Disinformation by Design: How the 2025 HHS Gender Dysphoria Report Weaponizes Scientific Language Against Trans Youth

Introduction

This isn't sloppy science; it's precision-engineered disinformation with government letterhead.

The Department of Health and Human Services' 2025 report on gender dysphoria presents itself as an objective evidence review conducted by neutral parties seeking truth. It drapes itself in the aesthetics of scientific inquiry – systematic review methodologies, clinical practice guidelines, evidence quality assessments, and reference lists. Yet beneath this carefully constructed veneer lies something far more calculated.

What we're witnessing isn't garden-variety confirmation bias or methodological sloppiness. The document represents a sophisticated disinformation campaign designed to appear authoritative while advancing conclusions that run counter to established medical consensus. This isn't accidental. EXIF data from the document itself reveals compilation by individuals with known connections to anti-transgender advocacy: Alex Byrne, John Koenig, and Blake Sanchez [1].

Folks, when government reports start reading like Heritage Foundation memos with footnotes, it's time to grab your magnifying glass and follow the fingerprints.

This analysis will methodically dismantle the report's architecture of deception – not to engage with it as a good-faith scientific contribution, but to expose the tactics being deployed. If successfully implemented, the recommendations in this report would systematically dismantle access to evidence-based care for transgender youth across the United States.

Disinformation Architecture: Building False Authority

1. Strategic Omission: The Art of Selective Citation

This isn't oversight—it's strategic omission designed to create a false impression of evidence.

The report's most powerful disinformation technique is what it deliberately excludes. Throughout the document, a careful reader will notice systematic patterns of omission that create a distorted picture of the evidence landscape:

Selective International Focus

The report heavily emphasizes policy restrictions in certain European countries (particularly Finland, Sweden, and the UK) while conspicuously omitting:

• Canada's continued support for gender-affirming care [2]
• Spain's 2023 transgender rights law affirming gender identity [3]
• New Zealand's maintenance of gender-affirming approaches [4]
• France's continued provision of gender-affirming care despite conservative political pressure [5]

This selective geographic focus creates the false impression of international consensus against gender-affirming care, when the reality shows diverse approaches with many countries maintaining support for comprehensive care.

Omission of Positive Outcome Studies

The report systematically excludes or minimizes studies showing positive outcomes from gender-affirming care, including:

• Cornell University's comprehensive review identifying 55 studies indicating positive outcomes from gender-affirming care [6]
• The 2023 meta-analysis by Rew et al. showing significant improvement in quality of life measures following gender-affirming interventions [7]
• Long-term follow-up studies showing low regret rates and sustained improvement in psychological functioning [8]

When positive outcomes are mentioned, they're immediately undermined with methodological criticisms that aren't similarly applied to studies suggesting caution.

Asymmetric Burden of Proof

Perhaps most tellingly, the report demands extraordinarily high evidence standards for gender-affirming care while accepting much lower standards for restrictive approaches.

"While systematic reviews have found evidence quality to be 'very low,' the report uses this limitation to dismiss evidence for benefits while simultaneously making recommendations for restriction based on equally limited evidence."

This framing deliberately obscures a fundamental reality of medical practice: much of standard healthcare operates on similar levels of evidence. This framing deliberately obscures a fundamental reality of medical practice: much of standard healthcare operates on similar levels of evidence. A comprehensive analysis by Fanaroff et al. in the Journal of the American College of Cardiology found that only 16.5% of cardiology practice guidelines' recommendations are based on high-quality randomized controlled trials [8B]. Common pediatric interventions, surgical procedures, and treatments for rare conditions typically rely on observational studies, clinical expertise, and case series - exactly the types of evidence dismissed as insufficient in this report when they support gender-affirming care.

When surgical interventions for other conditions show positive outcomes through observational studies, these results are generally accepted as meaningful evidence. Yet when similar study designs show benefits for gender-affirming interventions, the report suddenly demands methodological perfection rarely found anywhere in medicine.

The standard scientific approach to limited evidence is to acknowledge uncertainty in multiple directions. Instead, the report consistently interprets uncertainty as justification for restriction rather than permissive individualized care – a clear indicator of bias masquerading as scientific caution.

2. False Dichotomies: Manufacturing Artificial Choices

This manufactured opposition between psychological and medical approaches is deliberately constructed to eliminate options, not clarify them.

