Summary

The US Department of Health and Human Services ordered this review by executive order and published it in May 2025. It looks at the evidence for social transition, puberty blockers, hormones and surgery in under-18s. Its core gathers 17 earlier evidence reviews, which rated the evidence on mental health, quality of life and regret as very weak for every treatment. Other chapters cover policies abroad, WPATH, US practice, ethics and talk therapy. The main finding matches European reviews such as England's Cass Review. But the authors, named only in November 2025, include public critics of these treatments, and several were paid for legal or expert-witness work. US medical groups and academic critics say it misrepresents the evidence. Its evidence chapter fairly shows how uncertain the evidence is; its other chapters are argued opinion, not systematic research.

Key findings

• 该报告收集了17项早期的证据综述：2项关于社会性过渡，9项关于青春期阻断剂，8项关于跨性别激素，3项关于手术，5项关于谈话治疗。其中十项被评为低偏倚风险。
• 对于每一种治疗，关于痛苦、心理健康、生活质量和后悔的证据都被评为非常薄弱。只有预期的身体效应（如青春期确实被暂停）有强有力的证据支持。
• 九项青春期阻断剂综述中的研究，没有一项是随机试验（通过随机方式分配治疗），只有六项有可供比较的未治疗组。
• 报告列出了可能的伤害：不孕、性问题、骨骼生成减弱、心脏和代谢问题、心理健康状况、手术并发症和后悔。其中大部分是根据身体运作方式推理出来的，而不是在接受治疗的年轻人身上测量到的。
• 报告说，后悔的真实比率未知，需要更好的数据。它还认为，仅凭后悔或满意度并不能说明某种治疗在医学上是否合理。
• 第一版（2025年5月1日）没有署名作者。2025年11月19日的版本署名了九位贡献者，并发布了九份同行评审及回复。五位贡献者说，他们曾因性别医学方面的法律或专家证人工作获得报酬。
• 政府邀请美国儿科学会、美国精神医学会和内分泌学会对其进行评审。只有精神科医生同意，他们说其方法不够公开，不能直接相信其发现。

Conclusion

The Review concludes that the overall quality of evidence on the effects of any intervention for pediatric gender dysphoria (social transition, puberty blockers, cross-sex hormones, surgery) on psychological outcomes, quality of life, regret or long-term health is very low, so reported benefits are likely to differ substantially from true effects. Evidence on harms in systematic reviews is also sparse, but the authors argue that known physiology points to risks including infertility, sexual dysfunction, impaired bone density accrual, cardiometabolic effects, surgical complications and regret. They judge the WPATH SOC-8 and Endocrine Society guidelines to lack developmental rigour and say U.S. medical associations overstated professional consensus. On ethics, they argue that respect for autonomy does not create a right to non-beneficial interventions. They describe psychotherapy as a noninvasive alternative that systematic reviews have not linked to adverse effects. The Review states that it is not a clinical practice guideline and makes no legislative or policy recommendations.