The long-awaited publication of the names of the co-authors of the Trump Administration’s landmark springtime report on pediatric gender medicine has disclosed that the Department of Health and Human Services deployed a team of scholars who are all at least highly skeptical of providing minors with medical gender treatments. This team backed their skepticism with detailed scientific and bioethical arguments in the report, which the White House sought to lend academic credence to its dramatic reversal from the Biden Administration’s positions on gender identity issues. 

On Tuesday, HHS published the long-awaited final version of the report, which the Trump administration commissioned as the first U.S.-based systematic review of the evidence backing the field of pediatric gender medicine. The report, the initial draft of which was published in May, was sharply critical. It argued that given the risks, providing minors with medical gender transition interventions even in clinical trials would be “in tension with well-established ethical norms.” The updated report unveiled the identities of all nine of its coauthors for the first time.  

All the report’s coauthors are known as skeptics or opponents of providing adolescents with medical gender treatments, which include providing puberty blockers, cross-sex hormones, and gender-transition surgeries — mostly mastectomies — to treat gender-related distress.  

The updated report includes fairly minor edits made in response to a months-long peer-review process and a new, 240-page supplement with detailed responses to critiques of the report that HHS enlisted from a swath of experts. Most notably, this included criticism from the American Psychiatric Association, as well as a largely positive review from a former president of the Endocrine Society — a medical association that has issued foundational guidelines for providing gender-transition treatment to minors and supported the practice in the face of mounting political attacks by Republicans. 

Absent were critiques from the Endocrine Society itself and the American Academy of Pediatrics, each of which HHS invited to provide formal peer reviews. This after the AAP — even following increasing scrutiny over its own fervent support for pediatric gender treatments —  issued a statement lambasting the more than 400-page HHS report within hours of its initial publication in May, saying it “relies on a narrow set of data and perspectives.” The AAP did draft a formal review in response to HHS’s invitation, but pulled out at the 11th hour, a report coauthor told The New York Sun. The Endocrine Society declined HHS’s invitation. 

The HHS report’s coauthors also formally responded to scathing denunciations of the document issued in a pair of recently published papers that were not part of the report’s formal peer-review process and were written by prominent members and defenders of the pediatric gender medicine field.

Producing the report was an urgent White House priority. In an executive order President Trump signed January 28 entitled “Protecting Children From Chemical and Surgical Mutilation,” the president demanded within 90 days “a review of the existing literature on best practices” for caring for youth with gender-related distress. Following the report’s initial publication, critics theorized that the Trump Administration had curated a biased team of coauthors certain to deliver a pre-ordained conclusion — one that would buttress the president’s multi-pronged, and increasingly successful, effort to eliminate this entire pediatric field.

Much of the immediate public assessment of the report focused on the anonymity of its authorship. HHS asserted the names had been withheld to protect the integrity of the pending peer-review process. Many critics were unmoved by this claim and, arguing that poor transparency thwarted an imperative to scrutinize the authors for bias, leveraged the lack of named authorship in their efforts to dismiss the report and its findings. 

Emily G. Hilliard, an HHS press secretary, said in a statement that the report “is not a political exercise. It is a science-driven effort to ground federal policy in facts, not ideology.” Now the release of the identities of the coauthors, only one of whom — M.I.T. philosophy professor Alex Byrne — had previously been publicly confirmed, is certain to prompt renewed scrutiny and outcry from transgender advocates.

Among the coauthors are experts in evidence-based medicine, medical doctors, and academic philosophers and bioethicists. All of them have previously published or assisted with papers, editorials, or books or given lectures scrutinizing or criticizing pediatric gender medicine. Some have served as paid experts providing expert testimony to statehouses on behalf of bans of gender-transition treatment for minors (as have some of their most prominent critics, but for the other side), which are now in place in just over the majority of states and have the effective blessing of the Supreme Court.

The coauthors, who between them reported an array of personal politics that spread from left to right and was tilted leftward on average, expressed to the Sun confidence that none of the critical peer reviews or other attacks on the report had succeeded in undermining their core conclusions.

Gender-transition treatment “is a medical intervention on kids who have no physical pathology,” said Leor Sapir, a report coauthor who researches and publishes critically about pediatric gender medicine as a senior fellow at the Manhattan Institute, a conservative think tank. “So those who advocate for these interventions have the burden of proof to show that there’s a favorable risk-benefit profile and that it’s ethically permissible.” Asserting that the advocates who criticized the coauthors’ work “failed to point out any significant errors or omissions in the report,” Dr. Sapir said: “That is very, very troubling.”