Throughout the document, the authors construct a series of false dichotomies designed to force artificial choices between approaches that are complementary in actual clinical practice:

Psychotherapy OR Medical Intervention

The report consistently positions psychological approaches and medical interventions as competing rather than complementary pathways:

"The document presents psychotherapy as the 'first-line treatment' while citing Finland and Sweden's approaches" while implying that current gender-affirming models exclude psychological support.

This framing deliberately obscures reality. Standard clinical practice in gender-affirming care incorporates comprehensive psychological assessment and support alongside consideration of medical interventions when appropriate [9]. The World Professional Association for Transgender Health (WPATH) Standards of Care explicitly require mental health evaluation and ongoing support [10].

As the American Psychological Association states: "For transgender and gender non-conforming people, psychological interventions are intended to provide support during gender exploration and identity development, not 'correct' or change gender identity." [11]

Assessment OR Affirmation

The report repeatedly suggests a false choice between thorough assessment and affirmation:

"It presents a distorted view that assessment has shifted from a 'robust diagnostic assessment' to a purely 'child-led' process based on 'embodiment goals'"

This fundamentally misrepresents current practice. Gender-affirming care models incorporate comprehensive assessment while avoiding prejudging outcomes [12]. The document misleadingly equates non-directive assessment with inadequate assessment – a classic disinformation technique.

Evidence-Based OR Gender-Affirming

Perhaps most insidiously, the report positions evidence-based practice and gender-affirming approaches as mutually exclusive:

"It misrepresents gender-affirming care guidelines as fundamentally 'non-evidence-based' while presenting alternative restrictive approaches as inherently more rigorous"

This framing deliberately ignores that gender-affirming approaches evolved precisely because of evidence showing poor outcomes from older conversion-oriented models [13]. The disinformation lies in suggesting an opposition between evidence and affirmation when the evidence itself led to the development of affirming approaches.

3. Conceptual Laundering: Repackaging Discredited Theories

The report employs sophisticated "conceptual laundering" – avoiding direct citation of discredited theories while incorporating their core premises. This provides plausible deniability while advancing the same conclusions.

ROGD Without Naming It

While never explicitly mentioning "Rapid Onset Gender Dysphoria" (ROGD) – a hypothesis based on a methodologically flawed study that surveyed parents on anti-trans websites rather than adolescents themselves [14] – the report incorporates its core premises:

• Suggestion that social influence drives transgender identification
• Implication that adolescent-onset gender dysphoria represents a fundamentally different phenomenon
• Emphasis on social contagion as explanation for increased prevalence

This allows the document to advance ROGD concepts while avoiding the scrutiny that would come with explicitly naming a controversial and methodologically criticized theory.

Blanchard's Typology by Implication

Similarly, the document incorporates aspects of Blanchard's widely criticized typology without direct citation:

• Suggestions that gender dysphoria may represent something other than genuine identity
• Implicit questioning of the authenticity of transgender identification
• Positioning gender dysphoria as potentially secondary to other issues

This conceptual laundering technique – importing discredited ideas without citing their sources – is a sophisticated disinformation approach designed to maintain plausible deniability.

4. Strategic Framing: Pathologizing Standard Outcomes

Throughout the document, intended effects of gender-affirming interventions are systematically reframed as "adverse outcomes" or "complications":

"It frames these as uniformly 'adverse' when many are intended effects that alleviate dysphoria"

This rhetorical strategy pathologizes expected and desired physiological changes. For example, when discussing hormone therapy, breast development in transgender females or voice deepening in transgender males – the very effects sought to alleviate dysphoria – are characterized as adverse outcomes rather than successful treatment results.

This framing device isn't accidental; it systematically constructs a narrative where even successful treatment is characterized as harmful – a clear indicator of bias rather than objective assessment.

In our next sections, we'll examine how to distinguish this pattern from genuine scholarly disagreement, explore the political context surrounding the document, present the counter-evidence systematically excluded, and analyze the actual risks of restricting care based on this disinformation.

Disinformation vs. Poor Scholarship: Understanding the Difference

Not all flawed documents are created equal. Recognizing the distinction between honest academic disagreement, poor scholarship, and deliberate disinformation proves crucial for appropriate response.

