On Wednesday, the U.S. Department of Health and Human Services sent a letter to health care providers, risk managers, and state medical boards urging them to update their protocols for the treatment of pediatric gender dysphoria to accommodate the findings of HHS’ umbrella review, which concluded that the evidence supporting pediatric medical transition is very weak. Given the uncertain evidence for benefits and the more certain evidence for harm, the letter reminds providers of their ethical obligation to “Do No Harm.” Quoting Sweden’s National Board of Health and Welfare, the letter also recommends psychotherapy as the first line treatment for gender dysphoria. The letter also urges relevant parties to stop relying on WPATH’s SOC-8 as a clinical practice guideline, citing the many issues with its guideline development process including unmanaged conflicts of interest and the suppression of evidence reviews. The same day, the Centers for Medicare and Medicaid Services (CMS) sent a letter to “select hospitals” requesting information on the informed consent process for pediatric medical transition and the scope of medical interventions performed on dysphoric minors.
The U.S. Supreme Court has declined to hear the appeal of a student who was barred from wearing a T-shirt asserting 'there are only two genders at John T. Nichols Middle School in Massachusetts, after school officials expressed concern that the message could negatively impact the mental health of trans-identified students. Student Liam Morrison and his parents were seeking an appeal of a ruling by the 1st U.S. Circuit Court of Appeals which ruled that “it was reasonable for Middleborough to forecast that a message displayed throughout the school day denying the existence of the gender identities of transgender and gender nonconforming students would have a serious negative impact on those students' ability to concentrate on their classroom work." The student and his family are arguing that the school violated his free speech by censoring his expression. Justices Alito and Thomas issued dissenting opinions challenging the reasoning of the appeals court with Alito remarking that “some lower courts are confused on how to manage the tension between students' rights and schools' obligations…Our nation's students, teachers and administrators deserve clarity on this critically important question.”
To accommodate female athletes displaced by male competitors, the California Interscholastic Federation has announced a new “pilot program” allowing female athletes who failed to meet qualifying marks for the Track and Field state championships (by one spot) to participate in the event. Although the California Interscholastic Federation’s policies have failed to comply with Trump’s executive order on “Keeping Men out of Women’s Sports,” observers see the pilot program as an implicit concession that the rights of women and girls are often undermined by policies that privilege participation based on “gender identity” rather than sex. Notably, the CIF’s announcement came shortly after Trump threatened to withhold federal funding from the state for violating the EO on sports participation, highlighting the case of A.B. Hernandez, a trans-identified 17-year-old junior at Jurupa Valley High School in Ontario, who qualified for the state championships after beating female competitors in several events. On Wednesday, the Justice Department announced it had sent legal notices to the state attorney general, state superintendent of public instruction and the California Interscholastic Federation regarding an investigation into Title IX violations.
According to a memo obtained by the Daily Wire, the Federal Trade Commission plans to curtail the gender medicine industrial complex by using its considerable power to “protect consumers from unfair and deceptive trade acts and practices.” The memo states that “There is now considerable reason to believe that the doctors and medical providers pushing [gender-affirming care] on minors are knowingly deceiving parents by exaggerating [gender-affirming care’s] ‘benefits’ and downplaying its harmful side effects.” The memo signals that FTC leadership plans to launch investigations into providers and hospitals that make deceptive claims about medical transition, and that the FTC sees its role as protecting the public from an industry that has failed to regulate itself. The memo also notes the FTC plans to hold a conference in July on the ins and outs of gender medicine before initiating any legal action.
Part of the budget reconciliation bill passed in the House on May 22nd would prohibit Medicaid from covering medical transition procedures for the treatment of gender dysphoria and prohibit plans offered under the Affordable Care Act’s exchanges from treating these practices as “essential health benefits.” The original provisions of the Medicaid restrictions on medical transition for gender dysphoria specifically addressed procedures for minors, however, they were later amended to include adults.
Kara Dansky writes for The Hill about how the Democrats’ refusal to compromise on trans rights is increasingly alienating women from the party. Dansky explains how Democratic women seeking to have good faith debates around the tension between the rights of women as a sex-class and rights based around “gender identity” are often dismissed out of hand. Dansky highlights one instance in which members of the Women’s Liberation Front met with members of Congress to discuss women’s rights and were allegedly mocked by Senator John Fetterman’s chief of staff. The article claims that when women in attendance explained to the staffer that women were leaving the party over these issues, he reportedly responded “Good. Leave. Go.” “Liberal activists like these have long formed a core constituency for Democrats. But if Democrats keep asking liberal women to leave their party, then guess what — they will leave. And they are leaving” Dansky argues.
Utah’s Department of Health and Human Services has released a 1000-page report which controversially concludes that there is clear evidence for the benefits of pediatric medical transition, a conclusion that diverges from the findings of other systematic reviews, including HHS’ recent umbrella review. For context, Utah’s policy prohibiting minors from accessing medical transition procedures for the treatment of gender dysphoria was meant to be a moratorium while experts reviewed the evidence. Although reviews use different predefined protocols, the disconnect between the findings of this review and the findings of reviews completed by Sweden, Finland, the UK, and the U.S.–by Florida and more recently by HHS–raises questions about the integrity of the report and the methodology used by the authors. As the report itself notes, it did not synthesize findings across studies or systematically evaluate the quality of evidence. For now, Utah lawmakers have asserted they intend to keep the moratorium in place.
Australian psychiatrist Dr. Catherine Llewellyn provides excellent overviews of the limitations of medical transition for minors as a treatment for gender dysphoria as well as the failures of the Australian medical establishment to prioritize evidence-based care over ideology. In her analysis, Llewellyn lays bare the ideological underpinnings of medical transition, challenges the consensus that transition is “lifesaving,” and draws on the U.S. Department of Health and Human Services’ report on best practices for gender dysphoria to explain how dissenting views are suppressed. “Meaningful change to support the improved health of trans youth requires an uncompromising return to the highest standard of evidence-based medicine. But when we do, we will also need to brace ourselves for the harm that may have already been caused” Llewellyn concludes.
Joseph Figliolia
Policy Analyst
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