sex

The APA’s 5 Failed Critiques of HHS Report Discrediting Sex-Rejecting Procedures for Kids

The American Psychiatric Association (APA) tried and failed to discredit the Department of Health and Human Services’ (HHS) report showing sex-rejecting procedures harm minors.

HHS commended the association last week for for peer-reviewing Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, which the department first published in May. The American Academy of Pediatrics and Endocrine Society refused HHS’ invitation to review, though both support subjecting wrong-sex-identified children to surgical procedures, puberty blockers and [wrong]-sex hormones.

Though the APA agreed to review Treatment for Pediatric Gender Dysphoria, it did not do so carefully or in good faith. Its criticisms rely on half-truths, manipulations and outright falsehoods, demonstrating how little evidence “gender-affirming” organizations have to support procedures they call “evidence-based.”

Below are five of the America Psychiatric Association’s failed critiques of HHS’ Treatment for Pediatric Gender Dysphoria.

Failure to Read

The APA recommended HHS review 16 additional studies for the final version of Treatment for Pediatric Gender Dysphoria.

The original report had already addressed twelve of them.

Two other recommended studies examined the effect of sex-rejecting procedures on the wrong population (adults, not minors). Another did not investigate sex-rejecting procedures at all.  

HHS found only one of the APA’s recommended studies “potentially relevant.” Importantly, it came out after the department published Treatment for Pediatric Gender Dysphoria on May 1, 2025.

In its response to the association’s review, HHS speculates its “unfounded” criticisms “could have resulted from a failure to read core parts of the review.

Making Assumptions

The APA argued Treatment for Pediatric Gender Dysphoria failed to consider the risk of allowing children struggling with wrong-sex identification to go through puberty.

This critique reflects a common lie that sex-rejecting procedures stop wrong-sex-identified children from committing suicide or experiencing other debilitating mental illnesses.

More importantly, it subtly reveals the APA changes its conception and treatment of puberty based on the feelings of the developing child.

The association evidently considers puberty a natural and necessary process only when the child accepts it. Conversely, when puberty causes a child distress, the association considers it a sickness to be stopped and reversed.

HHS correctly recognizes puberty as a natural, necessary part of human life — regardless of the developing person’s feelings about growing up. Treatment for Pediatric Gender Dysphoria investigates the effects of disrupting this natural physical development with wrong-sex hormones, drugs that “block” puberty and sex-rejecting surgeries.

Cherry Picking

Treatment for Pediatric Gender Dysphoria references many findings and conclusions from The 2024 Cass Review — a comprehensive report on transgender medical interventions which prompted the UK to ban puberty blockers and prohibit the administration of wrong-sex hormones to minors outside experimental research.

The APA criticized HHS for cherry picking favorable portions of the Cass Review and ignoring lines like, “For some, the best outcome will be transition…”

Ironically, the association cherry picked this phrase from a larger paragraph, not on the benefit of sex-rejecting procedures, but on the UK National Health Service’s obligation to children struggling with wrong-sex identification:

For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/retransition and/or experience regret. The NHS needs to care for all those seeking support.

The APA selected this paragraph out of context to suggest the Cass Review equivocates on the benefits of sex-rejecting procedures. It doesn’t. The review clearly concludes evidence for sex-rejecting procedures is weak and, further, that doctors can’t know whether children will grow out of their wrong-sex identification and regret harming their bodies.

“Any reasonable interpretation of The Cass Review’s statements … must grapple with its findings about lack of evidence for benefit and deep uncertainties about diagnoses,” HHS writes. “Unfortunately, the APA fails to do so.”

Unsupported Conclusions

The APA criticized HHS for obfuscating how it chose and evaluated evidence in Treatment for Pediatric Gender Dysphoria.

Most other peer reviewers praised the report for its transparency and methodological rigor.

HHS highlights a positive peer review from two methodologists at the Belgian Centre for Evidence-Based Medicine. The scientists commended the reports’ methodology and described the results as “[written] transparently” and “easy to follow.”  

Misapplication of Scientific Norms

Healthcare “stakeholders” refer to any population or entity impacted by changes to the medical system, including patients.

The APA argued HHS improperly excluded stakeholder perspectives, particularly those of “transgender individuals and their families,” from Treatment for Pediatric Gender Dysphoria.

But scientists don’t need patients’ input to write reliable evidentiary reviews.

HHS suspects the association confused its report with a clinical practice guide, which dictates how doctors should diagnose and treat medical conditions. Clinical practice guides generally require feedback from patients who will be impacted by the recommendations.