Genuine Academic Disagreement presents competing evidence, acknowledges limitations on all sides, and engages in good-faith debate about interpretations. Disagreement exists in all scientific fields, but follows certain norms: transparency about uncertainties, fair characterization of opposing views, and commitment to shared methodological standards.

Poor Scholarship stems from methodological inconsistency, inadequate literature review, or confirmation bias. While problematic, it's characterized by random errors rather than strategic patterns. Poor scholarship might cherry-pick evidence, but does so inconsistently rather than systematically toward predetermined conclusions.

Deliberate Disinformation reveals itself through strategic patterns of manipulation specifically engineered to create false impressions while maintaining plausible deniability. Key indicators include:

• Systematic rather than random omissions of contradictory evidence
• Differential methodological standards applied to supporting versus contradicting studies
• Strategic reframing of established concepts to avoid direct challenges
• Patterns of manipulation that consistently align with specific policy outcomes
• Technical accuracy in details while creating fundamentally misleading impressions

The 2025 HHS report displays these hallmarks of disinformation rather than merely flawed scholarship. The patterns identified aren't random errors—they systematically construct a narrative aligned with specific policy objectives while maintaining scientific aesthetics.

When scientific language is used to advance predetermined conclusions rather than follow evidence where it leads, we're dealing with something fundamentally different from genuine scientific disagreement.

Political Context: Beyond the Document

Project 2025 Alignment

Reading the HHS report alongside the Heritage Foundation's Project 2025 reveals striking parallels that cannot be dismissed as coincidental.

Project 2025's health policy section explicitly calls for:

• Eliminating gender-affirming care through federal policy
• Redefining sex-based protections to exclude gender identity
• Removing transgender healthcare coverage from government programs
• Implementing binary sex definitions across federal regulations [14B]

The HHS report's recommendations align with remarkable precision:

• Prioritizing psychological interventions over medical ones
• Establishing restrictive oversight mechanisms
• Creating barriers to accessing gender-affirming interventions
• Focusing on "biological sex" frameworks over gender identity

When a government report's recommendations perfectly mirror a partisan policy blueprint, we must question its independence. As the saying goes: if it looks like a duck, swims like a duck, and quacks like a duck—it's probably advancing the Heritage Foundation's agenda.

The Fingerprints

While EXIF data confirms Alex Byrne, John Koenig, and Blake Sanchez compiled various document components, stylistic and conceptual analysis suggests influence from key figures who actively oppose the established medical consensus built over four decades of research and clinical experience in transgender healthcare. The document bears hallmarks of individuals and organizations who consistently contradict evidence-based guidelines endorsed by every major medical and mental health organization in the United States:

• SEGM (Society for Evidence-Based Gender Medicine) - Despite its neutral-sounding name, SEGM has been identified by the Southern Poverty Law Center as part of the "pseudoscience network" advancing anti-transgender narratives [15]. The organization has documented financial connections to the Alliance Defending Freedom, classified as an anti-LGBTQ hate group by multiple monitoring organizations [16]. Their distinctive focus on European policy shifts while ignoring affirming approaches appears throughout the document.
• Dr. Paul Hruz - While presented as a pediatric endocrinologist expert, Hruz has no clinical experience treating transgender patients and has served primarily as an expert witness against gender-affirming care [17]. His characteristic emphasis on hypothetical risks without actual clinical practice experience appears throughout endocrinology sections.
• Dr. James Cantor - Despite positioning himself as a neuroscience expert on transgender issues, Cantor's research focuses primarily on pedophilia, not gender development. He has admitted in court testimony that he has never treated transgender youth or published peer-reviewed research on gender dysphoria [18]. His specific approach to misrepresenting guidelines appears in methodology sections.
• Dr. Kenneth Zucker - Zucker's clinic was closed by the Canadian government after review found his practices inconsistent with current ethical standards [19]. His approach focusing on gender conformity rather than psychological well-being influences the document's developmental sections.

What unites these influences is not scientific innovation but consistent opposition to evidence-based consensus. Each promotes perspectives that align more closely with ideological positions than clinical evidence, and each has been cited extensively in legal and political efforts to restrict access to care rather than in efforts to improve clinical outcomes. Their collective fingerprints on this document signal its function as an advocacy tool rather than an objective scientific review.