The disclosure that likely has the greatest potential to impact the battle over the increasingly limited future of pediatric gender medicine is the fact that among the report’s coauthors is the cofounder of the Society for Evidence Based Gender Medicine , health researcher Evgenia (Zhenya) Abbruzzese. 

SEGM, which is a small but influential nonprofit focused on scrutinizing the evidence base behind this medical field, was branded a hate group by the left-wing advocacy nonprofit the Southern Poverty Law Center in 2024. Transgender activists have since leveraged this fact to attack two major North American universities for working with SEGM and are seeking to compel the retraction of the academic products of those partnerships. Others have dismissed the hate-group designation as indicative of the SPLC’s own political bias (the SPLC has also characterized conservative groups such as Turning Point U.S.A. as extremist groups) and asserted that such scurrilous branding of SEGM is supported by dubious arguments.  

SEGM’s critics are likely to argue that the organization is now explicitly aligned — and serving in partnership — with the Trump Administration in its fervent opposition to this medical field. Such critics have expressed outrage that the HHS report suggested that instead of gender-transition drugs, minors with gender-related distress should receive psychotherapy to at least treat the ancillary psychiatric conditions that are prevalent in this population. Many trans advocates believe such mental health treatment is de facto “conversion therapy” meant to force a child to stop identifying as transgender. The Supreme Court is set to rule on the constitutionality of state conversion therapy bans this term.

SEGM has routinely defended itself as a nonpolitical science group. Ms. Abbruzzese joined other coauthors in telling the Sun that notwithstanding the politically charged context in which the HHS report was conceived and now exists, it is neither a clinical practice guideline nor a policy document. They asserted that the report is neither medically nor politically prescriptive. 

“The HHS review is not a SEGM product. It’s a comprehensive report from a multidisciplinary team,” Ms. Abbruzzese said. The review, she added, “provides robust evidence evaluation and places the scientific findings within a broader ethical and clinical framework, responding to the urgent need for course-correction within the field of pediatric gender medicine.” 

A Damning Review

Leaders in pediatric gender medicine and LGBTQ advocacy groups routinely assert that gender-transition medical interventions are safe and effective at treating gender dysphoria — a psychiatric diagnosis involving distress stemming from a conflict between a person’s biological sex and perceived gender — in adolescents. They point to studies that they say demonstrate these treatments improve youths’ mental health and even claim they are life saving. 

However, a raft of systematic literature reviews — the gold standard of scientific evidence — recently published by researchers in Western nations outside of America, including a prominent Canadian team commissioned by SEGM, have examined the research in this nascent and controversial medical field and found it weak and inconclusive. This has prompted a swath of European nations to sharply restrict minors’ access to these treatments.  

Central to the HHS report on pediatric gender medicine was a so-called umbrella review, which assessed all existing systematic reviews. This review prompted the conclusion that the quality of evidence backing these medical practices in youth was very low, meaning that the benefits studies have indicated are associated with such treatment are likely to differ substantially from outcomes in real-world practice.  

The HHS review also found the evidence from systematic reviews characterizing harms of pediatric gender-transition treatment, which most notably includes infertility and sexual dysfunction, was “sparse.”  Yet the coauthors, to considerable pushback from transgender advocates, essentially argued that these potential harms can nevertheless be inferred and that in their ethical analysis of the reviews, concerns about those harms outweighed arguments that these treatments should be provided to minors. 

“When medical interventions pose unnecessary, disproportionate risks of harm, healthcare providers should refuse to offer them even when they are preferred, requested or demanded by patients,” the report stated. Failure to say no to such demands, the report continued, “reduces medicine to consumerism.” 

The report argued that a crucial reason why the evidence characterizing treatment risks remains so thin is that researchers investigating these practices have often failed to even measure certain potential negative outcomes, such as an inability to breastfeed following a mastectomy.

The report criticized medical gatekeeping practices in pediatric gender medicine as often considerably lax and egregiously led by the desires of adolescents who, being minors, cannot consent to their own treatment. In particular, they cited the Sun’s reporting that Boston Children’s Hospital has long maintained a policy of providing only a single, two-hour assessment appointment with a psychologist before determining whether a minor seeking gender-transition drugs should be referred to an endocrinologist. 

