FILE - President Donald Trump holds up an executive order after signing it at an indoor Presidential Inauguration parade event in Washington, Jan. 20, 2025. (AP Photo/Matt Rourke, File)

President Donald Trump’s administration released a lengthy review of transgender health care on Thursday that advocates for a greater reliance on behavioral therapy rather than broad gender-affirming medical care for youths with gender dysphoria.

The 409-page Health and Human Services 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 that has become a political lightning rod.

This new “best practices” report is in response to an executive order Trump issued days into his second term that says the federal government must not support gender transitions for anyone under age 19.

“Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions,” National Institutes of Health Director Dr. Jay Bhattacharya said in a statement. “We must follow the gold standard of science, not activist agendas.”

The report sharply contradicts guidance from the American Medical Association, which has urged 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.”

HHS said its report, however, is not clinical guidance and does not make any policy recommendations. The report is also limited to children and does not address treatment for adults.

Gender-affirming care for transgender youth under standards widely used in the U.S. includes supportive talk therapy and can — but does not always — involve puberty blockers or hormone treatment.

The Trump administration’s report says “many” U.S. adolescents who are transgender or are questioning their gender identity have received surgeries or medications. In fact, such treatments remain rare as a portion of the population. Fewer than 1 in 1,000 adolescents in the U.S. received gender-affirming medication — puberty blockers or hormones — according to a five-year study of those on commercial insurance released this year. About 1,200 patients underwent gender-affirming surgeries in one recent year, according to another study.

Many U.S. adolescents may decide not to proceed with gender-affirming medications or surgeries. Medical association recommendations say the best care includes developing a plan with medical experts and family members that includes psychotherapy for each young person.

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

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

Dr. Jack Drescher, a New York psychiatrist and psychoanalyst who works on sexual orientation and gender identity issues, said the report is one-sided and “magnifies the risks of treatments while minimizing benefits of the treatments.”

A judge has blocked key parts of Trump’s order, which includes denying research and educational grants for medical schools, hospitals and other institutions that provide gender-affirming care to people 18 or younger. Several hospitals around the country ceased providing care. The White House said Monday that since Trump took office, HHS has eliminated 215 grants totaling $477 million for research or education on gender-affirming treatment.

Most Republican-controlled states have also adopted bans or restrictions on gender-affirming care. A U.S. Supreme Court ruling is pending after justices heard arguments in December in a case about whether states can enforce such laws.

The Jan. 28 executive order is among several administration policies aimed at denying the existence of transgender people. Trump also has ordered the government to identify people as either male or female rather than accept a concept of gender in which people fall along a spectrum, remove transgender service members from the military, and bar transgender women and girls from sports competitions that align with their gender. This month, HHS issued guidance to protect whistleblowers who report doctors or hospitals providing gender-affirming care. Judges are blocking enforcement of several of the policies.

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.

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 study. 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 says that medical groups have relied on medical treatment rather than behavioral therapy for transgender youth partly because of a “mischaracterization of such approaches as ‘conversion therapy,'” which about half the states have banned for minors.

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