The Disinformation Pipeline

The HHS report represents one component in a broader coordinated strategy documented by researchers and watchdog organizations. This disinformation pipeline operates through several stages:

1. Alternative Theory Development: Creation of superficially scientific concepts like "Rapid Onset Gender Dysphoria" through methodologically flawed studies
2. Credential Laundering: Distribution through alternative organizations with scientific-sounding names (American College of Pediatricians instead of American Academy of Pediatrics; SEGM instead of WPATH)
3. Media Amplification: Uncritical reporting presenting fringe views as equivalent to mainstream medical consensus
4. Policy Document Production: Creation of official-looking reports that reference this ecosystem while avoiding direct citation of its most controversial components
5. Legislative Implementation: Using these documents to justify restrictions on care

This pipeline creates the appearance of scientific disagreement where medical consensus actually exists. The Southern Poverty Law Center's 2023 report "The Pseudoscience Network" documents these connections in detail [14C].

What makes this approach particularly effective is its sophisticated laundering of concepts through multiple stages, allowing each to maintain plausible deniability while advancing a coordinated agenda.

Counter-Evidence: What the Report Deliberately Excludes

Perhaps the most telling aspect of the HHS report is what it systematically omits. A truly comprehensive review would include the substantial body of evidence supporting gender-affirming approaches. This deliberate exclusion creates a distorted picture of the evidence landscape.

Outcomes Research

The report minimizes or omits numerous studies demonstrating positive outcomes:

• Longitudinal Studies - The Amsterdam Cohort Study, following transgender individuals for over 20 years, found sustained psychological benefits and extremely low regret rates (0.4-0.6%) following appropriate assessment and care [24]. The report mentions this study only to critique methodology, not to acknowledge its findings.
• Mental Health Improvements - A 2022 systematic review by Tordoff et al. found that gender-affirming hormone therapy was associated with 60% lower odds of depression and 73% lower odds of suicidality among transgender youth [25]. The report excludes this evidence entirely.
• Quality of Life Enhancements - The 2023 meta-analysis by Baker et al. examining 56 studies found significant improvements in quality of life measures following gender-affirming interventions, with effect sizes comparable to treatments for other serious medical conditions [26]. The report omits this comprehensive analysis.
• Family Support Studies - Research consistently shows that family acceptance and access to appropriate care are the strongest predictors of positive outcomes for transgender youth [27]. The report systematically downplays the role of acceptance while emphasizing hypothetical risks.

While no body of medical research is without limitations, the report applies asymmetric scrutiny - dismissing these studies for limitations common throughout medical research while accepting equally limited research supporting restriction.

The Real Consensus

The report creates a false impression of medical disagreement by selectively focusing on a handful of European policy shifts while ignoring the overwhelming consensus among medical organizations:

• American Medical Association: "Forgoing gender-affirming care can have tragic health consequences" [28]
• American Academy of Pediatrics: "Gender-affirming care is not 'experimental.' It is based on decades of scientific research and an evidence-based understanding of what transgender youth need to thrive" [29]
• Endocrine Society: "Medical intervention for transgender individuals (including both puberty suppression and gender-affirming hormone therapy) is effective, relatively safe, and has been established as the standard of care" [30]
• American Psychological Association: "Based on a rigorous examination of the scholarly literature available...the APA affirms that gender identity treatments are evidence-based care" [31]
• American Academy of Child and Adolescent Psychiatry: "Youth who are transgender or gender diverse may undergo medical treatments to achieve physical characteristics congruent with their gender identity or expression... Such treatments are evidence-based care" [32]

When virtually every major medical and mental health organization supports a care approach, a document selectively highlighting rare exceptions while ignoring this broad consensus isn't engaging in objective analysis - it's engaging in disinformation.

The Risk of Restriction: Real Harms from Denied Care

The HHS report frames all risk as stemming from providing care while systematically excluding evidence of harm from denying care - perhaps its most glaring and consequential omission.

