NORTHAMPTON — Local gender-affirming care clinic Transhealth is condemning a recent review put out by the federal Department of Health and Human Services that recommends against the use of medical treatment for gender dysphoria in youth.

The review, put out by the DHHS on May 1, pushed back against previous consensus of the use of gender-affirming care to help youth transition to the gender they identify as. Gender-affirming care can include the use of medical treatment such as hormone therapy and surgery.

Though only a very small fraction of youth receive medical treatment for gender dysphoria — a state of severe distress or unhappiness caused by feeling that one’s gender identity does not match one’s sex as registered at birth — the issue has become a target of attack by conservative activists and politicians across the country. The review appears to conform with the demands of such conservatives, criticizing gender-affirming care in place of “psychotherapeutic” treatment.

“Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions,” said National Institute of Health Director Jay Bhattacharya, a former Stanford professor and COVID-19 vaccine skeptic appointed to the position by President Donald Trump, in a statement regarding the report. “We must follow the gold standard of science, not activist agendas.”

In a statement put out by Transhealth the same day, the organization called the review “a brazen attempt to mislead the American public.” It also criticized the review’s recommendation of “psychotherapeutic” approach to treating gender dysphoria, which Transhealth referred to as “conversion therapy by another name.”

“We’ve been down this dark path before and we know where it leads,” the organization said in a statement. “Trans people are born not made, and no amount of shame, violence, or coercion will change who we really are.”

The organization also vowed to continue to provide the same care to youth with gender dysphoria, the same way it always has.

“Transhealth will not bow down to unscientific, deceitful and immoral tactics aimed at depriving trans youth of medically necessary healthcare,” the statement continued. “This report is not law and it changes nothing about the care and support Transhealth provides. If you are a patient at Transhealth, the care you receive remains unchanged.”

Transhealth declined to comment further on the recent DHHS report. In an interview with the Gazette in February, Transhealth CEO Jo Erwin spoke out against numerous executive orders issued by Trump that target transgender individuals and youth.

“Trans people are 1% of the population. That focus, and the entire cruelty directed at a very small percentage of the population, is really breathtaking,” Erwin said. “All of the care that is provided to trans youth is essential health care. There’s data that shows that it improves outcomes and prevents self-harm.”

Erwin also noted that executive orders issued by the president do not in themselves create laws, and that Transhealth is working to educate those concerned about how those orders might affect them.

“We’re trying to calm the waters a little bit,” Erwin said in February. “We don’t really have a lot to respond to from a process standpoint, until we really see the rule-making side of it.”

Gender-affirming care for youth under 18 is illegal or restricted in 26 states, but remains legal in Massachusetts. The state’s Attorney General Andrea Campbell has publicly vowed to protect the practice within the commonwealth.

Beyond Transhealth, the Hampshire Pride Parade held in Northampton last weekend also took on a more political tone than in previous years, with speeches given by several participants in response to attacks on LGBTQ rights by the current administration. The parade also included a video message from U.S. Sen. Ed Markey of Massachusetts affirming his support for trans rights.

“It’s a gut punch when rights are being rolled back, especially by government officials in charge of public policy making.” said Clay Pearson, the director and founder of Hampshire Pride, in an interview. “The pendulum has to swing from celebration to protest.”

Genny Beemyn, the director at the Stonewall Center at UMass Amherst, said that even among minors receiving gender-affirming care, surgical procedures are rarely performed, and always with the consent of parents and medical providers.

“Very few minors have surgery,” Beemyn said. “This is just getting the foot in the door to try to make [these practices] illegal, even for adults.”

In October, Northampton passed a resolution declaring itself a “trans sanctuary city,” committing to never using city resources for detaining persons for seeking or providing gender-affirming care, including surgery or hormone therapy. The city also committed to never cooperating with or providing information to out-of-state agencies regarding any lawful gender-affirming care in Massachusetts.

DHHS report details

The 409-page DHHS report questions standards for the treatment of transgender youth issued by the World Professional Association for Transgender Health and is likely to be used to bolster the government’s abrupt shift in how to care for a subset of the population.

The report questions the ethics of medical interventions for transgender young people, suggesting that adolescents are too young to give consent to life-changing treatments that could result in future infertility. It also cites and echoes a report in England that reinforced a decision by its public health services to stop prescribing puberty blockers outside of research settings.

The report’s focus on therapy alone troubles advocates.

The report accuses transgender care specialists of disregarding psychotherapy that might challenge preconceptions, partly because of a “mischaracterization of such approaches as ‘conversion therapy,’” a discredited practice that seeks to change patients’ sexual orientation or gender identification. About half the states have banned conversion therapy for minors.

The American Academy of Child & Adolescent Psychiatry has said evidence shows conversion therapies inflict harm on young people, including elevated rates of suicidal thoughts.

HHS said its report does not address treatment for adults, is not clinical guidance and does not make any policy recommendations. However, it also says the review “is intended for policymakers, clinicians, therapists, medical organizations, and importantly, patients and their families,” and it declares that medical professionals involved in transgender care have failed their young patients.

The report could create fear for families seeking care and for medical providers, said Shannon Minter, the legal director at the National Center for Lesbian Rights. “It’s very chilling to see the federal government injecting politics and ideology into medical science,” Minter said.

“It’s Orwellian. It is designed to confuse and disorient,” Minter added.

While Health Secretary Robert F. Kennedy Jr. has repeatedly pledged to practice “radical transparency,” his department did not release any information about who authored the document. The administration says the new report will go through a peer-review process and will only say who contributed to the report after, “in order to help maintain the integrity of this process.”

The report contradicts American Medical Association guidance, which urges states not to ban gender-affirming care for minors, saying that “empirical evidence has demonstrated that trans and non-binary gender identities are normal variations of human identity and expression.”

It also was prepared without input from the American Academy of Pediatrics, according to its president, Dr. Susan Kressly.

“This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care,” Kressly said. She said the AAP was not consulted, “yet our policy and intentions behind our recommendations were cited throughout in inaccurate and misleading ways.”

Gender-affirming care for transgender youth under standards widely used in the U.S. includes developing a plan with medical experts and family members that includes supportive talk therapy and can — but does not always — involve puberty blockers or hormone treatment. Many U.S. adolescents with gender dysphoria may decide not to proceed with medications or surgeries.

This latest HHS report, which Trump called for while campaigning last year, represents a reversal in federal policy. The U.S. Substance Abuse and Mental Health Services Administration, which is part of HHS, found that no research had determined that behavioral health interventions could change someone’s gender identity or sexual orientation. The 2023 update to the 2015 finding is no longer on the agency’s website.

Material from the Associated Press was used in this report. Alexander MacDougall can be reached at amacdougall@gazettenet.com.