What does the HHS gender-affirming care report mean for trans rights?

Breaking down the potential consequences of the latest attack on trans people by the Trump administration.

Earlier today, the Trump administration’s “review” of the current practises surrounding gender dysphoria in children was published. As expected, this review ignored the opinions of medical experts and the feelings of trans kids in favour of a heavily politicised narrative. It states that gender dysphoria in children and adolescents usually goes away without medical intervention (this is not true), so therefore current guidelines for medical transition should be replaced by policies pushing psychotherapy. Simply put, the amount of false statements in that ~400-page document would take hours to break down.

Obviously, RFK Jr.’s Department of Health and Human Services can say whatever it wants, and it's clearly been taking advantage of that liberty in the past three months. The HHS’ departure from science has been as swift as it has been devastating; funding cuts and an increasingly dangerous narrative against autism are just a fraction of the other changes affecting one of the United States’ most important government agencies. Surrounding trans kids, comparisons have been made by some (myself included in a previous piece I published here) to the NHS in the UK and its Cass Review. While the HHS is acting in a similar fashion, it’s important to remember that the influence the NHS has is vastly greater, and that matters.

Thanks to the United States’ decentralised structure, medical associations act independently, and as such, their guidelines won’t be directly affected by this report. I never thought I’d say this, but for once, the United States not having a nationalised health service may be protecting us, the transgender community, from something far worse. That being said, there are a number of ways this report can be weaponised against transgender youth.

Let’s start with the most immediate effect: legitimising laws banning gender-affirming care for minors. Currently, 23 states ban all forms of gender-affirming care for minors. Another two, Montana and Arkansas, have had their bans permanently blocked. Additionally, two more states, Arizona and New Hampshire, have bans in place prohibiting only surgical intervention for minors, although the effects of those bans are extremely limited. For many of these bans, litigation surrounding them is still ongoing, and this report provides a new weapon for those arguing in their favour.

As of this moment, this report constitutes the official stance of the United States government. In a legal sense, that isn’t nothing. However, given that many of the gender-affirming care bans already passed weren’t struck down by courts before this report was even out, I don’t see the needle being moved by this. Plus, since the case surrounding Tennessee’s ban, United States v. Skrmetti, was already argued before the Supreme Court back in December, it’s almost certain that this report will not affect the ruling there either.

Another highlight from the report is its pushing of conversion therapy, or, as the report calls it, simply “psychotherapy.” Although some states already have bans in place against all forms of the practise, many don’t. If the HHS continues to push this approach, it’s very likely that we will see an increase in the use of conversion therapy in states where it’s still allowed. With that, suicide rates for trans youth in Republican-controlled states, which are already climbing thanks to the aforementioned gender-affirming care bans, will almost certainly increase even further under the Trump administration.

Finally, as the report itself states, it isn’t a law or policy, but a summary of “evidence.” While it’s true that there will be no immediate changes in federal policy because of it, it may spur some Trump allies on Capitol Hill to introduce a bill aiming to ban gender-affirming care for minors nationwide. Should that happen, Democrats in the Senate will most likely put a stop to it (as they did with the trans sports ban a few months back), so this isn’t really an imminent threat right now.

Of course, it remains to be seen where the HHS will go from here. Given that the report calls for more studies into the potential harms that may arise from gender-affirming care for children, manufactured studies on that subject seem to be a logical next step. Although it seems inevitable that gender-affirming care for adults will eventually find itself in the crosshairs of Republican attacks, their focus hasn’t shifted towards that yet, and maybe it never will. Only time will tell. And while it may seem unlikely given the current makeup of the Supreme Court, there still remains the possibility that gender-affirming care bans across the nation will be definitively struck down next month, rendering all of these attacks moot.

For now, it’s important to stay strong. In the midst of this onslaught against our rights, it can be hard to see a light at the end of the tunnel, but I promise it’s there. As the Trump administration continues to get more unpopular, everything it stands for, including transphobia, will go down with it. We just have to weather the storm.