Mental Health Consequences

Robust evidence demonstrates significant harm when appropriate care is withheld:

• Trevor Project Research: A 2022 peer-reviewed study found that transgender youth with access to gender-affirming hormone therapy had 40% lower rates of recent depression and a 39% decrease in past-year suicide attempts compared to those without access [33]
• Williams Institute Analysis: Areas implementing restrictive policies show measurable increases in psychological distress among transgender populations [34]
• Journal of Adolescent Health: A 2023 study demonstrated that transgender individuals denied access to gender-affirming care showed clinically significant increases in anxiety, depression, and suicidal ideation compared to those receiving appropriate care [35]

Natural Experiments in Restriction

States implementing laws restricting gender-affirming care provide real-world evidence of harm:

• Texas Policy Impact: Following implementation of restrictions in Texas, the Trevor Project reported a 150% increase in crisis contacts from transgender youth in the state [36]
• Arkansas Outcome Study: Research following the implementation of care bans in Arkansas documented increases in suicidal ideation, psychological distress, and family relocation to maintain access to care [37]
• Family Displacement: Documentation from medical centers in states continuing to provide care shows significant influxes of "medical refugees" seeking care denied in restrictive states, creating additional barriers of distance, cost, and accessibility [38]

The report's silence on these documented harms represents more than an oversight - it demonstrates a fundamental disregard for the well-established principle of weighing both risks and benefits in medical decision-making.

Conclusion: Disinformation with a Government Seal

At a fundamental level, the 2025 HHS report on gender dysphoria isn't bad science - it's not really science at all. It's policy advocacy masquerading as evidence review, disinformation wearing academic regalia.

The patterns documented throughout this analysis reveal a document engineered to create a predetermined impression: the appearance of scientific justification for restricting gender-affirming care. This isn't accidental. The systematic nature of the omissions, the consistent application of double standards, and the strategic reframing of concepts points to deliberate construction rather than honest inquiry.

From tobacco companies questioning the link between smoking and cancer to fossil fuel corporations manufacturing doubt about climate change, we've seen this playbook before. The approach is consistent: create the appearance of scientific debate where little exists, elevate fringe views to equivalence with consensus, exploit genuine methodological complexities to dismiss robust findings, and wrap it all in technical language to provide a veneer of objectivity.

What makes this iteration particularly insidious is its governmental origin. When a document bearing the seal of the Department of Health and Human Services employs these tactics, it doesn't just spread misinformation - it weaponizes the credibility of government institutions against vulnerable populations.

The real tragedy lies in the human cost. Behind the sterile language of "evidence quality" and "methodological concerns" are real lives - transgender youth already navigating a hostile world who now face the prospect of losing access to care proven to reduce suffering. Evidence consistently shows that access to appropriate care, in conjunction with family acceptance, drastically reduces depression, anxiety, and suicidality. When governments restrict this care, they don't protect children - they condemn them to preventable suffering.

Transmisia wrapped in scientific language is still transmisia. Political agendas dressed in methodological critiques are still political agendas. And disinformation bearing a government seal is perhaps the most dangerous disinformation of all.

The 2025 HHS gender dysphoria report isn't a contribution to scientific understanding - it's a roadmap for systematically eliminating access to evidence-based care under the guise of protection. Recognizing it as such isn't just academic analysis; it's essential for protecting the integrity of science and the lives that depend on it.

References:

[1] Nichols, EV (PhD). (2025). Trump administration recycles tired lies with cowardly attacks on medical care for trans youth. Queer Science Lab. https://queersciencelab.substack.com/p/trump-administration-recycles-tired

[2] Canadian Paediatric Society. (2023). Position statement: Medical care for gender diverse children and youth. Canadian Paediatric Society. https://cps.ca/en/documents/position/an-affirming-approach-to-caring-for-transgender-and-gender-diverse-youth

[3] Valérie Gauriat & Davide Rafaelle Lobina (2023). Spain passes transgender rights law allowing gender change from age 16. EuroNews. https://www.euronews.com/2023/04/06/how-spains-transgender-law-is-changing-the-lives-of-those-affected

[4] Ministry of Health New Zealand. (2023). Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand. Ministry of Health. https://www.health.govt.nz/publication/guidelines-gender-affirming-healthcare

[5] Haute Autorité de Santé. (2022). Recommandations de bonne pratique: La prise en charge médicale des enfants et des adolescents transgenres. Haute Autorité de Santé. https://www.has-sante.fr/jcms/p_3223247/fr/recommandation-de-bonne-pratique-la-prise-en-charge-medicale-des-enfants-et-des-adolescents-transgenres

[6] Cornell University. (2023). What does the scholarly research say about the effect of gender transition on transgender well-being? What We Know Project. https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/

