ve probably lost most of you (perhaps permanently), but I think this is important, and I want to be really clear about this sequence of events.

1. Tordoff et al. is published and (eventually) roundly criticized for major methodological flaws and misrepresentation on the part of the authors.

2. A high-profile, extremely important systematic review conducted by the Cass team seems to confirm at least some of those criticisms, rating the study as providing only “Very low” certainty evidence for its conclusion.

3. An HHS report based in part on that systematic review explains that the evidence for youth gender medicine is quite weak, and explicitly mentions Tordoff et al. as an example of a study beset by methodological problems.

4. Science magazine accuses the HHS team of disregarding important studies like Tordoff et al.

If we’re going to trust outlets like Science, this sort of thing just can’t happen. If Phie Jacobs doesn’t know the difference between a cherry-picked handful of individual studies and systematic reviews, surely their editors do, and surely someone has to step in, at some point in the editorial process, and prevent this sort of outcome.

One final thing: The end of Jacobs’ Science article includes a quote from Casey Pick, director of law and policy at The Trevor Project, an anti-suicide LGBT nonprofit. Like the AAP, The Trevor Project quickly released a statement critical of the HHS report not long after it came out.

Jacobs writes:

HHS has thus far declined to say who authored the report, saying in a press release that names of contributors “are not initially being made public, in order to help maintain the integrity of this process.” A White House fact sheet released on Monday stated the agency “coordinated with a team of eight distinguished scholars” to produce the report, although their names have not yet been released either. “That’s one more reason why I can tell you this is an ideological, political document and not a scientific one,” Pick says. “Scientists stand by their work. There is nobody standing by this thing.”

Right after I found out about the Trevor Project report, I emailed their press contact seeking an interview with Pick, who was quoted in it. I never heard back despite follow-up emails. It’s almost too on the nose for someone like Pick to publicly talk about the need to stand by one’s work but refuse to answer basic follow-up questions about her own.

Unfortunately, this is now standard. The groups supporting these treatments have decided they can simply keep repeating the same lines over and over and over — the treatments are safe, the science is settled, gender-identity-related psychotherapy is basically conversion therapy — without addressing any of the very real concerns that have led to these treatments being severely restricted or banned in a sizable chunk of Europe and about half of the U.S.

To be fair, I’m completely biased here: I’m writing a book on this subject, and it would be much, much better for me to be able to interview more proponents of these treatments. But I also think it would be in their interest to realize that, in a very real sense, they’ve lost. Access to treatments that they claim to be lifesaving have been severely restricted, and no one who is informed and who follows this issue closely thinks the evidence meets normal standards for such serious interventions.

So the plan is to just. . . keep repeating the claims that failed to convince anyone the first time around? Blame journalists? Again: I’m biased, but I don’t get the endgame. If these institutions are unwilling to answer follow-up questions about their increasingly radical claims, it will only exacerbate the crisis of expert authority.

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Questions? Comments? Cherry-picked handfuls of studies? I’m at singalminded@gmail.com or on X at @jessesingal. Image: LONDON, UNITED KINGDOM - JULY 26, 2025: Demonstrators hold a placard reading 'Blockers are reversible, puberty is not' during the seventh Trans Pride protest march for transgender freedom and equality in the UK and globally in London, United Kingdom on July 26, 2025. London Trans+ Pride is the world's largest annual demonstration in support of trans, non-binary, gender non-conforming, and intersex lives. (Photo credit should read Wiktor Szymanowicz/Future Publishing via Getty Images)

1. My email to Science news editor Tim Appenzeller:

Hi,

I’m a journalist who has written about the youth gender medicine debate for The Atlantic, The Economist, The New York Times, and other outlets, and I’m presently working on a book about the subject that will be out next year.

I covered the HHS report for The Dispatch last week, and I’m working on a followup article about advocacy groups’ and media outlets’ responses to the report for my Substack, which for what it’s worth goes out to around 46,000 readers. My piece is going to include criticisms of Mx. Phie Jacobs’ article on the subject in Science, so I wanted to give them and your team a heads up and a chance to respond, if you’d like to do so. (I couldn’t find their email address, but of course feel free to forward this email on to them or anyone else at Science.)

Below is a list of problems and inaccuracies with the article I’m going to mention. If anyone from the Science team would like to respond to any of this, please shoot me a note by 2 pm ET tomorrow (also happy to hop on the phone if that’s easier — I’m presently on London time) [edit: whoops — for what it’s worth I did not mean to give them a false deadline]. Because many of these issues are addressed in the HHS report itself, I’m going to raise the possibility that Mx. Jacobs didn’t read it before writing their report (while noting that there’s now [sic] way for me to know this for sure). Thanks. -Jesse

“A mere 90 days is not enough time to conduct a thorough review, Baker argues. By contrast, the most recent standards for the treatment of gender dysphoria in youth issued by the World Professional Association for Transgender Health (WPATH)—an organization that determines the clinical protocols used by the majority of professionals who work with trans people—took more than a decade to compile with numerous systematic reviews, and ‘reflect the consensus of hundreds of experts in transgender health from around the world,’ Baker says. (In its report, HHS dismisses WPATH as an ideologically motivated organization.)”