The report acknowledged that a “natural response to the absence of credible evidence” backing these medical practices in minors would be “to call for more and better research.” The coauthors, though, suggested that even if a high-quality randomized controlled trial were feasible, “conducting it may conflict with well-established ethical standards for human subjects research.” 

Unmasked, the HHS Coauthors Face Inevitable Scrutiny

A sprawling 2023 report commissioned by the Southern Poverty Law Center portrayed SEGM as a hub of what it characterized as an anti-trans “pseudoscience network.” Consequently, trans activists are likely to seize on the fact that among the HHS report’s nine coauthors, one is SEGM’s cofounder and at least five others have ties to the group, having presented at the nonprofit’s conferences or conducted academic work on its behalf. An additional coauthor attended SEGM’s recent conference in Berlin.

The coauthors asserted to the Sun that their report for HHS maintains robust scientific merit, even in the face of scathing criticism.

“I would not have exposed myself to extreme scrutiny if I wasn’t confident that this was solid work in line with accepted standards in my field,” said Yuan Zhang, a report coauthor who is a Canadian evidence-based medicine expert and researcher. Dr. Zhang, who trained at McMaster University in Hamilton, Ontario, and studied under the famed EBM pioneer Dr. Gordon Guyatt, continued: “We also have had extensive peer review and no significant problems were identified.” 

Dr. Zhang teaches part-time at McMaster, which is under fire after members of Dr. Guyatt’s team published a trio of SEGM-commissioned systematic reviews of pediatric gender medicine; absent substantive claims that the papers themselves are critically flawed, trans activists have demanded the papers’ retraction because of their funding source and have sought to prevent publication of two pending papers from the commission. SEGM has also commissioned methodological analyses from Dr. Zhang, who asserted that his work with both the nonprofit and McMaster “are separate efforts” and “not relevant to this HHS review.”

A common criticism by trans advocates of Britain’s four-year Cass Review, which concluded in a mammoth 2024 report that pediatric gender medicine was based on “remarkably weak evidence,” was that its leading author, renowned pediatrician Dr. Hilary Cass, had no experience treating gender dysphoria. 

Similar denunciations of the HHS report’s authors are thus likely to follow. None of them have conducted primary research on treating pediatric gender dysphoria. And the four medical doctor coauthors share Dr. Cass’s inexperience in providing the medical treatments in question. Neither of the two psychiatrist coauthors, Dr. Kristopher Kaliebe, a professor at the University of South Florida, and Dr. Kathleen McDeavitt, an associate professor at Baylor College of Medicine in Houston, has referred patients for such treatment. They said they had, however, provided more general psychiatric care to gender dysphoric minors.

In the American Academy of Pediatrics’ statement criticizing the HHS report in May, AAP president Dr. Susan J. Kressley said that “bypassing medical expertise and scientific evidence has real consequences for the health of America’s children.” She urged policymakers to consider the “full breadth of peer-reviewed research” from this field.

Dr. Kaliebe has provided expert testimony and reports on behalf of several states’ legislative bans of pediatric gender medicine. Dr. McDeavitt has published papers scrutinizing the field, including one published in 2024 in which she assessed a roster of major papers on gender-transition treatment for youths and concluded that “some studies articulated positive conclusions about hormonal interventions even in the setting of insignificant, small or negative findings.”

Dr. McDeavitt and Dr. Kaliebe recently presented lectures critical of this medical field at the American Psychiatric Association’s annual conference. The APA put a rare restriction on public reporting of those lectures, along with a companion lecture that for a supportive examination of pediatric gender medicine expressed exceptional nuance about the field; but recordings were immediately leaked.

The individual HHS report coauthor with perhaps the most notorious reputation in the eyes of trans activists is Dr. Michael Laidlaw, given his influential testimony on behalf of successful Republican efforts to ban gender-transition treatment for minors in red states such as Alabama and Florida. A 2023 Mother Jones investigation defined Dr. Laidlaw, an endocrinologist in private practice in Rocklin, Calif., as a member of a “secret working group that helped push anti-trans laws across the country.” The article stated: “In his South Dakota testimony, Laidlaw compared gender-affirming care to Nazi experimentation and the Tuskegee Syphilis Study.” 