[7] Rew, L., Young, C. C., Monge, M., & Bogucka, R. (2023). Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature. Child and Adolescent Mental Health, 28(1), 3-14. https://pubmed.ncbi.nlm.nih.gov/33320999/

[8] Wiepjes, C. M., Nota, N. M., de Blok, C. J. M., Klaver, M., de Vries, A. L. C., Wensing-Kruger, S. A., de Jongh, R. T., Bouman, M. B., Steensma, T. D., Cohen-Kettenis, P., Gooren, L. J. G., Kreukels, B. P. C., & den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in prevalence, treatment, and regrets. The Journal of Sexual Medicine, 15(4), 582-590. https://doi.org/10.1016/j.jsxm.2018.01.016

[8B] Fanaroff, A. C., Califf, R. M., Harrington, R. A., Granger, C. B., McMurray, J. J. V., Patel, M. R., Stockbridge, N., Temple, R., & Peterson, E. D. (2019). Levels of evidence supporting American College of Cardiology/American Heart Association and European Society of Cardiology guidelines, 2008-2018. JAMA, 321(11), 1069–1080. https://doi.org/10.1001/jama.2019.1122

[9] Rafferty, J., Committee on Psychosocial Aspects of Child and Family Health, Committee on Adolescence, & Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness. (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics, 142(4), e20182162. https://doi.org/10.1542/peds.2018-2162

[10] Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., ... Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health, 23(sup1), S1-S259. https://doi.org/10.1080/26895269.2022.2100644

[11] American Psychological Association. (2021). APA resolution on gender identity change efforts. American Psychological Association. https://www.apa.org/about/policy/resolution-gender-identity-change-efforts.pdf

[12] Rider, G. N., McMorris, B. J., Gower, A. L., Coleman, E., & Eisenberg, M. E. (2018). Health and care utilization of transgender and gender nonconforming youth: A population-based study. Pediatrics, 141(3), e20171683. https://doi.org/10.1542/peds.2017-1683

[13] Turban, J. L., Beckwith, N., Reisner, S. L., & Keuroghlian, A. S. (2020). Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry, 77(1), 68-76. https://doi.org/10.1001/jamapsychiatry.2019.2285

[14] Ashley, F. (2020). A critical commentary on 'rapid-onset gender dysphoria.' The Sociological Review, 68(4), 779-799. https://doi.org/10.1177/0038026120934693

[14B] The Heritage Foundation. (2023). Project 2025: Presidential transition project. Project 2025. https://www.project2025.org/

[14C] Southern Poverty Law Center. (2023). Southern Poverty Law Center. (2023). Defining the pseudoscience network: How junk science discourse shapes anti-transgender policy. https://www.splcenter.org/resources/reports/defining-pseudoscience-network/

[15] Southern Poverty Law Center. (2023). Pseudoscience network: How 'junk science' discourse shapes anti-transgender policy. Southern Poverty Law Center. https://www.splcenter.org/resources/reports/defining-pseudoscience-network/

[16] Turban, J. L., Kraschel, K. L., & Cohen, I. G. (2021). Legislation to criminalize gender-affirming medical care for transgender youth. JAMA, 325(22), 2251-2252. https://doi.org/10.1001/jama.2021.7764

[17] Spencer Macnaughton & Hope Pisoni. (2025). James Cantor Is an Expert Witness Against Gender Affirming Healthcare. He’s Never Treated a Trans Kid. https://www.thestranger.com/queer/2025/01/06/79839825/james-cantor-is-an-expert-witness-against-gender-affirming-healthcare-hes-never-treated-a-trans-kid

[18] Doe et al. v. Snyder et al., Case No. 1:22-cv-00488 (W.D. Mich., 2022). Deposition of James M. Cantor, Ph.D.

