Gender-affirming care for minors under fire

These include infertility, sexual dysfunction, impaired bone development, elevated cardiovascular risk, and psychiatric complications.

"The physical consequences are often irreversible," the report warns.

Puberty blockers, frequently marketed as a reversible 'pause,' actually interrupt bone mineralisation at a critical growth stage-raising the risk of stunted skeletal growth and early-onset osteoporosis.

When followed by cross-sex hormones, as is common, the harms multiply. Known risks include metabolic disruption, blood clots, sterility, and permanent loss of sexual function.

Yet many clinics operate under a "child-led care" model, where a minor's self-declared "embodiment goals" dictate treatment.

The report notes that some leading clinics conduct assessments "in a single session lasting two hours," often with no robust psychological evaluation.

Consent and capacity

This raises a critical question: Are children capable of consenting to life-altering medical interventions?

According to the HHS, informed consent means more than simple agreement-it requires a deep understanding of risks, alternatives, and long-term impact.

And by definition, children lack full legal and developmental capacity for medical decision-making.

"When medical interventions pose unnecessary, disproportionate risks of harm, healthcare providers should refuse to offer them even when they are preferred, requested, or demanded by patients," the report states.

Supportive parents cannot shield clinicians from ethical responsibility. Many children who present for transition also have autism, trauma histories, depression, or anxiety-all of which can impair decision-making.

Yet clinicians frequently misread a child's desire to transition as evidence of capacity.