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

• 報告蒐集了 17 項早期證據審查：2 項關於社會性過渡、9 項關於青春期阻斷劑、8 項關於跨性別荷爾蒙、3 項關於手術，以及 5 項關於談話治療。其中十項被評為低偏誤風險。
• 對每一種治療，關於痛苦、心理健康、生活品質和後悔的證據都被評為非常薄弱。只有預期的身體影響，例如青春期確實被暫停，有強力證據支持。
• 九項青春期阻斷劑審查中的研究，沒有一項是隨機試驗（以抽籤方式分配治療），只有六項有未接受治療的對照組。
• 報告列出了可能的傷害：不孕、性方面的問題、骨骼生成變弱、心臟和代謝問題、心理健康狀況、手術併發症和後悔。其中許多是根據身體運作方式推論出來的，而不是在接受治療的年輕人身上衡量到的。
• 報告表示，後悔的真實比率未知，需要更好的資料。它也主張，單憑後悔或滿意度不能顯示一種治療在醫學上是否有正當性。
• 第一版（2025 年 5 月 1 日）沒有列出作者。2025 年 11 月 19 日的版本列出九位貢獻者，並發表了九份同儕審查及回覆。五位貢獻者表示，他們曾因性別醫學的法律或專家證人工作而獲得報酬。
• 政府邀請美國小兒科學會、美國精神醫學會和內分泌學會審查它。只有精神科醫師同意，而且他們表示，方法不夠公開，不能直接接受其發現。

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.