The promise was better mental health. Here is what the researchers actually wrote down.
These kids are real, and their pain is real. Many are living with depression, anxiety or autism. That is exactly why they deserve treatment that is proven to help.
The Cass Review on the evidence
This is an area of remarkably weak evidence.
The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.
Dr. Hilary Cass, Independent Review of Gender Identity Services for Children and Young People, final report, April 2024.1
The suicide claim did not hold up
It has been suggested that hormone treatment reduces the elevated risk of death by suicide in this population, but the evidence found did not support this conclusion.
It is the most frightening argument a parent can hear. The review found the evidence did not support it.
Cass Review final report, April 2024.1
HHS: benefit “very uncertain”
The evidence for benefit of pediatric medical transition is very uncertain.
The U.S. Department of Health and Human Services’ peer-reviewed report rated the overall quality of evidence on psychological outcomes “very low” and found “no evidence that pediatric medical transition reduces the incidence of suicide.”
HHS, Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, final report, Nov. 19, 2025.3
2,083 young people, 24 years of records
Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality…
Once the researchers accounted for psychiatric treatment history, the difference in suicide deaths largely disappeared. Mental illness was the strongest predictor, and gender reassignment had no clear impact on suicide risk.
Ruuska, Tuisku, Holttinen & Kaltiala, BMJ Mental Health, 2024.5
Who these children are
Many of these children and adolescents have co-occurring psychiatric or neurodevelopmental conditions.
HHS found suicidal thoughts and behavior are “independently associated” with those conditions, and “no independent association between gender dysphoria and suicidality has been found.”
HHS final report, Nov. 2025.3
The problem nobody was treating
Cass warned of “diagnostic overshadowing.” Once a child’s distress is seen only through the lens of gender, depression, anxiety and autism get overlooked. She recommended a full mental health assessment and autism screening for every child, and standard treatment for anxiety and depression.
Cass Review final report, April 2024.2
The safer option was sitting on the shelf
HHS called psychotherapy a “noninvasive alternative” and reported that systematic reviews “have found no evidence of adverse effects of psychotherapy in this context.”3 Finland made psychotherapy the first-line treatment back in 2020.6 In Michigan, Democrats went the other way and put therapists’ licenses on the line. The record below has the details.