The SoC 8 is not based on “numerous systematic reviews,” and Baker’s claim was the subject of a somewhat tangled controversy that I wrote about in The Economist. Long story short: Because of documents that have been published as a result of a lawsuit, we now know that WPATH commissioned a number of SR but then refused to allow them to be published, almost certainly because they did not demonstrate evidence for youth gender medicine. WPATH directly suppressed scientific research on this subject, in other words. Baker, for his part, authored one of those reviews, but it found a lack of evidence supporting gender medicine (that review covered both adult and youth studies). On top of that, Baker and his team allowed WPATH to interfere with the publication of that SR and then included straightforwardly false language claiming the team had worked independently. This is actually referenced right in the HHS report:

Internal WPATH documents reveal that Baker et al. complied with all the mandatory steps of WPATH’s updated approval policy—from approving the conclusions before the manuscript was drafted to ensuring extensive WPATH engagement in the process and obtaining the final approvals. The Baker et al. SR was published with the mandatory disclaimer that “WPATH had no role in study design, data collection, analysis, interpretation, or drafting” of the SR, despite the checklist clearly recording that WPATH had engaged in the design, drafting, and final approval of the article.

I’m going to argue that Baker is just far too conflicted a figure to be seen as a reliable source here, especially because the HHS team found his SR to be of low quality.

If Science can point me to the “numerous” systematic reviews included in WPATH, I’ll of course not include this rebuttal. I believe the actual number is two, though. For what it’s worth the SoC 8 explicitly says there wasn’t enough evidence on youth gender medicine to run a systematic review (which isn’t how SRs work, but that’s beside the point). I believe Science's claim of “numerous systematic reviews” is absolutely false and easily debunked if one simply reads the SoC 8 or is at all familiar with the debates which surrounded its publication.

“It either downplays or dismisses studies that have found that access to these treatments leads to improved mental health, Cahill says.

The study your article links to is somewhat infamous among skeptics of these treatments because the team that published it severely misrepresented their own findings. I wrote about this back in 2022, or see this from the HHS report itself:

The study by Tordoff et al. reported mental health outcome data for adolescents and young adults aged 13-20 years who were treated with PBs or CSH for up to one year. The study claimed to provide “quantitative evidence” of mental health improvements; however, the rates of depression in youth who started PBs or CSH remained unchanged—about 6 in 10 youth were moderately-to-severely depressed both pre- and post-intervention. These data were reported in a supplement which was available only online.

The table in question plainly shows that there was no improvement. I’m going to simply point out that Science is misrepresenting the result of this study. On the broader question of “downplaying or dismissing” studies that show youth gender medicine works, I’m going to argue that this is a complete misunderstanding of the HHS evidence review. The authors conducted a so-called “umbrella” review of existing systematic reviews and, drawing upon the most rigorously conducted ones, concluded the same thing Finland, Sweden, the U.K., and other countries have concluded: overall, the evidence for these treatments is quite weak. Everyone who works at Science, given its past coverage of the replication crises and various efforts to improve science, is well aware of the difference between an SR and an individual study, and knows that you can’t respond to an SR by pointing to an individual study or group of studies. This is a really basic thing to have gotten wrong.

The report promotes psychotherapy as the only safe approach for treating gender dysphoria in children and adolescents, Cahill notes, even though there is no evidence to suggest therapy can change a person’s gender identity. “Ex-trans therapy doesn’t work,” he says, “and it causes harm.”

Nowhere in the HHS article does the team suggest psychotherapy should be used to change a person’s gender identity. Again, this is the sort of basic fact that’s right there if you simply read it. The authors explicitly point out that while some activists have tried to present “exploratory psychotherapy” as akin to conversion therapy, this sort of exploration of a young person’s gender journey is part of the Dutch protocol, which has produced some of the evidence most widely cited by proponents of youth gender medicine. It’s a bog-standard part of the assessment process, and for Science to describe it as similar to conversion therapy is a remarkably serious allegation to make, especially how little evidence there is to support it.

Thanks,
Jesse

2. Jacobs’ response:

Hello,

I am writing in response to your request for comment on my article “Researchers slam HHS report on gender-affirming care for youth.” For this article, I specifically focused on reporting how medical associations and researchers were reacting to the HHS report and the criticisms they had raised. The final piece is based on my conversations with my sources and on statements released by medical associations and advocacy organizations.

The sentence stating WPATH SOC8 “took more than a decade to compile with numerous systematic reviews” refers to the fact that the authors of the SOC8 considered dozens of pre-existing systematic reviews while developing their recommendations (one looking at the global burden of HIV in trans women, one on psychiatric disorders in people with gender dysphoria, and one on the impact of gender-affirming hormone therapy on blood pressure, to name just a few cited in the document’s footnotes), as well as the reviews specifically commissioned by WPATH (Baker et al. 2021 and Wilson et al. 2020) that were published separately.

The sentence stating that the HHS report “either downplays or dismisses studies that have found that access to these treatments leads to improved mental health” is based on my conversation with Sean Cahill, who noted the overall body of evidence linking access to gender-affirming care with lower rates of depression and suicidality and improvements in body dissatisfaction (including studies like Green et al. 2021, Kuper et al. 2020, Costa et al. 2015, Allen et al. 2019, Turban et al. 2022, van der Miesen et al. 2020, Grannis et al. 2021, Chelliah et al. 2024, López de Lara et al. 2020, Olsavsky et al. 2023, and McGregor et al. 2024 to name a few). It might have been more precise to say that Torkoff et al. 2022 in particular found that gender-affirming treatments appeared to mitigate comparative risk (i.e. that subjects who received care showed lower rates of depression and suicidality compared to similar subjects who didn’t), but I believe that distinction is splitting hairs.

Finally, the sources quoted in the article did not claim that psychotherapy for transgender youth is conversion therapy. They specifically raised concerns about the HHS report’s focus on “exploratory psychotherapy.” In their opinion, this intervention, in practice, tends to treat transgender identity as a pathology to be corrected.

Best,
Phie Jacobs (they/them/theirs)
General Assignment Reporter, Science
American Association for the Advancement of Science (AAAS)
[personal contact info redacted]