On Thursday, the Department of Health and Human Services released a 400-page document titled “Treatment of Gender Irritability in Children: Review of Evidence and Best Practices.”

The author of the comment is not named by HHS. According to the press release, the title “is not originally publicized to help maintain the integrity of the post-publication peer review process.” HHS did not immediately answer NPR's questions about the number of authors, professional background and their affiliation.

The current approach to transgender youth accredited by all major medical associations in the United States is to confirm the gender identity of young people and provide medical interventions to their families, such as pubertal blockers and hormone therapy.

The report fundamentally misleads this approach. Its authors concluded that doctors and clinics that provide gender-affirming care “have no responsibility to prioritize the health benefits of young patients.”

White House Vice President Stephen Miller used the term “barbarian” when describing medical interventions on gender at the White House on Thursday. "They violated the medical ethics of all voices. They were completely unfounded. They irreversibly hurt children. This is torture for children. This is torture for children. This is ill-treatment of children. This is medical malpractice."

The group was "deeply shocked" by the new HHS documents, Dr. Susan Kressly, president of the American Academy of Pediatrics, wrote in a statement. "This report misrepresents the current medical consensus and fails to reflect the reality of pediatric care," she wrote, asserting that the report is unreliable because it "based on certain perspectives and a narrow set of data dependencies."

She added that the report has not consulted the AAP yet, but its recommendations are "inaccurate". (AAP official recommendation section says transgender youth should “access the comprehensive, gender-affirming and development of appropriate health care that is provided in a safe and inclusive clinical space.”)

The report concluded that, given that the report was commissioned in accordance with the executive order to protect children from chemical and surgical disabilities, gender care for young people should be restricted. “Across the country today, medical professionals are creating more and more irreversible medical interventions to change children’s gender for an increasing number of impressive children,” it writes. This trend continues: “It must be over.”

During the campaign, President Trump and the Republican Party spent more than $200 million on anti-trade television advertising. Since taking office, Trump has quickly moved to target schools and hospitals that affirm transgender youth, restrict transgender participation in sports and the military, demanded passports to reflect a person’s gender at birth, and canceled millions of dollars in LGBTQ+ health research funding. Some of these efforts were blocked in the courts.

The HHS report describes health care related to the transition to young people as too easily available, but more than half of us have banned it. The Supreme Court will rule this spring that Tennessee has banned the challenge of providing gender care to young people.

In terms of tone and form, the HHS report reflects the CASS comments published in the UK last year and are commissioned by the National Health Service. (The name of "CASS" was cited 149 times in the HHS report.) Like the new HHS report, the review submitted by Dr. HILARY CASS reviewed the available evidence and concluded the benefits of gender-affirming care. But Cass is also the public face of the censorship process, and she spent four years interviewing transgender young people, parents and clinicians to prepare for the report. HHS did not answer NPR's questions about its lengthy reports.

One physician said: "The purpose of this promotion is to give science a veneer. NPR agreed not to name the doctor because they did not have permission from their employer to talk to the media and because they were worried about their safety.

The doctor added that the anonymous author of the report and the politicians who commissioned the report "have said their ideas - they think that it is not trans people that are real, they should not allow trans people to do what they want to do to their bodies, they think that gender is this unchanging concept and that it is not real for everyone."

On social media, Kristen Wagoner, president of the Alliance for Christian legal groups defending freedom, praised the report, saying "It should lead to the closure of every gender clinic in the United States. Doctors who perform these experiments on these children should lose medical permissions and cause damage."