Treatment for Pediatric Gender Dysphoria does not weigh in on diagnoses and treatment; it compiles and evaluates all evidence on the effects of sex-rejecting procedures on minors. The perspectives of patients and other stakeholders do not — and should not — affect its scientific conclusions.  

Ironically, HHS notes, the current “gender affirming” clinical practice guides for wrong-sex-identified children score low on stakeholder involvement.

Why It Matters

Treatment for Pediatric Gender Dysphoria suggests the American medical system performed sex-rejecting procedures on wrong-sex-identified children with no evidence of those procedures’ benefits and every evidence of their harms.

HHS gave standard-bearers like the APA the opportunity to respond to this serious implication. They either refused or presented weak, deceptive arguments devoid of evidence.  

That’s unacceptable. Protecting children from sex-rejecting procedures requires illuminating these cop-outs and pursuing justice for families and children harmed by these unconscionable practices.

Additional Articles and Resources

Counseling Consultation & Referrals

Resources for families struggling with wrong-sex identification

HHS Finalizes Report Finding Sex-Rejecting Procedures Harm Minors

HHS Releases Report on Harms of ‘Transgender’ Medical Interventions for Minors

FTC Begins Investigating ‘Gender-Affirming’ Medical Community for Deception, False Advertising

The Shifting Ground of ‘Gender-Affirming Care’

Don’t Fall for the ‘Affirm Them or They Will Die’ Lie

Transgenderism and Minors: What Does the Research Really Show?

UK Bans Puberty Blockers for ‘Transgender’ Minors

U.K.’s Review of Child Gender Policy Reveals Profound Failures That U.S. Still Defends

England’s NHS Stops Dispensing Puberty Blockers for Children — Not Safe or Effective

Addressing Gender Identity with Honesty and Compassion

Newsom Signs Bill Connecting Students to ‘LGBT Hotline’ and Unsafe Chatrooms

HHS Finalizes Report Finding Sex-Rejecting Procedures Harm Minors

The Department of Health and Human Services (HHS) released its final, peer-reviewed report on the effects of sex-rejecting procedures on minors last week.

Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, which HHS first published in May, found “transgender” medical interventions — including puberty blockers, [wrong]-sex hormones and surgical operations — pose “significant, long term and too often ignored” harms to children.

The report’s groundbreaking conclusion remains unchanged in the final version published November 19. The latest copy includes peer reviewers’ evaluations of the report and the department’s responses to their critiques. It also reveals the names of review’s nine prestigious authors.

HHS invited three of the report’s biggest critics — the American Academy of Pediatrics, the American Psychiatric Association and the Endocrine Society — to participate in the peer review process.

All three organizations recommend sex-rejecting procedures for minors struggling with wrong-sex identification. Upon the release of Treatment for Pediatric Gender Dysphoria in May, the American Academy of Pediatrics claimed it “misrepresented the current medical consensus and failed to reflect the realities of pediatric care.”

But only the American Psychiatric Association agreed to review the report. HHS thoroughly refuted its critiques, such that The Washington Post editorial board wrote:

[The HHS report’s] core finding — that the evidence for [transgender medical] interventions is highly uncertain — echoes the results of systematic reviews in other countries. None of the peer reviews of the HHS report ultimately rebut that conclusion.

Critics attacked HHS for bias and lack of transparency in May, when it kept the authors of Treatment for Pediatric Gender Dysphoria anonymous.

“That’s one more reason why I can tell you this is an ideological, political document and not a scientific one,” Casey Pick, director of law and policy at the Trevor Project, a radical LGBT activist group, told Science in May. “Scientists stand by their work.”

In the final report, HHS notes withholding authors’ names is an “established practice in scientific review” meant to reduce bias in the peer reviews.

Nine multi-disciplinary experts authored Treatment for Pediatric Gender Dysphoria, HHS reveals, including two bioethicists, two psychiatrists, a philosopher, an evidence-based medicine specialist, an endocrinologist and two researchers — one who specializes in healthcare and another who covers “pediatric gender issues” for a think tank.

“These are not ideological cranks; they are thoughtful researchers,” the Post’s editorial board admits, concluding:

It is fair to say [the authors’] work has withstood scrutiny, with minor updates.

Treatment for Pediatric Gender Dysphoria withstands even the most critical peer reviews. That means Americans must acknowledge national medical authorities perform sex-rejecting procedures on children struggling with wrong-sex identification, despite evidence showing such interventions cause irrevocable harm.

“The American Medical Association and American Academy of Pediatrics peddled the lie that chemical and surgical sex-rejecting procedures could be good for children,” HHS Secretary Robert F. Kennedy Jr. castigated in a press release announcing the final report.