Dr. Laidlaw told the Sun that while he was politically conservative, dispassionate clinical concerns and a thorough assessment of medical research motivated his critiques of this medical field.

“My first thought is really about safety and efficacy,” Dr. Laidlaw said. He said he was not motivated by animus toward transgender people and supported adults’ autonomy to make decisions about medically transitioning. Responding to the Mother Jones characterization, he said, “I would characterize this as a group of primarily medical doctors and attorneys who sought to promote sensible legislation for age minimums for gender transition related hormones and surgeries”

The HHS report coauthors declined to provide details about who assembled the group and according to what criteria, by what means the team maintained contact with HHS and the White House about their effort, and whether any of them was at least the effective leader of the effort. 

After Dr. Byrne was identified as a coauthor in May, some trans advocates criticized him for, as a philosopher, authoring a report about medicine. The coauthors, though, told the Sun that they divided the drafting of the report’s various chapters, which included segments concerning the philosophy behind pediatric gender medicine, in particular the clinical rationale for treating minors with these drugs, according to their individual specialties.

Addressing claims that the Trump administration stacked the deck by selecting biased coauthors, Dr. Laidlaw argued he and his colleagues were no extremists and were instead guided by scientific circumspection. “If they really wanted the report to come out a certain way,” he said of the Trump administration, “they would have picked a different set of people.” Multiple coauthors told the Sun that HHS assured them independence during their work on the report and kept to its word.

“Had the administration attempted to influence the content, I would have resigned,” said philosopher Alex Byrne, who is the author of Trouble With Gender, a book which challenges gender theorists’ deconstruction of the sex binary. Most of his colleagues, including Dr. Farr Curlin, a professor of medical humanities at Duke University School of Medicine, reported having maintained such red lines.

Ms. Hillard, the HHS secretary, said: “The report’s authors conducted their work independently, guided solely by evidence and the pursuit of scientific truth. Peer reviewers, who volunteered their time without compensation, brought diverse expertise and perspectives to ensure rigor and integrity.”

“A Dangerous Example of Government Incursion”

According to Dr. Zhang, the team behind the report recommended to HHS as potential peer reviewers a diverse roster that “intentionally included both individuals and organizations who are supportive” of gender-transition treatment for minors and those who were “likely to be critical of our work.” However, Dr. Zhang said: “Most declined to participate, unfortunately.” 

Coauthor Leor Sapir said the team had hoped that HHS’s request for reviews from the American Academy of Pediatrics, Endocrine Society and American Psychiatric Association, which are all devoutly supportive of pediatric gender medicine, would lead those organizations to tap an array of prominent supporters of the field for the assignment. The APA and the AAP each agreed to participate. According to one report contributor, the AAP in particular drafted a review and then backed out shortly before the final report’s publication. 

Otherwise, HHS secured peer reviews from seven individual experts whom Dr. Sapir said he had expected to approach the task more neutrally; they provided largely positive, and in some cases laudatory, assessments. This included a positive review by Dr. Richard J. Santen, an emeritus professor of endocrinology at the University of Virginia. Dr. Santen was president of the Endocrine Society from 2014 to 2015.

Dr. Santen told the Sun he had no hand in the society’s release of its influential updated guidelines for treating gender dysphoria in adolescents in 2017. “I have taken a major interest in this completely independently of the Endocrine Society,” he said of pediatric gender medicine. “I have tried to establish myself as an objective assessor of the data and the ongoing controversy.”

Characterizing the HHS report’s umbrella review as “scientifically sound,” Dr. Santen asserted in his peer review that “there is currently no agreement whether gender-affirming hormonal therapy” for minors “is experimental or standard practice.” 

The APA critique, written by New York psychiatrists Dr. William M. Byne and Dr. Jack Drescher, each of whom is an expert in LGBTQ-related care, spanned a little over one page of bullet-point critiques plus another two pages of footnotes. They asserted that “the report’s claims fall short of the standards methodological rigor” for a “policy guidance in clinical care” and that the report “lacks sufficient transparency,” in part because the coauthors’ names were shielded.

They criticized the report for drawing “heavily” from the Cass Review despite expert criticism of that report while overlooking that Cass concluded that “for some” youth “the best outcome will be transition.” They also faulted the HHS report for failing to apply “any kind of rational scrutiny to potential harms that have been associated with withholding” such treatment. 

