WASHINGTON, D.C. — The U.S. Department of Health and Human Services urged health care providers Wednesday to stop several treatments for children with gender dysphoria, including puberty blockers, cross-sex hormones and surgeries.

The announcement came just a couple hours before the Centers for Medicare & Medicaid Services sent letters to hospitals throughout the country, promising “a comprehensive review of federal payment policies” and demanding information about how they determine children and adolescents can give their consent.

“These are irreversible, high-risk procedures being conducted on vulnerable children, often at taxpayer expense,” CMS Administrator Dr. Mehmet Oz wrote in a statement accompanying his agency’s letter.

Secretary Robert F. Kennedy Jr. wrote in a two-page open letter shared on social media that health care providers should read a review that HHS published earlier this month about treatment options for children with gender dysphoria. He, however, didn’t note that paper was widely criticized by major health organizations.

Kennedy, instead said that HHS expects health care providers to follow the 409-page report’s recommendations and “make the necessary updates to your treatment protocols and training for care for children and adolescents with gender dysphoria to protect them from these harmful interventions.”

The letter recommends “psychotherapy (talk therapy) as a noninvasive alternative” and seeks to discourage health care providers from following the World Professional Association for Health’s Standards of Care for the Health of Transgender and Gender Diverse People, version 8.

Among the letter’s criticisms for that standard of care is that it “relied on legal and political considerations rather than clinical ones.”

“The Hippocratic Oath lays down the foundational commitment for the medical profession: ‘First, do no harm.’ The Review makes clear that ‘the evidence for benefit of pediatric medical transition is very uncertain, while the evidence for harm is less uncertain,’” the HHS letter says. “For this reason, the Review states that 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.’”

HHS did not immediately respond to a request for comment about what would happen to health care providers who opt to continue prescribing the treatment protocols that the federal government is trying to eliminate.

Associations say HHS misrepresents research

WPATH and the U.S. Professional Association for Transgender Health released a joint statement earlier this month after HHS released its initial report, saying it “misrepresents existing research and disregards the expertise of professionals who have been working with transgender and gender-diverse youth for decades.”

“The HHS report fails to meet established scientific standards,” the two organizations wrote. “Authored anonymously, it relies on discredited narratives and selectively compiles prior systematic reviews, omitting critical findings from recent studies that support treatment interventions for appropriately identified individuals. Instead of conducting a new systematic review, the report dismisses multiple international clinical guidelines and disregards the prevailing medical consensus on gender-affirming care.”

The statement said WPATH “supports a comprehensive, multidisciplinary assessment, ensuring that mental health professionals evaluate and address any co-occurring mental health conditions in youth who are exploring their gender identity and options for treatment.”

Dr. Susan J. Kressly, president of the American Academy of Pediatrics, wrote in a statement released following the earlier HHS report that the document “misrepresents the current medical consensus and fails to reflect the realities of pediatric care.”

“AAP was not consulted in the development of this report, yet our policy and intentions behind our recommendations were cited throughout in inaccurate and misleading ways,” Kressly wrote. “The report prioritizes opinions over dispassionate reviews of evidence.”

WPATH and The American Academy of Pediatrics did not immediately respond to a request for comment about the HHS letter published Wednesday.

The Endocrine Society — which represents more than 18,000 health care providers who treat and research diabetes, obesity, fertility, bone health and hormone-related cancers, as well as gender dysphoria — wrote in a statement shared with States Newsroom on Wednesday that its “guideline development process adheres to the highest standards of trustworthiness and transparency as defined by the National Academy of Medicine.”

“The widely accepted view of the professional medical community is that medical treatment is appropriate for transgender and gender-diverse teenagers who experience persistent feelings of gender dysphoria,” the Endocrine Society’s statement said. “Medical studies show that access to this care improves the well-being of transgender and nonbinary people.”

Matt Rose, senior public policy advocate at the Human Rights Campaign wrote in a statement that the letter released Wednesday shows “HHS is focusing its time and taxpayer dollars spreading anti-science misinformation in order to interfere with health care decisions best made by families with their doctors.”

“This approach is not only ignorant, but also deliberately harmful to a community that depends on best practice, evidence-based healthcare to live their most authentic lives,” Rose wrote. “This letter does nothing except attempt to frighten and compel providers into doing the Trump administration’s bidding.”

Louisiana Republican Sen. Bill Cassidy —chairman of the Health, Education, Labor, and Pensions Committee — celebrated the HHS letter.

“As a doctor, I am extremely concerned that medical organizations continue to push irreversible gender transition procedures for children against scientific data,” Cassidy wrote in a statement. “I applaud President (Donald) Trump’s strong leadership in telling providers directly that these dangerous practices must end.”

CMS demands info on gender-affirming care

The Centers for Medicare & Medicaid Services sent a separate letter Wednesday to hospitals that perform gender-affirming procedures, asking them to answer a series of questions within the next month.

CMS Administrator Oz wrote in a statement released alongside the letter that hospitals “accepting federal funds are expected to meet rigorous quality standards and uphold the highest level of stewardship when it comes to public resources—we will not turn a blind eye to procedures that lack a solid foundation of evidence and may result in lifelong harm.”

The letter asks hospitals to detail how staff determine that children with gender dysphoria are capable of giving medical consent for a procedure and when parental consent is required.

Hospitals are asked to tell CMS if they plan to update their clinical practice guidelines as requested in the HHS letter sent earlier in the day.

And hospitals are told to share information about “adverse events related to these procedures, particularly children who later look to detransition.”

The CMS letter also tells hospitals to share billing information for the cost of pediatric gender-affirming care procedures that were “paid, in whole or in part, by the federal government.” The letter says the information will be used to conduct “a comprehensive review of federal payment policies related to gender transition procedures for patients under 19 years of age.”

Oregon Capital Chronicle is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Oregon Capital Chronicle maintains editorial independence. Contact Editor Julia Shumway for questions: info@oregoncapitalchronicle.com.