He continued:

They betrayed their oath to first do no harm, and their so-called “gender-affirming care” has inflicted lasting physical and psychological damage on vulnerable young people. That is not medicine — it’s malpractice.

The Daily Citizen heartily agrees.

Additional Articles and Resources

Counseling Consultation & Referrals

Resources for families struggling with wrong-sex identification

HHS Releases Report on Harms of ‘Transgender’ Medical Interventions for Minors

FTC Begins Investigating ‘Gender-Affirming’ Medical Community for Deception, False Advertising

The Shifting Ground of ‘Gender-Affirming Care’

Transgenderism and Minors: What Does the Research Really Show?

UK Bans Puberty Blockers for ‘Transgender’ Minors

U.K.’s Review of Child Gender Policy Reveals Profound Failures That U.S. Still Defends

Addressing Gender Identity with Honesty and Compassion

Newsom Signs Bill Connecting Students to ‘LGBT Hotline’ and Unsafe Chatrooms

Texas Legislation Uses Real Science to Define Two Sexes: Male and Female

The Texas House passed a bill to define “sex” as male and female in government statutes and the state’s collection of vital statistics.

In the bill, HB 229, the Texas House used science to define male and female by their reproductive capacity – not the pseudo-scientific ideology of “gender” activists who claim that “sex is a spectrum.”

The legislation, which now moves to the Senate for consideration, passed by a vote of 87 to 56. It received fierce opposition from “transgender” activists, as The Texas Tribune reported:

Dozens of trans people and their allies gathered in the outdoor Capitol rotunda Friday, chanting at the top of their lungs, “They will not erase us.”

However, the bill erases no one – whatever that means.

Instead, as State Representative Ellen Troxclair posted, “The bill defines what a woman is, recognizing biological reality.”

Imbed post: https://x.com/EllenTroxclair/status/1922046267217031413

HB 229 begins by noting basic differences between females and males:

  1. Males and females possess unique immutable biological differences that manifest prior to birth and increase as individuals age and experience puberty.
  2. Biological differences between the sexes mean that only females are able to get pregnant, give birth, and breastfeed children.
  3. Biological differences between the sexes mean that males are, on average, bigger, stronger, and faster than females.

The legislation states that girls and women have “historically suffered discrimination in education, athletics, and employment.” But “inconsistencies in court rulings and policy  and policy initiatives” have led to conflicting definitions of sex-related terms, endangering “single-sex spaces and resources.”

HB 229 explains some of the areas where single-sex spaces need to be protected:

There are legitimate reasons to distinguish between the sexes with respect to athletics, prisons and other correctional facilities, domestic violence shelters, rape crisis centers, locker rooms, restrooms, and other areas where biology, safety, or privacy are implicated.

Every person is male or female, the bill states, adding that the small percentage of those “diagnosed with a disorder of sex development or as intersex are not considered to belong to a third sex,” and should be accommodated in state and federal laws.

Male and female are defined in the bill on the basis of the development of biological reproductive systems: Female bodies are “developed to produce ova,” and male bodies are developed “to fertilize the ova of a female.”  

Colin Wright, an evolutionary biologist and a fellow at the Manhattan Institute, explains the scientific truth behind this simple definition in an article in City Journal, “Understanding the Sex Binary”:

When biologists claim that “sex is binary,” they mean something straightforward: there are only two sexes. This statement is true because an individual’s sex is defined by the type of gamete (sperm or ova) their primary reproductive organs (i.e., gonads) are organized, through development, to produce.
Males have primary reproductive organs organized around the production of sperm; females, ova. Because there is no third gamete type, there are only two sexes that a person can be. Sex is therefore binary.

Some transgender activists point to intersex conditions or other disorders of sexual development, such as when a female may have XY chromosomes or a male may have XXY or XX chromosomes, as evidence that sex is a spectrum.  But Wright makes it clear that these are rare anomalies that do not create a third sex – these individuals do not create a different type of sperm or egg necessary for reproduction.  

He points out that such individuals are almost always identifiable as male or female, as shown by their sex organs and anatomy. And, as he writes, real intersex conditions are very uncommon, and claims that intersexuality is the same as transgenderism is nonsense:

The terms intersex and transgender are entirely distinct and should not be conflated. Intersex people have rare (approximately 0.018 percent of all births) developmental conditions that result in apparent sex ambiguity.
Transgender people, on the other hand, need not be sexually ambiguous at all; indeed, current progressive orthodoxy insists that it is enough for one merely to “identify” as the opposite or neither sex.