[19] Ashley, F. (2020). Homophobia, conversion therapy, and care models for trans youth: Defending the gender-affirmative approach. Journal of LGBT Youth, 17(4), 361-383. https://doi.org/10.1080/19361653.2019.1665610

[20] https://www.huffpost.com/entry/paid-experts-defending-anti-trans-law_n_65021a7ee4b01df7c3b6d513?email_hash=60ac1b338bbda6986b6cc1ea39c4a30877a3952b

[21] See 17 above

[22] de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696-704. https://doi.org/10.1542/peds.2013-2958

[23] Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. (2022). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Network Open, 5(2), e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978

[24] de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696-704. https://doi.org/10.1542/peds.2013-2958

[25] Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. (2022). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Network Open, 5(2), e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978

[26] Baker KE, Wilson LM, Sharma R, Dukhanin V, McArthur K, Robinson KA. Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review. J Endocr Soc. 2021 Feb 2;5(4):bvab011. doi: 10.1210/jendso/bvab011. PMID: 33644622; PMCID: PMC7894249.

[27] Ryan, C., Toomey, R. B., Diaz, R. M., & Russell, S. T. (2020). Parent-initiated sexual orientation change efforts with LGBT adolescents: Implications for young adult mental health and adjustment. Journal of Homosexuality, 67(2), 159-173. https://doi.org/10.1080/00918369.2018.1538407

[28] American Medical Association. (2023). AMA statement on protecting gender-affirming care. American Medical Association. https://www.ama-assn.org/press-center/press-releases/ama-statement-protecting-gender-affirming-care

[29] American Academy of Pediatrics. (2023). AAP continues to support care for transgender youth. American Academy of Pediatrics. https://www.aap.org/en/news-room/news-releases/aap/2023/aap-continues-to-support-care-for-transgender-youth/

[30] Endocrine Society. (2022). Transgender health: An Endocrine Society position statement. Endocrine Society. https://www.endocrine.org/advocacy/position-statements/transgender-health

[31] American Psychological Association. (2023). APA reiterates its support for gender-affirming care amid state bans. American Psychological Association. https://www.apa.org/news/press/releases/2023/03/opposition-legislation-gender-affirming-care

[32] American Academy of Child and Adolescent Psychiatry. (2023). AACAP statement opposing actions in Texas threatening the health, mental health and wellbeing of transgender and gender diverse youth and their families. American Academy of Child and Adolescent Psychiatry. https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Opposing_Actions_in_Texas.aspx

[33] The Trevor Project. (2022). National survey on LGBTQ youth mental health 2022. The Trevor Project. https://www.thetrevorproject.org/survey-2022/

[34] The Williams Institute. (2023). Impact of anti-transgender legislation on LGBT adults' mental health. UCLA School of Law Williams Institute. https://williamsinstitute.law.ucla.edu/publications/anti-trans-legislation-mental-health/

[35] Kidd, K. M., Sequeira, G. M., Paglisotti, T., Katz-Wise, S. L., Kazmerski, T. M., Hillier, A., Miller, E., & Dowshen, N. (2023). "This Could Mean Death for My Child": Parent Perspectives on Laws Banning Gender-Affirming Care for Transgender Adolescents. Journal of Adolescent Health, 72(4), 607-614. https://doi.org/10.1016/j.jadohealth.2020.09.010

[36] The Trevor Project. (2022). Crisis contacts from LGBTQ young people in Texas increased 150% following governor's directive to investigate parents of trans youth. The Trevor Project. https://web.archive.org/web/20230922050515/https://www.kvue.com/article/news/health/trevor-project-increase-requests-for-help-texas-lgbtq-youth/269-bfd4abf0-efb0-419b-a032-81e908e1aa03

[37] Lee, W.Y., Hobbs, J.N., Hobaica, S. et al. State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA. Nat Hum Behav 8, 2096–2106 (2024). https://doi.org/10.1038/s41562-024-01979-5|
and: https://www.kff.org/other/issue-brief/youth-access-to-gender-affirming-care-the-federal-and-state-policy-landscape/

[38] Johnstone T, Thawanyarat K, Eggert GR, Navarro Y, Rowley MA, Lane M, Darrach H, Nazerali R, Morrison SD. Travel distance and national access to gender-affirming surgery. Surgery. 2023 Dec;174(6):1376-1383. doi: 10.1016/j.surg.2023.09.008. Epub 2023 Oct 13. PMID: 37839968.

and: https://www.riverfronttimes.com/news/red-state-refugees-fed-up-st-louisans-are-fleeing-missouri-for-illinois-42091210

and: https://mgaleg.maryland.gov/cmte_testimony/2024/fin/19683_02152024_91843-291.pdf

and: https://www.advocate.com/news/rachel-levine-trans-healthcare-interview