The Trump administration has ordered the National Institutes of Health to study the physical and mental health effects of undergoing gender transition, according to an internal NIH memo obtained by NPR.
The directive was shared with NPR by two current NIH staffers who did not want to be identified for fear of retribution. It is from acting NIH Director Mark Memoli, and says the NIH must study the impact of "social transition and/or chemical and surgical mutilation" among children who transition. Specifically, the White House wants the NIH to study "regret" and "detransition" among children and adults who have transitioned.
"This is very important to the President and the Secretary," the memo says, referring to President Trump and Department of Health and Human Services Secretary Robert F. Kennedy Jr. It adds: "They would like us to have funding announcements within the next six months to get this moving."
The NIH now has to decide the scope and design of the project, how it will be funded, and which researchers will conduct it.
The plan is causing deep concern among many researchers and in the LGBTQ+ community. NPR discussed the memo with some researchers and advocates.
"What they're looking for is a political answer not a scientific one," says Adrian Shanker, who served as deputy assistant secretary for health policy at HHS under President Biden. "That should be an alarm for everyone who cares about the scientific integrity of the National Institutes of Health."
Among the red flags in the directive is the language, Shanker and others say.
"Chemical or surgical mutilation? These are deeply offensive terms," says Harry Barbee, an assistant professor at the Johns Hopkins Bloomberg School of Public Health.
"This terminology has no place in serious scientific or public health discourse," Barbee says. "The language has been historically used to stigmatize trans people. Even the phrase[s] 'regret' and 'detransition' can be weaponized."
Many researchers say there is already a solid body of evidence that the level of regret after transition and the decision to reverse the transition is very low.
"Regret rates for gender-affirming care are about less than 1%, which is much lower than regret rates for procedures that we see as quite common and that are widely accepted," such as hip replacements, obesity surgeries and even tattoos, says Lindsey Dawson, who directs LGBTQ health policy at KFF, a non-partisan health research group.
Dawson and others say they're not surprised by the directive, given the rhetoric about trans people that Trump used during the campaign and other steps the administration has taken since coming into office. But some researchers and advocates see the demand for this research as cynical, given the administration recently slashed funding for hundreds of studies about important physical and mental health issues facing people in the LGBTQ community, including trans people.
"This is especially concerning given the recent defunding of probably hundreds of NIH-supported studies that focused on trans health," says Brittany Charlton, who directs the LGBTQ Health Center of Excellence at the Harvard T.H. Chan School of Public Health and has been tracking the funding terminations nationwide. "Having the NIH shift their focus really impedes our ability to actually understand the full picture."
Neither the NIH nor HHS, its parent agency, responded to NPR's requests for comment.
But some people argue that previous research on trans regret and related issues have been poorly done and is outdated.
"We are starting to see much greater numbers of young people who are seeing that they went down the wrong path for them and they're now left with irreversible changes to their body and they no longer identify as transgender," says Evgenia Abbruzzese, the co-founder of the group Society for Evidence-Based Gender Medicine. "But they are left with these permanent effects."
She adds: "There are a lot of negative impacts of transition. And regret is definitely one of them," she says. "It's a very important area of medicine to study."
Others agree.
"The research on detransition is very useful, it's a very important area," said Michael Biggs, an associate professor of sociology at the University of Oxford. "This is an understudied population to collect systematic data on."
Still, Barbee from Johns Hopkins worries whether high-quality research can be done in the short time period outlined in the memo and how the research will be used. One concern is the results could be used to justify state laws restricting access to trans care.
"I support rigorous, ethically grounded research into all aspects of transgender health, and that includes the experience of detransition," says Barbee. "However, it's imperative that such research be framed in a way that neither pathologizes transition nor undermines the overwhelming evidence showing that gender-affirming care is beneficial and even life-saving for the vast majority of trans people who desire such services."
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