Wright also explains a very important point – these activists and their allies conflate “how sex is determined with how sex is defined for an individual” (his emphasis). He adds:

“Sex determination” is a technical term in developmental biology referring to the process by which certain genes trigger and regulate sex development. 

The normal developmental process may have things go awry, but those don’t negate the sexual binary – as determined by reproductive anatomy and a body’s capacity to produce one type of gamete – eggs or sperm.

Legislation similar to the common-sense law has been passed in 13 other states, with executive orders proclaiming the reality of male and female in two others. Let’s hope this bill passes – and that the trend continues in more states.

Related articles and resources:

Texas Values – A Focus on the Family ally that helps Texans engage in the legislative process

Key articles from Colin Wright on these issues:

Citations for the Gamete-Based Definition of Male and Female

Sex Is Not a Spectrum

Understanding the Sex Binary

Focus on the Family and Daily Citizen:

Counseling Consultation & Referrals

Even Hard-Boiled Evolutionists are Standing Strong Against Gender Madness

Mississippi Law Protects Single-Sex Spaces in Public Schools

President Trump: ‘There are Only Two Genders: Male and Female’

There is No Pride in Denying Reality or the Image of God in Humanity

Two States Pass Laws Defining ‘Male’ and ‘Female’ and Protecting Women’s Spaces

Transgender Resources

Rapid Onset Gender Dysphoria – Researcher’s Work Vindicated

In August 2018, Dr. Lisa Littman published a research paper in the peer-reviewed, online journal PLOS ONE. The paper, originally titled “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports,” was a qualitative survey of 256 parents whose adolescent and young adult children identified as transgender.

Littman coined the term “Rapid-onset gender dysphoria” (ROGD) to describe a phenomenon she was seeing, “whereby teens and young adults who did not exhibit childhood signs of gender issues appeared to suddenly identify as transgender.” 

The study was greeted by outrage and protest from transgender-activists and their allies. As a result, PLOS ONE decided to give her work another review, and Brown University, where Littman works as an Assistant Professor, retracted a press release announcing its publication.

After being re-evaluated by PLOS ONE, her report has been republished – with a slightly different title but very few changes from the original: “Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria.” This new release of the report has received little media attention, but Littman’s study is an important first look at teens and young adults confused about being male or female. Here are three things you should know about this study and the controversy surrounding it.

  1. The number of children, adolescents and young adults who struggle with confusion about being male or female has increased tremendously.

Boston Children’s Hospital opened the first U.S. treatment center for gender confused youth in 2007. By 2015, there were 40 such clinics across the country. There’s also been a four-fold increase in transgender surgery from 2000 to 2014.  

In Britain, similar growth has occurred, as the number of youth referred for “gender treatment” grew from 97 in 2009-10 to 2,519 in 2017-18. The number of girls referred for such treatment increased from 40 to 1,806 during that time period. This was such a large rise, in less than a decade, that the U.K.’s Equalities Minister called for an investigation.

Surveys also indicate a large increase in youth who identify as transgender. A 2016 report in Pediatrics showed that 2.7% of teens in the 2016 Minnesota Student Survey identify as “transgender and gender nonconforming.” According to the Diagnostic and Statistical Manual of Mental Disorders, the prevalence of gender dysphoria in the adult population ranges from 0.005% to 0.014% for men and from 0.002% to 0.003% for women. For almost three percent of teens to identify as “gender nonconforming” is a huge increase from that tiny percentage.

Littman began noticing this increase in young people identifying as transgender, especially among girls. She says, “Late-onset had only been observed in natal males [those born male] until quite recently. About seven years ago, the phenomenon of natal females [those born female] exhibiting late-onset gender dysphoria first started to become visible.” As she notes in her report, until 2012 the incidence of adolescent girls suddenly identifying as transgender was virtually non-existent in psychological literature.

  1. In Littman’s study, parents reported a number of possible contributing factors to their children’s gender confusion.

Littman explains, in an interview with Quillette, that she became interested in researching teens with gender dysphoria “when I observed, in my own community, an unusual pattern whereby teens from the same friend group began announcing transgender identities on social media, one after the other, on a scale that greatly exceeded expected numbers.” Her study found that peer and social media influence seemed to be influencing factors for many of the young people: 21.5% were part of peer groups where others were identifying as transgender; 19.9% had increased their use of social media and the internet; and 45.3% had experienced both of these influences.

Parents reported that online advice to their children included “how to tell if they were transgender”; “the reasons they should transition right away”; “what to say and what not to say to a doctor or therapist in order to convince them to provide hormones”; and “they should use the ‘suicide narrative’ (telling the parents that there is a high rate of suicide in transgender teens) to convince them [the parents].”

