Government health documents are, or at least they should be, boring. Tables, methods sections, confidence intervals. I've read a lot of them, because assessing gender-diverse kids is what I do for a living. In August the Department of Health and Human Services published one with a scalpel and blood spatter on the cover, in a horror-movie font, called Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of "Gender Medicine." When a health agency reaches for cover art, it stops making a scientific argument and starts making a sale.

I read all 64 pages of the HHS transgender report.

Who wrote the HHS transgender report

The paper's contributors were the president of the Center for Christian Virtue, a communications executive formerly of Fox News, staff from what the report calls the storytelling arm of a conservative advocacy group, and a lawyer from the Trump White House. Three physicians signed on: a trauma surgeon, a psychiatrist, and a pediatric endocrinologist. None of them has published outcome research on this population.

Notice who isn't there. No epidemiologist. No biostatistician. No psychologist, which is to say nobody who does the assessment work this report claims to be evaluating.

It's opinion shopping.

When Britain wanted answers about care for transgender youth, it gave Dr. Hilary Cass four years, commissioned independent systematic reviews from the University of York, and sat her down with clinicians, researchers, parents, and gender-diverse young people. That's a government taking a medical question seriously. This isn't.

"Sex-rejecting procedures" is not a clinical term

The vocabulary gives the game away. "Sex-rejecting procedures" runs through the whole document. In ten years of practice, I have never seen that phrase in a textbook, a diagnostic manual, or a journal. They made it up. When you have the evidence, you use the field's own words and beat them with the data. When you don't, you rename the thing.

The one real finding: E34.9 and insurance coding

The report contains no new clinical findings. HHS calls its own results "directional signals" requiring verification against the underlying records. The headline says fraud. The footnote says we can't verify any of this.

One thing in the report is real, and it's doing a lot of work. Some providers billed gender-related care under vague codes, most often E34.9, unspecified endocrine disorder. That deserves an honest look, and it's the only load-bearing fact in 64 pages.

So look at the report's own sources. The CMS paper it cites says the vague code was used to shield patients from stigma. The insurance guidance it reproduces shows accurate codes were routinely denied. If the honest code gets your patient refused and the vague one gets them covered, that's a coverage failure. You fix it by making insurers pay under accurate codes.

That's the whole case. Everything else borrows its credibility. A real irregularity sits at the front, and behind it come the invented terminology, the unverified claims, and the eight interviews, all of them carrying an authority the coding problem lent them, and none of them earned. That's one true thing doing security detail for the rest.

The $120 million fraud claim

They even try to claim widespread financial gain. The headline figure is roughly $120 million billed nationwide since 2019, total, every hospital and clinic combined. American hospitals bill more than a trillion dollars a year. Fraud is fraud at any size and should be prosecuted. But that number isn't a national emergency.

And the theory of the crime is that ongoing care proves the scam. Regular labs, follow-ups, refills. That also describes diabetes, asthma, epilepsy, and ADHD. By this logic, insulin is a racket.

Eight detransition interviews are not outcome data

Which brings us to the report's real center: eight interviews about detransition and regret.

Detransitioners are real. I write about them, I've worked with them, and I've been one. Several of those accounts describe kids carrying trauma who needed slower and more careful evaluation than they got, and I've spent my career arguing for exactly that.

But there's a question the report never asks, and I can't answer it either. How would anyone know that transition wasn't the thing that let a person settle into who they are? Someone who transitioned, came back, and now has firm ground under them isn't obvious evidence that the transition was the injury. It may have been the route.

Eight curated stories aren't data. If eight interviews set national policy, I'll bring 800 people who say this care was beneficial, and then we're just trading anecdotes. That's the problem science exists to solve.

What a serious HHS report would have looked like

The federal government holds more health data than any institution on earth. It could have funded the outcome studies. It hired storytellers instead.

Kids in distress deserve rigorous evidence. Families deserve honest information. This isn't an investigation. It's a press release with blood on the cover.