On 28 January US President Donald Trump published Executive Order 14187, “Protecting Children from Chemical and Surgical Mutilation”. The order claimed that the “irreversible medical interventions […] will be a stain on our Nation’s history, and it must end”.

The EO not only demanded the shutdown of “gender-affirming care”, but also “Ending Reliance on Junk Science”. It singled out the World Professional Association for Transgender Health (WPATH), the advocacy group of doctors, psychologists, lawyers, electrologists and other non-experts which appointed itself to create “standards of care”.

Trump called for a review into “best practices for promoting the health of children who assert gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion”. This morning that review, “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices”, was published.

Many advocates of gender-affirming care are billing this report — 409 pages, including citations — as the American version of the UK’s Cass Review. “While the need for respect and compassion resonates with all reasonable Americans,” it reads, “an invasive treatment with lifelong ramifications deserves the highest level of dispassionate scrutiny.” However, it goes further than the Cass Review, which was a relatively dispassionate evaluation of the state of gender youth medicine, with the goal of improving it. This review is a comprehensive series of arguments about why the entire paediatric gender medicine industry should be dismantled.

The review begins by rehashing what many of us already know about the actual evidence for youth gender-affirming care, and what its supporters deny: there is none. Rather than conduct yet another systematic evidence review — which evaluates not just the conclusions of studies, but their reliability — the authors compiled an umbrella review. That’s essentially a review of reviews, which all came to the same conclusion in what Cass concluded was an area of “remarkably weak evidence”.

And yet this report, while not explicitly making suggestions about guidelines or reforms to the industry, ranges from evaluating evidence to exploring the ethics of treatments. First, it says we don’t even know what we’re treating, in part because we can’t define the terms. In a chapter on terminology, the authors point out that gender identity is defined as “a person’s deeply felt, internal, intrinsic sense of their own gender”. This is a circular definition. Gender-affirming care actually refers to cross-sex hormones, puberty blockers and surgeries like mastectomies or orchiectomies, but using this vague term obscures that reality. Surely, if the original moniker for young people who transitioned — “juvenile transsexual” — were still used, instead of “trans kid”, we’d have seen fewer of them. If we can’t even define what we’re treating, how do we know if treatments are working? After all, gender dysphoria itself is “currently impossible to measure”.

WPATH famously nixed its own chapter on ethics, but this review finally delivers one. Is it morally right to give young people these treatments, when we have no way to measure risks and benefits, when we have no concrete evidence, when we have no standard definitions of the problems or the solutions? “A natural response to the absence of credible evidence is to call for more and better research,” the review states. “Even if high quality research such as randomized controlled trials on pubertal suppression or hormone therapy were feasible,” it goes on, “conducting it may conflict with well-established ethical standards for human subjects research.” Because the research is so scant, there’s no way to ethically conduct studies on, say, puberty blockers, according to the review.

Those authors aren’t named, “in order to help maintain the integrity of this process”, per a press release. Ostensibly, they want it to be about what’s in the report, not who wrote it. Still, trans activists are rejoicing over the anonymity, dangling it as reason to dismiss the report.

Not that they needed help with that. After all, it comes from the Trump administration via an agency headed by vaccine sceptic Robert F. Kennedy Jr. That may be why the press release cites the well-respected NIH Director Dr Jay Bhattacharya, rather than Trump or Kennedy. “Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions,” Bhattacharya said. “We must follow the gold standard of science, not activist agendas.” The messenger should not be as important as the message, but in such a politicised environment, unfortunately, it surely will be.

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