By Rich Lowry
Tuesday, December 30, 2025
HHS Secretary Robert F. Kennedy, Jr. has plenty of
unsubstantiated theories, but his latest controversy involves following the
science.
HHS is pushing back against so-called gender-affirming
care for children under age 18, undertaking a number of regulatory actions to
discourage doctors and hospitals from continuing the practice.
As part of the effort, HHS released a review of the state
of research into gender-affirming care. The study establishes that this suite
of interventions — involving puberty blockers and cross-sex hormone therapy, as
well as surgery — has been justified by a bogus, ideologically driven
scientific consensus.
The HHS review can’t be dismissed as partisan hackery.
Writing in Newsweek, two co-authors of the report, Moti Gorin and
Kathleen McDeavitt, note that they and most of the other co-authors are left of
center.
The seedbed of the mania for aggressive treatment of
pediatric gender dysphoria was a pair of desperately flawed, but enormously
influential, Dutch studies.
In an important 2023 journal article, health-care
researcher Evgenia Abbruzzese and her co-authors dismantled the Dutch research.
Since gender-reassignment surgery on adults wasn’t
solving their mental distress, Dutch clinicians thought earlier interventions
might be more successful, and seemed to get positive results.
The sample size of the Dutch studies was very small,
though, with only 55 cases, and there was no control group. On top of this, the
selection of the subjects skewed toward the positive cases. The method of
determining whether gender dysphoria had been resolved in the patients also
tilted toward finding success.
The studies had no way of determining whether purported
modest psychological gains were the product of the medical interventions or,
ultimately, of psychotherapy or simply growing older and more mature.
The physical downsides of the treatments, including
sterility, were discounted.
Finally, Dutch researchers excluded minors who
experienced the onset of gender dysphoria around the time of puberty and who
had preexisting mental illnesses. Since the wave of gender dysphoria over the
last ten years overwhelming involves minors with these characteristics, the
Dutch studies — whatever their merits — don’t apply to this population.
None of this mattered. The Dutch research led to what
Evgenia Abbruzzese and her colleagues refer to as “runaway diffusion,” the
rapid spread of an experimental treatment before it is thoroughly researched.
Since gender-affirming care was believed to be an
instrument of compassion and justice, contrary indications were dismissed as
the handiwork of reactionaries and haters. The “science” was supposedly
settled, and it happened to validate exactly what trans activists, crusading
clinicians, and progressive politicians wanted to believe.
Now, finally, the evidence is catching up. Reviews
elsewhere in the Western world of the state of the research have come to much
the same conclusions as the HHS report. The 2024 Cass Review in the U.K. found
“we have no good evidence on the long-term outcomes of interventions to manage
gender-related distress.” The U.K. tapped the brakes on its medical treatments.
Finland pulled back on its pediatric interventions in
2020. Sweden followed suit, and so have Denmark and Norway. These places aren’t
red states full of alleged transphobes, but Scandinavian countries associated
with adventurous progressive policies. That they’ve been more clear-eyed about
these matters than a United States still beholden to a fabricated consensus is
a surprise and a scandal.
Aggressive pediatric interventions have imposed real
physical harms on children for speculative psychological benefits. It makes
more sense to take an approach of watchful waiting, using talk therapy and
other forms of support until minors with gender dysphoria are adults and better
suited to make life-changing medical decisions.
HHS is working to bring the U.S. in line with the trend
toward more prudent practices in other advanced countries. Still, there is
fierce resistance; 19 states and the District of Columbia are suing over the
new rules in hopes of preserving the status quo. RFK Jr., to say the least,
isn’t always very careful about evidence, but, on this one, the most
painstaking research is on his side.
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