In response, the HHS coauthors pointed to portions of their report they said answered the APA critique’s questions about their methodology in detail. The coauthors cited peer reviewed criticisms of the critiques of the Cass Review, including papers coauthored by Dr. McDeavitt and Ms. Abbruzzese, and argued that the APA had mischaracterized the British report’s degree of certainty about transition treatment sometimes being the best option. They noted that they found “no credible evidence” about the impacts of withholding treatment among minors. 

With only the APA providing a more critical assessment, the HHS report coauthors decided to step outside of the formal peer-review process and also publish responses to two recently published journal articles that were witheringly critical of the report. Those critical articles included as coauthors leaders in pediatric gender medicine, including coauthors of major research papers deemed unreliable by the systematic reviews that formed the basis of the HHS report. One article condemned the report as a “dangerous example of government incursion into the provision of evidence-based medical care.” The other denounced it as “replete with factual errors” and said it “distorts current scientific evidence and defies expert medical consensus.” 

The HHS report’s coauthors provided detailed rebuttals to both papers, arguing that the authors had distorted their work and the field’s evidence base.

HHS report coauthor Moti Gorin, a bioethicist and associate professor of philosophy at Colorado State University, told the Sun that the three critical assessments of the HHS report were “further illustrations of the pervasive problems in the pediatric gender medicine literature.” Dr. Gorin, who has published multiple papers critiquing this field’s approach to bioethics, continued: “For example, the authors seem not to understand some of the basic principles of evidence-based medicine. Sometimes they mischaracterize studies they themselves co-authored; other times they seem simply not to have read major parts of the review.”

The report has also added a response to a lengthy University of Utah report published in May. Presenting itself as a systematic review, the Utah report flew in the face of all the other such reviews by concluding that the evidence base supported pediatric gender-transition treatment as safe and effective. The HHS report countered that the Utah effort did not, in fact, qualify as a systematic review, given it lacked two crucial elements of such an effort: a formal synthesis of the scientific evidence and an assessment of the evidence’s certainty. 

“The report provides a transparent, detailed explanation of the methods used, including relevant limitations,” said Suzanne Winchester, a University of Utah spokesperson.

The AAP and Drs. Byne and Drescher did not respond to requests from the Sun for comment.

Alleged ‘Publication Bias’

One of the HHS report’s individual peer reviewers, Dr. Lane Strathearn, a professor of pediatrics and psychiatry at the University of Iowa, noted in his review that he had been approved by the Journal of Pediatrics, where he is an editorial board member, to prepare a commentary about pediatric gender medicine. He was to assess the tranche of systematic reviews of the field that Dr. Cass commissioned from the University of York and that informed the Cass Review.  

One of the York reviews concluded that many of the clinical guidelines and position statements on pediatric gender-transition treatment, including those most referenced in the United States, “lack a robust and transparent approach to their development.” Among those of the lowest quality, the review found, was the AAP’s foundational, and harshly contested, 2018 policy statement about caring for gender dysphoric youth.  

“Unfortunately, but not unexpectedly, the Commentary was not received favorably” by the peer reviewers, Dr. Strathearn wrote of his submission, in which he had highlighted the discrepancy between the limited evidence base in this field and the strong support for it by the U.S. medical establishment. The reviewers, he wrote, “used many of the arguments effectively countered” by the HHS report. He said that he wrote a “comprehensive rebuttal” and resubmitted his commentary to a Journal of Pediatrics sister publication as the journal recommended, and yet his commentary went unpublished. 

The HHS report’s coauthors characterized Dr. Strathearn’s account as a probable example of what academics call publication bias. Citing a recent paper by a SEGM researcher that documented such cases, they asserted that neutral or critical accounts of pediatric gender medicine are “too often rejected” by major journals while positive accounts “appear to pass peer review easily, even when the conclusions are not supported by the data presented.”  

In response to the HHS report’s highly critical account of pediatric gender medicine, Dr. Strathearn said it “provides a valuable and much needed contribution to his important field of practice.” He said that there is “insufficient evidence to clearly understand the ‘risk of potential harm’ for some of these treatments.” But he emphasized that “the responsibility for medical practitioners to ‘first do no harm’ means that the primary burden of evidence should be for the likelihood of benefit, especially when there is even a potential for harm.”