A recent U.S. Department of Health and Human Services evidence review on treatments for pediatric gender dysphoria has prompted debate over the benefits and risks of puberty blockers, cross-sex hormones, and surgeries for minors. In a commentary for The Daily Wire, lawyer Jesse Franklin-Murdock, who represents detransitioners, outlined ten takeaways he says show substantial uncertainties and potential harms, particularly regarding bone health, neurocognitive development, cardiovascular effects and long-term outcomes.
The HHS report, titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” examines the quality and reliability of medical literature on pediatric gender medicine, according to an opinion essay by attorney Jesse Franklin-Murdock published by The Daily Wire.
In that essay, Franklin-Murdock argues that activist influence has affected some professional organizations, including the World Professional Association for Transgender Health (WPATH), and says the federal review is therefore a "necessary development" in the field.
Bone health and puberty blockers
Franklin-Murdock’s summary states that the HHS review found “marked deterioration of bone health” among children who receive puberty blockers to remain in a pre-pubescent state longer. He writes that, in one cited data set, about one-third of patients had bone density scores consistent with osteoporosis of the hip and about one-fourth had osteoporosis of the spine.
He further notes that a scientific review referenced in the HHS document concluded that the effect of puberty blockers on neurocognitive development is unknown, while there is “some evidence” suggesting that these medications may suppress IQ scores in children.
Testosterone in females and cardiovascular concerns
For females who receive testosterone, Franklin-Murdock cites the review as reporting vaginal atrophy and other medical symptoms, including findings from one study in which 100% of vaginectomy specimens contained abnormal prostatic tissue growth.
He also says the report discusses “moderate and high certainty evidence” of some incidence of cardiovascular events in women under 26 who received testosterone. His characterization reflects the review’s assessment of evidence quality rather than a quantified population-level risk.
Puberty blockers, genital development, and adult outcomes
According to Franklin-Murdock’s reading of the HHS document, males who start puberty blockers at Tanner Stage 2 (the early stage of puberty) and later take estrogen typically retain genitalia similar to that of a pre-pubescent or early-puberty male.
He further points to a 2011 Swedish study of adults who had medically and surgically transitioned, writing that those individuals experienced 19 times the rate of suicide deaths and nearly three times the rate of all-cause mortality and inpatient psychiatric care compared with age- and sex-matched peers in the general population.
Detransition, regret, and mortality studies
Franklin-Murdock says the precise rate of detransition remains unknown but cites a British study that found one-fifth of patients stopped hormone treatment within five years, and that about half of those individuals reported either detransition or regret. He presents this as evidence that long-term satisfaction with medical transition is not universal.
He also references research from the United States, United Kingdom, the Netherlands and Sweden examining mortality among transgender-identifying people compared with the general population. Across these studies, he writes, researchers observed elevated mortality in trans-identifying cohorts, with the Swedish study indicating a 2.8 times higher risk of death for transgender individuals than for age- and sex-matched peers.
Fertility and ethical considerations
Franklin-Murdock reports that the HHS review concludes it would be unethical to run a randomized trial specifically to measure fertility impacts of puberty blockers and cross-sex hormones, because the mechanism by which these treatments can interfere with fertility is already well understood and does not require confirmation in a clinical trial.
Prevalence of cross-sex hormones in U.S. adolescents
Citing the federal review, Franklin-Murdock notes that a 2025 JAMA Pediatrics study found that between 2018 and 2022, about one in 1,000 (0.1%) of 17-year-olds in the United States received cross-sex hormones. He argues that, although the percentage is small, it still represents a large absolute number of adolescents given the size of the U.S. population.
Questions about consent and risk–benefit balance
In his Daily Wire commentary, Franklin-Murdock raises questions about informed consent and the maturity of minors undergoing gender-related medical interventions. He asks whether doctors sufficiently warn young patients that they may face significant negative health outcomes years or decades later, whether those minors can adequately understand the long-term implications, and whether they are encouraged to consider the possibility of future desistance or detransition.
He concludes that public discussion of pediatric gender interventions has often focused on politics, law and philosophy, rather than on clinical effectiveness. Based on his interpretation of the HHS evidence review, Franklin-Murdock contends that the medical risks to minors from puberty blockers, cross-sex hormones and surgeries significantly outweigh any potential benefits—a position he presents as his own assessment of the report’s findings.