High percentages of the young people also struggled with a wide variety of mental disorders and neurodevelopmental disabilities before coming out as transgender. Sixty-three percent had one or more diagnoses, including: anxiety, depression, attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), autism spectrum disorder (ASD), eating disorder, bipolar disorder and psychosis. Parents reported frustration with clinicians who evaluated their child for gender dysphoria and did not explore these mental health issues or even ask for medical records.

In addition, 48.4% of parents reported that their adolescent or young adult had experienced a trauma – such as their parents’ divorce, the death of a parent, sexual harassment, rape, bullying, an abusive dating relationship, a serious illness or psychiatric hospitalization – before the onset of gender confusion. Again, many parents expressed concern that when evaluated by a clinician for gender dysphoria, these issues were not discussed.

Littman hypothesizes that transgenderism may be a “maladaptive coping mechanism,” a “response to a stressor that might relieve the symptoms temporarily but does not address the cause of the problem and may cause additional negative outcomes.” For young people who use hormones and surgery to try to live as the opposite sex, those negative outcomes can be devastating. After having double mastectomies and taking male hormones, some young women have gone back to living as women – but the effects of hormones and surgery remain.

  1. Dr. Littman is not the only medical professional or researcher to have her work attacked and maligned by transgender activists and their allies.

Littman said she did not expect the opposition she received for publishing her study, “I was completely floored by the magnitude and the contentiousness of the debate. And I did not expect the pushback to cross the boundary from social media into academic and scientific institutions.” She says that she lost a consulting job, unrelated to her ROGD research, “Some members within the organization expressed concerns that the paper did not support the gender-affirming perspective.”

Those who don’t support the “gender-affirming perspective” often face the wrath of transgender activists. Dr. Kenneth Zucker, for example, was the head of the Child Youth and Family Gender Identity Clinic in Toronto for more than 30 years. The leading expert on gender confused children, he generally supported a “watch and wait” approach to treating them, rather than immediately letting them live as the opposite sex. Zucker was ousted from his position when activists accused him of practicing “conversion therapy” and falsely alleged he’d mocked clients. Three years later, the clinic apologized and gave him a settlement of almost $600,000 in damages and legal fees.

In England, psychotherapist James Caspian, who identifies as gay and says he’s helped “hundreds of people while they were transitioning,” had likewise seen the upsurge in young women identifying as transgender. He also saw stories of individuals unhappy with their “transition” who went back to living as their biological sex. His proposal to study this “transgender desistance” was approved, and then rescinded, by Bath Spa University. According to Caspian, “The fundamental reason given was that it might cause criticism of the research on social media, and criticism of the research would be criticism of the university. They also added it’s better not to offend people.”

More recently, the Alliance Defending Freedom filed a lawsuit against the University of Louisville on behalf or Dr. Allan M. Josephson. Josephson was hired in 2003 to head the school’s Division of Child and Adolescent Psychiatry and Psychology. In 2017, he spoke at a Heritage Foundation panel where he explained his views about treating gender-confused children. He emphasized that parents and therapy should work toward helping a child align with his or her biological sex. The suit alleges that for espousing these views, Josephson was demoted and then his contract was not renewed.

Standing for Truth about Sexual Identity Confusion

The current treatment protocol for young people confused about being male or female is called “gender-affirmative care” or simply “affirmative care.” Created largely by gender ideologues and their allies, it basically says that doctors and therapists should believe every child who says “I’m really the opposite sex” – without question – and help the child live as the opposite sex. This standard of treatment includes prescribing body- and mind-altering puberty blockers and opposite-sex hormones, followed by surgeries.

Dr. Michelle Cretella, director of the American College of Pediatricians, is an outspoken critic of this treatment. She writes that puberty blockers have not been proven safe for gender-confused children and opposite-sex hormones are associated with dangerous health risks. In her words, “Today’s institutions that promote transition affirmation are pushing children to impersonate the opposite sex, sending many of them down the path of puberty blockers, sterilization, the removal of healthy body parts, and untold psychological damage.”

Thankfully, some medical professionals, such as Dr. Littman and others described above, have not bought into the “born in the wrong body” ideology and refuse to be cowed by transgender activists and their allies. This openness to inquiry about the influencing factors that lead to gender dysphoria could help young people find real healing and embrace their biological bodies.

For more on this topic:

Transgender Resources

Transgenderism Trumping Parents’ Rights

When Transgender Issues Enter Your World