Since President Donald Trump returned to office in January, federal policy has shifted to promote psychological therapy as the only treatment for transgender youth in distress.
A report issued last month by the Trump administration’s Department of Health and Human Services on care for transgender and nonbinary people analyzed 17 studies out of more than 3,400 looking into gender-affirming care — an umbrella term that can include talk therapy, puberty blockers, hormone treatments and surgeries.
They included only analyzes of other studies that did not include any patients older than 26. Those that examined mental health generally found improvements from gender-affirming care, although with low certainty, because they did not include a large enough group, the effects were small, or other factors.
The report had more sweeping conclusions, however, stating that people under 19 with gender dysphoria should receive only psychological therapy, rather than being able to choose puberty blockers or hormone therapy. Gender dysphoria refers to distress when someone’s gender identity and their sex, or the way others see them, don’t match.
Major medical groups, such as the American Academy of Pediatrics, have endorsed offering the full range of affirming care to appropriate patients, and experts interviewed by The Denver Post agreed that while some patients only need therapy, others benefit from gender-affirming medical care.
The new report comes as the administration ordered providers to stop offering puberty blockers and hormone therapy to anyone under 19, threatening to take away federal funding from hospitals that did not comply. A federal judge blocked Trump’s executive order while a legal challenge plays out from four states, including Colorado.
The Trump administration also forbade transgender people from serving in the military, threatened federal funding for schools if they promote “gender ideology,” removed references to LGBTQ health disparities from health websites, ordered the Justice Department to take action to stop trans girls from playing on sports teams with cisgender girls, forbade the issuing of passports displaying the gender trans people identifying with, and moved inmates who are trans women into men’s prisons.
Dr. Rae Narr, a nonbinary psychologist in Denver, said the administration’s actions targeting transgender people suggest the government is going to push therapy that attempts to change someone’s sexual orientation or gender identity. But, done right, therapy can also be affirming, they said.
“On their face, what they are suggesting is therapy and support for these youth,” Narr said. “When you really look at what they’re suggesting, it’s conversion therapy.”
Conversion therapy, as typically practiced today, looks for a pathological root for someone’s sexual orientation or gender identity, Narr said. For example, the practitioner might argue that another condition, such as autism, caused someone to think that they were transgender, or that they wanted to change their gender because of shame about being gay or a history of sexual trauma, they said.
Mainstream medical groups condemn the practice and Colorado banned conversion therapy for minors, although the law faces a challenge at the Supreme Court.
