The U.S. Department of Health and Human Services (HHS) released a report on Thursday, May 1, aiming to discredit gender-affirming-care and instead encouraging transgender and nonbinary individuals to try “exploratory therapy”—or psychotherapy—and stating that mental health care alone is a way to treat gender dysphoria in children.
“There is a dearth of research on psychotherapeutic approaches to managing gender dysphoria in children and adolescents. This is due in part to the mischaracterization of such approaches as ‘conversion therapy,’ the report said. “Psychotherapy is a noninvasive alternative to endocrine and surgical interventions for the treatment of pediatric gender dysphoria.”
Though the report argues that this “exploratory therapy” is not the same as the long practice of “conversion therapy”—which is a practice of attempting to change someone’s sexual orientation or gender identity—advocates see little difference.
“This report not only rejects health care best practices for transgender people, it goes a step further by recommending conversion therapy, though under a new, rebranded name, ‘exploratory therapy,’” said Casey Pick, director of law and policy at the LGBTQ+ advocacy group the Trevor Project, in an emailed statement. “Despite the report’s claims, this is, in fact, the same harmful practice of conversion therapy, just using friendlier language. We urge this Administration to respect and support people for who they are—and to let families and doctors make decisions based on what keeps people healthy, not government ideology.”
Read More: Is Conversion Therapy the New Frontier for Anti-LGBTQ+ Groups?
The report arrives following a Trump Executive Order, titled “Protecting Children from Chemical and Surgical Mutilation,” which threatens to cut federal funding to hospitals and medical providers that provide gender-affirming-care to people ages 19 or younger. The Executive Order directed HHS to release a report on the existing literature for treatment for children with gender dysphoria in 90 days, which fell on April 28.
The language used in the report expresses a shift in policy and in sentiments regarding gender-affirming care—referring to the practice only as “Pediatric Medical Transition” and referring to “gender confirmation surgery” as “sex reassignment surgery.” This shift is in line with language brought about by Trump’s Jan. 20 Executive Order which proclaimed that there are only two sexes and that gender identity is “disconnected from biological reality,” calling for an erasure of the term.
Read More: The Implications of Trump’s Executive Order on Sex
A federal judge issued a preliminary injunction against the order—and though the order hasn’t fully been enforced, some federal offices, including the Centers for Medicare & Medicaid Services, issued notices stating that they will change their practices to comply with Trump’s restrictions on gender-affirming-care.
Conversion therapy aims to alter someone’s sexual orientation or gender identity. It has been proven to be ineffective and harmful to LGBTQ+ people, and it can include a wide variety of practices.
“Endorsing this kind of therapy is devastating,” says Shannon Minter, vice president of legal of the National Center for Lesbian Rights. “Being gay, being transgender is not a choice. No amount of talking or persuasion or any kind of counseling can change that.”
Gender-affirming-care is supported by the major medical associations in the U.S., including the American Academy of Pediatrics and American Medical Association. Meanwhile, conversion therapy has been discredited by numerous medical associations.
As the Trump Administration ushers in an era of anti-trans policy at the federal level, Supreme Court cases could also dictate LGBTQ+ rights. In March, the nation’s highest court announced it would be hearing oral arguments for Chiles v. Salazar, which challenges Colorado’s conversion therapy ban under the premise that it infringes on free speech. A decision for U.S. v. Skrmetti—expected in June—will decide whether gender-affirming-care bans for minors are unconstitutional.
“Those cases just raise the stakes of the issue even higher and create really maximum danger for transgender young people,” says Minter. “Worst-case scenario would be for the Supreme Court to uphold state laws banning essential medical care for these young people, and then turn around and strike down state laws protecting LGBTQ+ youth from conversion therapy. That would be a devastating double blow.”
A 2022 report estimated that there were some 300,000 transgender youth ages 13 to 17 in the U.S., according to UCLA School of Law’s Williams Institute.
Trump’s Executive Order on gender-affirming-care also called for investigations into this type of health care in sanctuary states, stating that medical professionals were “maiming… impressionable children.” Trump also declared April as “National Child Abuse Prevention Month,” and in his proclamation stated that he is “taking action to cut off all taxpayer funding to any institution that engages in the sexual mutilation of our youth.”
More than 500 anti-LGBTQ+ bills were introduced on the state level for the 2025 legislative session, per the ACLU’s legislative tracker. In Kentucky, legislators voted to overturn their existing conversion therapy ban, legalizing the practice in the state. Attacks on gender-affirming-care have been much more rampant in recent years, as 26 states have passed laws limiting access to such care for trans and nonbinary people, according to the Human Rights Campaign.
“This isn’t about us as doctors. This is about our patients and ensuring that they continue to get the science-based, evidence-based, standard-of-care medicine that really keeps them whole and healthy,” says Dr. Morissa Ladinsky, an academic general pediatrician at Stanford Medicine who treats children with gender dysphoria. Ladinsky was named as a plaintiff in Ladinsky v. Ivey, a 2022 lawsuit against an Alabama law that criminalizes parents for allowing their children to access gender-affirming-care. (The case was later taken down and another lawsuit against the Alabama law was filed.)
Experts and advocacy organizations warn of the detrimental effects of conversion therapy. A peer-reviewed study conducted by the Trevor Project in 2020 found that young LGBTQ+ people who underwent conversion therapy were more than twice as likely to report attempting suicide compared to those who did not.
Nearly half of all U.S. states ban the controversial practice, though attempts to ban it at the federal level have never proven fruitful. A 2023 Trevor Project report found that conversion therapy still happens across the country. Two years ago, there were at least 1,300 practitioners believed to be still offering the practice in the U.S.
