A new report released by the U.S. Department of Health and Human Services (HHS) on Thursday has ignited a firestorm of criticism from LGBTQ+ advocacy groups, medical professionals, and civil rights organizations. The report recommends “exploratory therapy” — a form of psychotherapy — as an alternative to gender-affirming medical care for transgender and nonbinary youth, drawing sharp parallels to the widely discredited practice of conversion therapy.
The document, published in response to a Trump-era executive order, questions the current medical consensus around gender-affirming care and suggests that mental health therapy alone may be sufficient to treat gender dysphoria in children. It claims that research on psychotherapeutic alternatives has been stifled by what it calls a “mischaracterization” of such approaches as conversion therapy.
LGBTQ+ advocates, however, have condemned the report’s recommendations. “This is, in fact, the same harmful practice of conversion therapy, just using friendlier language,” said Casey Pick, Director of Law and Policy at The Trevor Project. “It’s a dangerous rejection of health care best practices for transgender people.”
The report follows a January executive order from former President Donald Trump titled “Protecting Children from Chemical and Surgical Mutilation.” The directive threatens to cut federal funding from hospitals and clinics that provide gender-affirming care to individuals under 19. Though the order has not yet been fully enforced, several federal agencies, including the Centers for Medicare & Medicaid Services, have signaled intent to comply.
In its language, the HHS report reflects a stark shift in tone and terminology — using terms like “sex reassignment surgery” and “pediatric medical transition” instead of “gender confirmation” or “gender-affirming care.” These changes mirror rhetoric in the executive order, which asserts that gender identity is “disconnected from biological reality.”
Medical professionals and legal experts warn that the shift in federal stance could have devastating consequences for trans youth. “Being gay or transgender is not a choice. No amount of therapy can change that,” said Shannon Minter of the National Center for Lesbian Rights.
Major medical organizations, including the American Medical Association and the American Academy of Pediatrics, continue to support gender-affirming care as safe, effective, and often life-saving. Conversely, conversion therapy has been widely discredited and linked to increased rates of depression, anxiety, and suicidal ideation.
The policy change arrives amid an ongoing legal battle over LGBTQ+ rights. The Supreme Court is expected to weigh in on two pivotal cases this year: Chiles v. Salazar, which challenges Colorado’s ban on conversion therapy, and U.S. v. Skrmetti, which addresses state bans on gender-affirming care for minors.
Advocates fear a “double blow” if the Court upholds bans on essential care while also striking down protections against conversion therapy. “These cases raise the stakes for trans youth across the country,” said Minter.
According to UCLA’s Williams Institute, more than 300,000 transgender youth aged 13 to 17 live in the U.S. As of this year, 26 states have enacted laws limiting or banning access to gender-affirming care. Meanwhile, the ACLU reports over 500 anti-LGBTQ+ bills introduced across state legislatures in the 2025 session.
“This is about our patients,” said Dr. Morissa Ladinsky, a Stanford pediatrician. “They deserve evidence-based, life-affirming care — not politically motivated ideology.”
